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THANKS SO MUCH FOR INVITING ME TO YOUR CONFERENCE!

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THANKS SO MUCH FOR INVITING ME TO YOUR CONFERENCE! Strategies for Empowering Direct Care Workers and Improving Job Outcomes Linda S. Noelker, Ph.D Senior Vice ... – PowerPoint PPT presentation

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Title: THANKS SO MUCH FOR INVITING ME TO YOUR CONFERENCE!


1
  • THANKS SO MUCH FOR INVITING ME TO YOUR CONFERENCE!

2
Strategies for Empowering Direct Care Workers
and Improving Job Outcomes
  • Linda S. Noelker, Ph.D
  • Senior Vice President
  • Director, Katz Policy Institute
  • Benjamin Rose Institute
  • Presented at the North Carolina Conference on
    Aging, September 10, 2007, Winston-Salem, NC.

This research was supported by a grant from the
Institute for the Future of Aging Services under
the Better Jobs Better Care initiative funded by
the Robert Wood Johnson Foundation and Atlantic
Philanthropies.
3
Benjamin Rose Institute (BRI)
  • Established in 1908
  • Endowment (currently 120 million)
  • Mission To advance the health, independence, and
    dignity of older adults by raising the standards
    for quality of care
  • A non-profit agency that includes Home
    Community-based Services(HCBS), Applied Aging
    Research, and Public Policy Institutes

4
What changed at BRI?
  • 1961 BRIs first 115-bed nursing home opened
  • 1997 BRIs new 184-bed nursing home opened
  • 2006 BRI got out of the nursing home business

5
Kethley House _at_ Benjamin Rose Place
6
What does it reflect about Long Term Care?
  • Inadequate reimbursement under Medicaid
  • Shift to HCBS (rebalancing)
  • Liability issues (threat to BRIs endowment)
  • Licensed nursing shortage
  • Direct care workforce (DCW) issues (e.g.,
    increasing health insurance costs, projected
    shortages)

7
Todays Objectives
  • Further understanding of the touch points between
    Rosabeth M. Kanters theory of worker empowerment
    and the stress and social support model as they
    affect DCW job satisfaction
  • Present findings on factors affecting DCW job
    satisfaction with a focus on education and
    training
  • Promote improved DCW training based on their
    recommendations

8
What is empowerment?
  • A process by which the characteristics of the
    organization and the job
  • create an environment in which the employee feels
    in control
  • and has the power and ability to affect the
    achievement of organizational goals (Kanter, 1993)

9
Key Elements of Empowerment
  • Training and education so workers can learn and
    grow
  • Supportive leadership and work environment
  • Information sharing
  • Access to needed resources

10
DCW Training and Education
  • Competencies are developed broadly
  • Include interpersonal and group process skills,
    problem-solving and decision-making skills,
    leadership, customer relations skills, and
    technical skills

11
Comments Reflecting a Lack of Empowerment
around Education
  • You cant expect them to learn that.
  • Continuing education is the same old thing over
    and over.
  • I cant leave the unit to attend.
  • They get to go to the Marriott for their
    continuing education.

12
Empowerment Outcomes
  • Higher job satisfaction
  • Greater job commitment
  • Reduced job-related stress burnout
  • Higher retention

13
Better Education Better Jobs BRIs
Survey of DCWs
  • Employed stress support conceptual model to
    guide the research
  • Both DCW-level and organization-level analyses
    conducted to address issue of nested data
  • DCWs from nursing homes, assisted living and home
    health agencies included

14
Study Design and Methods
  • Cross-sectional survey in-person/phone DCW
    interviews
  • Questionnaires for data on organizational
    characteristics and management practices
  • Study sites drawn using proportionate random
    sampling from all Nursing Homes (NHs), Assisted
    Livings (ALs) and Home Health Agencies (HHAs) in
    five counties in NE Ohio
  • 90 sites chosen/49 agreed (41 participation
    rate)
  • 27 NHs, 14 ALs, and 8 HHAs

15
DCW Sample
  • Proportionate random sampling of DCWs within the
    49 sites
  • Targeted 900, 1058 contacted, 644 participated
    (61 participation rate)
  • Over time over budget on sample recruitment and
    data collection
  • Is is possible to obtain a representative sample
    of DCWs?

16
LTC Stress and Support Model Predicting Direct
Care Workers Job Satisfaction
A. Background Characteristics
C Workplace Support
E Outcomes
B. Stressors
  • Direct Care Workers
  • Age
  • Marital Status
  • Race
  • Direct Care Workers
  • Positive Negative Relationships
  • With Residents/Clients
  • With Staff
  • Direct Care Workers
  • Job Satisfaction
  • Direct Care Workers
  • Personal
  • Family Financial
  • Health Changes
  • Job-Related
  • Training
  • Pay Benefits
  • Scheduling Changes
  • Permanent Assignment

D. Organizational Variables
  • Characteristics
  • Types of LTC Setting
  • Profit Status
  • of Minorities Served
  • of Medicaid Reimbursement
  • Management Issues
  • Turnover of DCWs
  • Minimum Pay

17
Analytic Approach
  • Multiple Linear Regression Analysis using
    individual-level DCW data to predict job
    satisfaction
  • Hierarchical Linear Modeling using
    organizational-level data to predict average job
    satisfaction score in study sites after
    controlling for individual-level variables

18
Perceived Adequacy of Training
  • Entry-level
  • Job orientation
  • Continuing Education
  • Recommendations for improvement

19
Positive and Negative Support in the Workplace
  • Positive interaction with peers and
    residents/clients (e.g., feelings of respect,
    affection)
  • Negative interaction with peers and
    residents/clients (e.g., feelings of anger,
    frustration)
  • Frequency of hearing racist remarks from
    residents, families and other staff

20
Findings DCW characteristics
  • Age (average) 39 years
  • Minorities 59
  • Female 95
  • Unmarried 63
  • Work in LTC (average) 8.7 years

21
Multiple Linear Regression Results for DCW
Job Satisfaction
  • Adj. R2 .51 (plt.01)
  • Background characteristics Non-minority
  • Personal Stressors Physical health
    emotional health change lower depression scores
  • Job-related Stressors adequacy of job
    orientation continuing education fewer
    scheduling changes fair pay more benefits
    (health insurance, retirement)
  • Workplace Support less negative interaction
    fewer racist remarks

22
Racist Remarks
  • Heard make remarks To be hurtful
  • Clients/Residents 70 4
  • Families 15 38
  • Other staff 21 65

23
Quotes from Workers
  • I want to leave because I cannot take the racial
    comments anymore. I am training to go into
    medical billing.
  • There seems to be a white standard and a
    colored standard. The white workers are
    expected to do more and be more responsible which
    makes them feel discriminated against and angry.

24
Results from HLM Analysis of Factors Affecting
DCW Job Satisfaction
  • Adjusted average DCW job satisfaction scores were
    higher for
  • DCWs in Assisted Living and Home Health Agencies
  • Sites reporting less difficulty with DCWs
    quitting and being fired
  • Sites with a higher rate of starting pay

25
DCW Reports about Training
  • NH DCWs AL DCWs HHA DCWs
  • Initial training made
  • me well prepared 55 59 71
  • Job orientation was
  • very helpful 49 47 63
  • Very useful to have
  • a mentor 74 77 79
  • Continuing education is
  • very useful 53 51 70

26
CEU Topics Most Frequently Covered
  • Preventing injuries at work (not as helpful for
    NH/ALF DCWs)
  • Caring for those with dementia
  • Communicating with residents/clients
  • Resident/client care skills such as bathing (need
    more in ALFs)
  • How to deal with difficult coworkers

27
CEU Topics Needing More Attention
  • DCW Teamwork (especially in NHs)
  • Organizing tasks so everything gets done
    (especially in HHA)
  • CPR (especially in NHs)
  • Problem solving on the job (especially in ALFs)
  • Managing job stress (especially in NHs)
  • End-of-life issues/grief (especially in ALFs)

28
Recommendations for Improving Entry-Level
Training
  • Longer/more hours
  • More clinical time
  • More one-on-one instruction (peer mentoring)
  • Cover teamwork, respect, communication, dementia
    care, lifts/transfers, vital signs

29
Recommendations for Improving Continuing
Education
  • More frequent, shorter sessions
  • Offer on all shifts/all days of the week
  • Interactive training (e.g., role plays)
  • Obtain DCW input on content and design
  • Ensure coverage to foster attendance
  • Cover teamwork, respect, communication, mental
    illness, vital signs, and CPR

30
References
  • Ejaz, F., Noelker, L.S., Menne, H.L. Bagakas,
    J. G. (in press) The impact of stress and support
    on direct care workers job satisfaction, The
    Gerontologist.
  • Kanter, R. M. (1993) Men and Women of the
    Corporation. N.Y. Basic Books.
  • Noelker, L.S., Ejaz, F.K. Menne, H.L. (in
    press) Knowledge as empowerment Improving
    nursing assistants education and training, in
    Empowering Work Teams in Long Term Care Why and
    How to Create Self-directed Teams, Yeatts, D.,
    Noelker, L.S. Cready, C.M. (eds.), Health
    Professions Press.

31
Today, Tomorrow, Together!
  • Working collaboratively to improve the size and
    quality of the Direct Care Workforce
  • Ensuring quality jobs and quality care for older
    and younger disabled citizens
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