Designing Better Jobs for Better Care
Direct care workers--personal care attendants, nurse aides and home health aides--are the life blood of the long-term care system. These workers provide basic health and personal care needs to millions of frail elderly persons as well as younger persons with chronic diseases and disabilities.
High turnover and staggering vacancies among direct care workers have affected the long-term care industry. Turnover rates have been reported to range from 40 percent to over 100 percent annually. Forty-two states report that nurse aide recruitment and retention are major issues.
Dr. Peter Kemper
There is increasing evidence that these recruitment and retention problems are impacting both the quantity and the quality of long-term care services. Unfortunately, the shortage of direct care workers is likely to worsen as baby boomers age.
The Robert Wood Johnson Foundation and The Atlantic Philanthropies are looking at ways to improve working conditions and decrease turnover for direct care workers under Better Jobs, Better Care, a program that was launched and is supported by both foundations. Researchers at Penn State have been selected to evaluate the effectiveness of the methods being utilized to improve employment conditions for direct care workers.
"The project is looking at the efforts of coalitions of stakeholders in each state--nursing homes, home health agencies, assisted living facilities, adult day care centers, labor unions, consumers--all of the people affected by long term care, and trying to change public policy and management practices to improve direct care workers' jobs," says Dr. Peter Kemper, principal investigator and professor of Health Policy and Administration.
"Low pay and lack of respect and empowerment are some of the biggest hurdles for improving these jobs," explains Dr. Theresa Barry, project manager, who has worked as a nurse's aide and personally experienced many of the problems that direct care workers face.
"People in these positions change diapers, give baths, socialize with residents and work as a liaison between the residents, the families, nurses, and doctors," Barry says. "It is very physical and emotional work. People who enter into these jobs are a very self-selected group, yet there is almost a stereotype that they are uneducated and couldn't get any other kind of work. I don't see that at all."
"The Better Jobs, Better Care project is pushing for a 'culture change' that will give these workers greater respect and empowerment," adds Dr. S. Diane Brannon, co-principal investigator and professor of Health Policy and Administration. "The aim is to change managerial practices at these provider organizations, such as more training, peer mentoring, supervisor training, developing care teams, career ladders, promotions for experience and training, and giving direct care workers greater autonomy, with the goals of reducing turnover, improving the quality of care, and breaking down communication barriers."
Penn State's role in the project is to conduct a formative evaluation of management practices to determine the most successful practices and whether they do reduce turnover, improve the quality of care, and empower employees. Dr. Kathryn Dansky, associate professor of Health Policy and Administration, who previously ran a home health agency, is a co-investigator on the project. Penn State's Survey Research Center will collect the data for the evaluation.
"We will measure empowerment at the beginning and end and see in which interventions empowerment increased," Kemper explains. "One of our hypotheses is that empowered workers will have less turnover, which will save money and lead to a greater continuity of care for the residents. Our hope is that we will be able to see the different determinants of turnover and trace them back to specific interventions, find the most successful practices and then replicate them across the country."
Better Jobs, Better Care is a 4-year, $15.5 million program funded by The Robert Wood Johnson Foundation and The Atlantic Philanthropies, and is administered by The Institute for the Future of Aging Services. Penn State is receiving $830,000 over a four year period to conduct its evaluation. Research is also being conducted at locations in Iowa, Vermont, Pennsylvania, North Carolina and Oregon. For more information see the project's web site at www.bjbc.org.