Category Archives: Nursing Homes & Long Term Care

Unpaid Caregiving Roles and Sleep Among Women Working in Nursing Homes: A Longitudinal Study

Source: Nicole DePasquale, Martin J Sliwinski, Steven H Zarit, Orfeu M Buxton, David M Almeida, The Gerontologist, Advance Access, Published: January 19, 2018
(subscription required)

From the abstract:
Background and Objectives:
Although sleep is a critical health outcome providing insight into overall health, well-being, and role functioning, little is known about the sleep consequences of simultaneously occupying paid and unpaid caregiving roles. This study investigated the frequency with which women employed in U.S.-based nursing homes entered and exited unpaid caregiving roles for children (double-duty-child caregivers), adults (double-duty-elder caregivers), or both (triple-duty caregivers), as well as examined how combinations of and changes in these caregiving roles related to cross-sectional and longitudinal sleep patterns.

Research Design and Methods:
The sample comprised 1,135 women long-term care employees who participated in the baseline wave of the Work, Family, and Health Study and were assessed at three follow-up time points (6-, 12-, and 18-months). Sleep was assessed with items primarily adapted from the Pittsburgh Sleep Quality Index and wrist actigraphic recordings. Multilevel models with data nested within persons were applied.

Results:
Women long-term care employees entered and exited the unpaid elder caregiving role most frequently. At baseline, double-duty-child and triple-duty caregivers reported shorter sleep quantity and poorer sleep quality than their counterparts without unpaid caregiving roles, or workplace-only caregivers. Double-duty-elder caregivers also reported shorter sleep duration compared to workplace-only caregivers. Over time, double-duty-elder caregiving role entry was associated with negative changes in subjective sleep quantity and quality.

Discussion and Implications:
Simultaneously occupying paid and unpaid caregiving roles has negative implications for subjective sleep characteristics. These results call for further research to advance understanding of double-and-triple-duty caregivers’ sleep health and facilitate targeted intervention development.

Does Paid Family Leave Reduce Nursing Home Use? The California Experience

Source: Kanika Arora, Douglas A. Wolf, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018
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From the abstract:
The intent of Paid Family Leave (PFL) is to make it financially easier for individuals to take time off from paid work to care for children and seriously ill family members. Given the linkages between care provided by family members and the usage of paid services, we examine whether California’s PFL program influenced nursing home utilization in California during the 1999 to 2008 period. This is the first empirical study to examine the effects of PFL on long-term care patterns. Multivariate difference-in-difference estimates across alternative comparison groups provide consistent evidence that the implementation of PFL reduced the proportion of the elderly population in nursing homes by 0.5 to 0.7 percentage points. Our preferred estimate, employing an empirically-matched group of control states, finds that PFL reduced nursing home usage by about 0.65 percentage points. For California, this represents an 11 percent relative decline in elderly nursing home utilization.

Comparing Public Quality Ratings for Accredited and Nonaccredited Home Health Agencies

Source: Scott C. Williams, David J. Morton, Susan Yendro, Home Health Care Management & Practice, Vol 30, Issue 1, 2018
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From the abstract:
This was a descriptive study comparing 1,582 accredited and 10,008 nonaccredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid Services Home Health Compare data set. Metrics included the star rating and 22 quality measures. A longitudinal model was used to determine differences between accredited and nonaccredited organizations on the quality measures. Categorical differences in star ratings and risk-adjusted outcome categories were analyzed using a chi-square test. Accredited agencies had statistically higher star ratings than nonaccredited organizations (3.4 vs. 3.2, p < .001), and they were more likely to be categorized 4, 4.5, and 5 star organizations (p < .001). Absolute differences between accredited and nonaccredited agencies on the OASIS quality measures were generally small but consistently favored accredited facilities over all 3 years studied (p < .05).

Nursing Home Workers Win Wage Gains with Credible Strike Threat

Source: Leah Fried, Labor Notes, May 26, 2017

After close to three years of negotiations, stickers and leaflets weren’t getting the boss any closer to a fair agreement. The master contract covering 10,000 nursing home workers in Illinois had been expired for two years and extended several times.

Management was insisting on a wage freeze until Illinois overcame its budget impasse and increased Medicaid reimbursements. Long-term workers were languishing at minimum wage, even when their employers had begun offering higher wages to entice new hires.

Meanwhile, staffing was dangerously short. Often a certified nursing assistant was forced to care for 20 or more residents in an eight-hour shift—bathing, feeding, and assisting them at a furious pace. On top of keeping the nursing home clean, a housekeeper had to collect meal trays for hundreds of residents because there weren’t enough dietary aides.

To win a new agreement, it was clear that workers would need to be prepared to strike.

But their local, Service Employees (SEIU) Healthcare Illinois-Indiana (HCII), hadn’t ever waged a strike over its master nursing home contract. In fact, the last time there was a nursing home strike at any of these facilities was in 1979. The local’s previous contract campaigns had been lackluster. Mobilization had been limited to stickers, petitions, and a practice picket.

And giving each nursing home the organizing attention it needed now was a huge challenge. The bargaining unit covers 28 different employers and 103 facilities statewide…..

Implementation of a resident handling programme and low back pain in elder care workers

Source: Andreas Holtermann, Occupational & Environmental Medicine, Volume 74, Issue 6, 2016
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From the introduction:
Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have particularly high prevalence of LBP, and a considerable fraction of the LBP is considered to be caused by work-related factors. Moreover, LBP is a particular barrier for sustainable employment among workers with physically demanding work. Therefore, implementation of equipment (mechanical lifts or other assistive devices) for reducing the mechanical loading of healthcare workers during manual handling of residents should theoretically be efficient for preventing LBP and sickness absence among those with LBP. However, interventions implementing equipment for reducing the mechanical loading on healthcare workers during manual handling of residents show conflicting results on LBP. This might be due to the relatively short follow-up period of previous intervention studies introducing equipment for manual handling, which may need longer time before being fully implemented in an organisation. Moreover, it can be caused by lacking repetitive measures of both the implementation of the intervention as well as the often fluctuating level of LBP. Thus, there is a research gap in the documentation of the effects on LBP

The Impact of the Affordable Care Act on Health Coverage for Direct Care Worker

Source: Stephen Campbell, PHI, Issue Brief, March 2017

From the summary:
Direct care workers—nursing assistants, home health aides, and personal care aides who support older Americans and people with disabilities—are among America’s lowest paid workers, often struggling to access health coverage. However, new coverage numbers show that this workforce benefited substantially from the Affordable Care Act (ACA). Between 2010 and 2014, half a million direct care workers gained coverage. At the same time, the uninsured rate across this workforce decreased by 26 percent. As the Trump administration and the new Congress consider the future of the Affordable Care Act (ACA) and Medicaid, it is important to consider the impact of these changes on this critical U.S. workforce.

60 Caregiver Issues

Source: PHI, 2017

In 2017, PHI began identifying the most pressing policy issues facing direct care workers. Our research, unique industry expertise, and partnerships with state and national leaders aptly position us to address a worsening concern: direct care workers are walking away from this sector at a time when we need critical supports to age in our homes and communities. In turn, families and the agencies that serve them are left with few options.

Recognizing a growing workforce shortage among our nation’s home care aides, nursing aides, and personal care aides, as well as the need to provide quality care to a rapidly growing population of older people and people with disabilities, PHI launched a national campaign: 60 Caregiver Issues.

Over the course of two years, PHI will release a new issue every 2-3 weeks, inspiring policy makers and long-term care leaders to pinpoint what needs to be done to remedy this shortage and create a vibrant, sustainable system of long-term care.

The Family Time Squeeze: Perceived Family Time Adequacy Buffers Work Strain in Certified Nursing Assistants With Multiple Caregiving Roles

Source: Nicole DePasquale, Jacqueline Mogle, Steven H. Zarit, Cassandra Okechukwu, Ellen Ernst Kossek, and David M. Almeida, The Gerontologist, Advance Access, First published online: January 10, 2017
(subscription required)

From the abstract:
Purpose of the Study: This study examined how certified nursing assistants (CNAs) with unpaid family caregiving roles for children (“double-duty-child caregivers”), older adults (“double-duty-elder caregivers”), and both children and older adults (“triple-duty caregivers”) differed from their nonfamily caregiving counterparts (“workplace-only caregivers”) on four work strain indicators (emotional exhaustion, job satisfaction, turnover intentions, and work climate for family sacrifices). The moderating effects of perceived family time adequacy were also evaluated.

Design and Methods: Regression analyses were conducted on survey data from 972 CNAs working in U.S.-based nursing homes.

Results: Compared with workplace-only caregivers, double-and-triple-duty caregivers reported more emotional exhaustion and pressure to make family sacrifices for the sake of work. Triple-duty caregivers also reported less job satisfaction. Perceived family time adequacy buffered double-duty-child and triple-duty caregivers’ emotional exhaustion and turnover intentions, as well as reversed triple-duty caregivers’ negative perceptions of the work climate.

Implications: Perceived family time adequacy constitutes a salient psychological resource for double-duty-child and triple-duty caregivers’ family time squeezes. Amid an unprecedented demand for long-term care and severe direct-care workforce shortages, future research on workplace factors that increase double-and-triple-duty caregiving CNAs’ perceived family time adequacy is warranted to inform long-term care organizations’ development of targeted recruitment, retention, and engagement strategies.

Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes

Source: Amy Restorick Roberts and John R. Bowblis, Health & Social Work, Advance Access, First published online: December 7, 2016
(subscription required)

From the abstract:
Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009–2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed.