Recently in long-term care workers Category

The other day, Josh Wiener, who is one of the nation's experts on long-term care, presented three papers on certified nursing assistants (CNAs) in nursing homes. Josh and his colleagues at the consulting firm RTI International looked at quality of care, immigration, and injuries. And some of what they found may surprise you. The papers are available here (some may require subscriptions)

The first question they asked was what workforce issues determined quality of care in nursing facilities. Lots of research has identified the problems: worker shortages and high turnover, low wages and few benefits, poor training, and a sometimes-hostile relationship between aides and managers. But which of these problems could be linked to low quality?

Surprsingly, Josh and his colleagues did not find much difference in some of these characteristics between high- and low-quality facilities. For instance, wages didn't seem to matter much. Neither did staffing levels. But access to health insurance and paid days off did matter and so did a more collegial organizational culture. This last finding suggests that the culture change movement in nursing homes, which attempts to create an environment where aides are given both more authority and responsibility, may be on to something.  

Their second paper looked at immigration, an important issue since about 20 percent of CNAs are foreign-born. Some results were not surprising. For instance, Wiener found only about half of immigrant CNAs reported English as their primary language. And half reported problems communicating with residents. But it turns out that nearly as many (41 percent) native born workers also reported these problems.

Other results were just as interesting. Foriegn-born workers were older, more likely to be married, and better educated than their U.S-born colleagues. Their average wages were about 10 percent higher and while fewer reported getting bonuses or reimbursement for training, more said they got paid holidays and subsidized child care. And immigrants were more likely to work for the highest quality facilities (based on the government's five-star rating system)

Finally, Josh and his colleagues looked at injuries. Aides have among the highest injury rates of any occupation in the country--the Labor Department reports that almost nine percent were hrt on the job in 2006, the third highest among any occupation in the U.S.

But Josh found many more injuries than were officially reported. He found that nearly 60 percent of nursing home aides reported suffering some injury during the course of the year. While most were back injuries caused by lifting, many others were inflicted by residents (12 percent were a result of bites).

One way to reduce back injuries is through the use of mechanical lifts. Josh found that 88 percent of facilities had these devices available, but only 61 percent of aides said they always used them. The research also found that madatory overtime, inexperience, lack of training, and lack of time to spend with residents all contributed to injury.  

These results are contrversial, espcially some of the conclusions about the relatonship between pay and staffing and quality. But, as with all of Josh's research, it is worth looking at.

I spent yesterday with more than a hundred elder care professionals at the Seven Acres senior care campus in Houston. For a while they listened to me, but for much of the time I had the opportunity to listen to them. And what I heard was striking, and an important addition to the HSC Foundation's recently published study based on listening to family caregivers.

We had a wide range of professionals at this program, the 24th annual Lou Lewis Symposium in Gerontology: executives from nursing homes, assisted living facilites, and home health agencies; case managers, social workers, nurses, and maybe even a physician or two. Early in the program I asked how many had also been caregivers for their own family members. At least 80 percent raised their hands.

After I spoke, the participants broke up into a dozen small groups to come up with their own ideas for improving today's long-term care system. Not surprisingly, there were many suggestions. But there was also a striking consensus on a few broad themes.

Participants were tremendously frustrated at how poorly the system works today. Their biggest frustration may have been over the lack of communication between families and professionals and the absence of care coordination within the health system itself.

A word I heard over and over again was education. These professionals felt passionately that family members, aides, doctors, and--yes--politicians need to learn much more about how elder care works, not at a broad policy level but for individuals. The resources out there today, such as Area Agencies on Aging and Aging and Disability Resource Centers, help. But the participants thought they need to do much more. 

We talked about the need for better training for all caregivers, both family members and aides.

The participants felt strongly that community groups, local businesses and, especially, faith-based organizations need to play a greater role in caring for the frail elderly. We talked about the village movement, where seniors join together to form community non-profits to help one another. But many participants felt that churces, synagogues and other religious institutions could do much more to aid their own congregants. This assistance could come from volunteer committees who help arrange rides, friendly visits, and phone calls.

We also discused the importance of financing long-term care. This group, at least, was skeptical about whether young people would enroll in the voluntary CLASS Act. Even though this was Texas, some even felt the country would do better with a social insurance design for long-term care. But, once again, they felt that better education is the key to encouraging people to begin preparing for future long-term care needs.

I learned a lot yesterday, and I hope the participants follow up on some of their teriffic ideas. 

The Democrats on the Senate Health, Education, Labor, and Pensions Committee have, as I expected, included three key long-term care services proposals in their massive 615-page health reform bill. The measure would require states to offer the same access to home and community care as they currently provide for skilled nursing facilities under Medicaid. It would provide new incentives for training both paid and family caregivers. And, the bill includes Senator Ted Kennedy's CLASS Act, which would create a national long-term care insurance program. 

It is hard to overestimate just how far-reaching these changes would be. In my new book, Caring for Our Parents, I discuss each of these ideas. The long-term care training proposal has a good chance of passing this year. The Medicaid changes may be quite costly--as much as $5 billion-a-year--and supporters will have to compete for scarce dollars with dozens of other health reform proposals. The CLASS Act may face the longest odds this year, but at the very least it will focus a tremendous amount of attention on the critical issue of how we pay for long-term care.

Unfortunately, the Democratic leaders of three House committees also laid out their broad blueprint for health reform, but said barely a word about long-term care. Except for worker training incentives, reforms aimed at caring for the disabled as well as the the frail elderly seem to be on the back-burner.

But remember, this is just the first leg in what will be a very long race. Congress will be debating health reform at least through the end of this year.