The E-mail message field is required. Boomers facing long-term care decisions may be more willing and able to pay for formal care services. Program Design Medicare-covered skilled nursing and home health care and Medicaid-covered nursing-home care are entitlements with little room for innovation. The proportion of black women age 25 or over with a high school education increased from 51. The literature contains descriptions of programs in nursing home and home care settings that have attempted to address problems related to the recruitment, retention, and ongoing maintenance of the paraprofessional long-term care workforce. As a result, the nursing home and home care industries are converging and are beginning to compete for people in the same labor pool, contributing to the shortage of frontline workers.
The preceptors meet regularly to share progress and problems, and participate in program evaluations every six months. The first section provides a profile of the workers and describes the nature of their jobs across the continuum of long-term care settings. Research on home care workers has been more difficult to conduct because it must be carried out in individual homes. In their national study of home care workers providing assistance to the Medicare population, Leon and Franco 1998 found that 29 percent of the workers were self-employed. The confluence of the above factors and individual employer and employee decisions are played out in the workplace. The Wellspring model of quality improvement is another approach to changing nursing home workplace culture. Policymakers and providers need to consider the interactions of the factors described below, including the countervailing effects of certain initiatives, in enhancing or impeding the development of a qualified, sustainable frontline workforce.
The care they provide is intimate and personal. This crisis is not limited to the United States. A variety of factors, however, may offset the long-term demand for and supply of paraprofessional workers Wilner and Wyatt 1998. They assessed the effect of intrinsic rewards e. Immigration Policy Given the current labor shortage and gloomy projections about the future pool of workers, many providers have expressed interest in using immigrants to expand the potential labor pool.
Each facility has created neighborhood units, with kitchen and dining areas serving as focal points. In addition to these health care paraprofessionals, personal care aides help the elderly, convalescents, or people with disabilities with daily living activities at the person ' s home or in a care facility. These front-line workers provide hands-on care, supervision, and emotional support to millions of elderly and younger people with chronic illness and disabilities. Formerly competitors, these agencies developed common standards and processed all referrals through one organization. The researchers found that paraprofessional behavior is driven by predisposing circumstances that can set up a cycle of powerlessness and unfamiliarity with the skills and rewards associated with performance and achievement in the workplace. About 55 percent of nursing assistants are white, 35 percent are black, and 10 percent are Hispanic. Policymakers need to better understand the magnitude of the long-term problem so that they are more motivated in developing this workforce, the barriers to doing so, and the possible consequences of different policy interactions.
While the dependency ratio is not a proxy for the frontline worker-to-elderly ratio, these findings do suggest that immigration policy would have to be designed to allow a large influx of low-skilled immigrants if it were to address the demand for long-term care workers. This trend will contribute to an increased demand for formal long-term care services over the next three decades. Recruitment, retention, and turnover are related to conditions in both the long-term care labor market and the overall labor market Atchley 1996; Burbridge 1993. Countries such as Japan, Italy and Germany that are far grayer than the United States have already begun to pursue an aggressive immigration strategy: For example, Italy recruits from Peru, and Japan has begun to encourage immigration from the Philippines. Is such a workforce capable of addressing the needs of our aging population? In the early 1990s, Genesis Eldercare, a multi-facility provider headquartered in Pennsylvania, developed a comprehensive three-level career ladder program. At least 10 states are currently exploring strategies to improve training of frontline workers in all long-term care settings; California and Oklahoma are focusing special attention on dementia care. Internal evaluations of the program over the past nine years show a reduction in turnover rates and high satisfaction ratings among old and new employees.
If payment rates fail to keep up with the true cost of providing services, organizations have less flexibility to offer competitive wages and benefits. According to , there were approximately 2. Their analysis of the data from 1950 to 1990 indicates that, although immigrations impact has contributed to higher worker-to-elderly ratios, the amount of immigration over the past decades has been insufficient to counteract the much stronger impact of population aging. These more-educated women will be less willing to work in the same low-wage, low-benefit jobs as those who preceded them Burbridge 1993. In focus groups with nurse supervisors employed by several nonprofit nursing homes in Kansas, Long and Long 1998 found that understaffing was a major contributor to nurses decisions to leave the facility. It did, however, result in more inquiries and enrollees for the local technical colleges nursing assistant classes. At the same time, as baby boomers approach old age, the pool of middle-aged women who have traditionally provided care will also be substantially smaller.
Program design features, such as whether consumer-directed home care is provided, can also affect the size of the labor force by making it easy or hard for relatives and friends to be paid for care provided. Other residential care sites are small and homey, offering privacy and choice to residents. Finally, we need to develop and test creative ways of developing new pools of workers to meet the demand for services in the future. . Is such a workforce capable of addressing the needs of our aging population? In fact, during the late 1980s, tight labor markets in many communities created significant worker shortages that catalyzed policy debate, state and provider initiatives, and several seminal research activities, including the development of the first national profile of the paraprofessional workforce Crown 1994; Crown et al. At the macro level, these include how society views this occupation, the status of the economy, and policies affecting health and long-term care, labor, welfare and immigration.
Your question was prompted by a 2001 prepared by the Urban Institute for the U. The baby boom workforce has passed through this age range, and the rate of increased participation of women in the workforce is slowing considerably. Their wages are higher than the average for home care aides, and they receive fringe benefits as well as guaranteed hours. In the aggregate, the interventions reduced turnover rates by 11 to 44 percent. Low wages and benefits, hard working conditions, heavy workloads, and a job that has been stigmatized by society make worker recruitment and retention difficult.
Nursing aides, such as certified nursing assistants, typically: 1. Factors Affecting the Supply and Quality of Workers The success of efforts to recruit, retain, and maintain a long-term care workforce is dependent on a variety of interdependent factors. While these policies are designed to protect trainees from being shunted into poverty-level jobs, they essentially preclude graduates from entering the paraprofessional long-term care labor force. New York Is Experiencing a Shortage in Personnel for Home and Community-Based Services. Indeed, many observers refer to the current difficulty of attracting workers as a crisis.