Quality Jobs/Quality Care
March 11, 2004
________________________________________________________________________________\
____________________________________________
“Quality Jobs/Quality Care” is a free e-mail newsletter that covers issues
concerning direct-care workers in long-term care. It’s published twice a month
by the National Clearinghouse on the Direct Care Workforce
(
http://www.directcareclearinghouse.org), which provides reliable, up-to-date
information related to the direct-care workforce nationwide. The Clearinghouse
is a project of the Paraprofessional Healthcare Institute
(
http://www.paraprofessional.org)
________________________________________________________________________________\
___________________________________________
Dear Friend:
It’s official: The save-the-date card for the Direct Care Alliance’s September
conference is online
(
http://www.directcarealliance.org/sections/2004natConf.htm)
and will soon be mailed out to hundreds of potential attendees. So carve out
space now in your calendar to join other workers, consumers, providers and
advocates interested in finding solutions to long-term care challenges. The
meeting will be held September 18-20, and it’s sure to be worthwhile for anyone
interested in improving conditions for direct-care workers and consumers.
In this issue, we bring you news of:
* A poll aimed at updating standards for nurse aide practice that seeks input
from CNAs, CNA educators, and other long-term care professionals
* Testimony by direct-care workers at a CMS conference
* An issue brief on worker associations that outlines their achievements, the
benefits they offer members and other long-term care stakeholders, and
organizational models that have proven successful
* The publication of the final rule requiring nursing homes to post information
about their nurse staffing
* A study of state laws governing minimum staffing ratios for nursing homes
* A Kansas intervention aimed at reducing nursing assistant turnover that
concluded the response would have been stronger if it were not for “the stress
and tension associated with under-staffing.”
* A call for nominations for awards recognizing ways of supporting and
developing the direct support workforce
* A New York Times article about the growing number of robotic items being used
in Japanese elder care
* A New Jersey law banning nursing homes and home health care employers from
requiring hourly health care workers to work overtime.
COMPETENCY TESTING GROUP SEEKS INPUT FROM CNAS, EDUCATORS AND OTHERS
There’s one day left to participate in a poll that will help set new standards
for nursing assistant practice.
Capstar, which does competency testing for nursing assistants, is polling CNAs,
home health aides, nursing assistant educators and supervisors, licensing and
certification regulators, and other long-term care professionals for an analysis
of nurse aide work standards. The goal of the study, according to the group, is
“to update the standards for safe and competent nurse aide practice in long-term
care, home healthcare and acute care settings, on a national scope” and gather
“valuable information about how emerging unlicensed roles are regulated.”
To participate in the poll, which is available online until March 12, go to
http://directcare.c.topica.com/maab18Laa45e9bepIZjb/
SYSTEMS CHANGE GRANTEES HEAR FROM DIRECT-CARE WORKERS
Direct-care workers were on the agenda of the third annual Real Choice-Systems
Change Conference hosted earlier this month by the Centers for Medicare &
Medicaid Services (CMS).
Personal care attendant Roberta Record and direct support professional Julie
Moulton addressed the approximately 150 attendees at a March 1 pre-conference on
the workforce. The two also attended the March 2-3 main conference and hosted a
poster session about the Maine Personal Assistance Services Association, the
worker association they belong to, which is funded by a Systems Change grant.
The pre-conference attendees were a mix of state policymakers, researchers,
consumers, worker advocates, and people from agencies that coordinate personal
assistance services who are working to improve access to home- and
community-based long-term care services with the help of CMS grant money. They
heard from the workers about why they had chosen their profession, why they stay
in it, why they thought others left, and what could be done to make the job
better.
For details, go to
http://directcare.c.topica.com/maab18Laa45hmbepIZjb/
ISSUE BRIEF EXPLORES HOW AND WHY TO ORGANIZE WORKER ASSOCIATIONS
Professional associations like the Maine Personal Assistance Services
Association, the group that brought Roberta Record and Julie Moulton to the CMS
Systems Change conference, provide direct-care workers with needed support,
giving them opportunities to develop their professional skills, gain
recognition, network with peers, and influence public policy. An eight-page
issue brief, “Direct-care Worker Associations: Empowering workers to improve the
quality of home- and community-based care,” traces the history and achievements
of these organizations, the benefits they offer members and other long-term care
stakeholders, and organizational models that have proved successful.
The brief, which was written by the Paraprofessional Healthcare Institute and
MEDSTAT for CMS, also offers tips on how to organize a direct-care worker
association.
To download a free copy, go to
http://directcare.c.topica.com/maab18Laa45fabepIZjb/
FINAL RULE ON POSTING STAFF INFORMATION FINALLY PUBLISHED
On February 27, the Federal Register published the final rule requiring nursing
homes to post information about their nurse staffing. The regulation was
implemented last year, but CMS has added new details and is inviting comments
now.
As currently written, the rule requires nursing homes to post the number of
full-time equivalent registered nurses, licensed practical nurses, licensed
vocational nurses, and nursing assistants on each shift every day. Only those
directly responsible for resident care are to be included in the posting, which
must also contain the current number of residents in the facility. The
information must be displayed in a prominent place that is readily accessible to
residents and visitors, posted on a form as required by CMS, and made available
to the public on request. It must also be retained for at least three years or
as required by state law, whichever is greater.
The background accompanying the final rule says: “we do not believe sufficient
evidence exists to warrant minimum nurse staffing ratio requirements. However,
we do acknowledge the importance of improving nurse staffing and making accurate
information available to the public. Consistent with our November 2001
initiative to disseminate and publish reliable information on nursing home
quality for Medicare and Medicaid beneficiaries, our objective is to make
staffing information available to the public to assist them in making informed
decisions when choosing health care providers. With reliable information,
nurse-staffing levels may simply increase due to the market demand created by an
informed public.”
Comments are due to CMS by April 27.
To read the final rule and learn how to submit comments, go to
http://www.gpoaccess.gov/fr/index.html, type CMS-3121-P into the 2004 search
engine, and click on the HTML or PDF version of "Medicare and Medicaid Programs;
Requirements for Long Term Care"
REPORT OUTLINES STATE EXPERIENCES WITH STAFFING RATIOS
A study of state laws finds that minimum staffing ratios for nursing homes can
serve as a foundation for quality care, but they are not sufficient to guarantee
it.
Conducted by the Urban Institute for the U.S. Department of Health and Human
Services’ Office of the Assistant Secretary for Planning and Evaluation, “State
Experiences With Minimum Nursing Staff Ratios For Nursing Facilities: Findings
from case studies of eight states” was commissioned as a follow-up to the Phase
I and Phase II studies of nursing home staffing conducted for CMS by Abt
Associates.
The researchers surveyed staffing standards nationwide, finding that 36 states
currently have them, and conducted case studies of eight states — Arkansas,
California, Delaware, Minnesota, Missouri, Ohio, Vermont, and Wisconsin — that
either instituted, modified or eliminated nursing staff ratios in recent years.
The report concludes: “Most observers agreed that minimum ratios can help impose
a standard on those facilities where staffing falls below the ratios. Thus,
staffing ratios may serve as a minimum bar for facilities, not a standard that
most need to strive to reach. Observers also asserted that facility staffing is
not the only factor that affects the quality of care that nursing home residents
receive. Other factors such as staff training and facility management also
affect quality, and when asked for recommendations for the federal level, very
few stakeholders called for national standards.”
To read the report, go to
http://directcare.c.topica.com/maab18Laa45fcbepIZjb/
RETENTION INITIATIVE GETS MIXED RESULTS
A report on a Kansas intervention aimed at reducing nursing assistant turnover
found “an ongoing willingness to try to continue to implement behavior change,
even in a difficult work environment.” However, the researchers say, the
response probably would have been stronger if it were not for “the stress and
tension associated with under-staffing.”
“Keeping Frontline Workers in Long-Term Care: Research Results of an
Intervention” documents the impact of a three-part intervention on nursing
assistant retention, relationships between frontline staff and supervisors, and
supervisory capabilities. The intervention included interpersonal skills and
empathy training for both nursing assistants and supervisors, biweekly support
groups for both, and online supervisory training for supervisors.
The supervisory training was found to have a major impact on the supervisors,
but its impact was less noticeable for the nursing assistants, although they
observed some positive changes. The survey, says the study, “revealed a sense of
cynicism with one’s fellow human beings among study participants” that is
“characteristic of people who have experienced a great many hard times and
disappointments.” It also recorded a high level of stress among all
participants, both before and after the intervention.
The report, a collaboration by the Institute for the Future of Aging Services,
the Kansas Association of Homes and Services for the Aging, and Wichita State
University, can be found at
http://directcare.c.topica.com/maab18Laa45fdbepIZjb/
CALL FOR NOMINATIONS FOR DIRECT SUPPORT STAFF DEVELOPMENT AWARDS
The National Alliance for Direct Support Professionals and the Research and
Training Center (RTC) at the University of Minnesota’s Institute on Community
Integration are seeking nominations for the 2004 Moving Mountains Awards. The
nominations are part of a national research project in which the RTC will
conduct in-depth case studies describing best practice initiatives designed to
improve the competence, status, compensation, and stability of direct support
staff.
The deadline for applications is March 30.
To read about the award and how to apply, go to
http://directcare.c.topica.com/maab18Laa45febepIZjb/
ROBOTS REDUX
Robots can be a boon to long-term care, promoting independence for people with
disabilities. But they can also be misused, substituted for people or animals in
situations that call for live interaction.
In past issues, we’ve reported on such dubious advances as robotic pets meant to
provide “social stimulation” for lonely elders and a robotic “companion” that
lets clinicians communicate with residents and staff from a distance, both of
which are being tested in the U.S. Meanwhile, Japan has been testing robots of
its own.
According to a March 6 article in the New York Times, items now in use in
Japanese elder care include a “human washing machine” that bathes people with
minimal input from a nursing home or home care worker, a motorized "robot suit"
aimed at helping the mobility-impaired move, and the Wakamaru, “a mobile,
three-foot-high speaking robot equipped with two camera eyes . . . used largely
by working people to keep an eye on their elderly parents at home.”
The article says the motivation behind such devices includes a rapidly growing
aging population, a stagnant pool of working-age adults, and rebellion by an
increasing number of Japanese women against “traditional expectations that they
will stay home to care for aged relatives.” The problem could be solved, it
points out, by importing workers, but “xenophobia” prevents the Japanese from
embracing that option.
Meanwhile, it remains to be seen whether elders will embrace robots in place of
direct-care workers. “Some people in the industry say Japanese people are not
able to accept a robot as a nurse, that they attach importance to the humanity
aspect,” a Sanyo executive is quoted as saying. “So we are stuck in the middle
between efficiency and nursing with a human touch. But if you pay attention to
the humanity side, you obviously need labor power.”
NEW JERSEY BANS MANDATORY OVERTIME
A New Jersey law bans hospitals, nursing homes, and home health care employers
from requiring hourly health care workers to work overtime. The law, which went
into effect on February 17, applies to nursing assistants and other direct-care
workers. Facilities may make exceptions in emergency situations.
According to CNN, Washington state has a similar law and West Virginia lawmakers
recently passed one that is awaiting the governor’s approval.
- - - - - - - - -
To comment on this newsletter or provide ideas for future issues, please contact
Elise Nakhnikian (
elise@...; 609-430-1881). If you have
information, questions, or suggestions for the Clearinghouse, please contact
Director Vera Salter (
vera@...; 718-402-2788).
When forwarding material from “Quality Jobs/Quality Care,” please credit the
National Clearinghouse on the Direct Care Workforce. Do not reproduce without
permission.
To subscribe, visit the Clearinghouse website at
http://directcare.c.topica.com/maab18Laa45ffbepIZjb/ and look for "Free E-mail
Alerts."
====================================================================
Update Your Profile:
http://www.topica.com/f/?a84tsY.bepIZj.aHR1cm5o
Unsubscribe:
http://www.topica.com/f/?a84tsY.bepIZj.aHR1cm5o.u
Confirm Your Subscription:
http://www.topica.com/f/?a84tsY.bepIZj.aHR1cm5o.c
Delivered by Topica:
http://www.topica.com/?p=T3FOOTER
Having problems with message search?
Fill out this form to ensure your group is one of the first to be migrated to the new message search system.
Send Email