Transcript Slide 1

The Aging
Services Workforce:
Moving from Accidental
to Valued Profession
The Aging Services Workforce:
Moving from Accidental to Valued Profession
Robyn I. Stone, DrPH
Executive Director, Center for Applied Research
Senior Vice President of Research, LeadingAge
Institute on Aging
Chapel Hill, NC
April 03, 2014
Who Comprises the Aging
Services Workforce
 Physicians – Primary Care Physicians,
Medical Directors
 Nurses
 LPNs overrepresented in nursing homes as
charge nurses
 RNs primarily DONs and ADONs
 GNPs
 Social Workers/Psychologists
 Pharmacists
 Dieticians
 Administrators
Composition of the LTC
Workforce cont.
 Therapists—PT, OT, ST
 Direct Care Workers
 Certified nurse aides
 home health aides
 personal care/home care aides/dietary aides
Why is the Workforce
Accidental?
 Little societal value (ageism, fear of the 3 Ds—
decrepitude, dementia, death)
 Negative image, particularly of nursing homes
 Lack of financial incentives (poor compensation,
career paths etc.)
 Occupations viewed as “easy”; destination
following burnout
Consequences for
Recruitment and Retention
 Difficulty in recruiting staff at all levels and across
all settings
 Rapid turnover, high vacancy rates
 Aging of professional and direct care staff
 Focus on warm bodies—not necessarily trained
and competent
Why Laws of Supply &
Demand Don’t Work
 Historical labor pool of caregivers is shrinking
 Negative stereotype of LTC
 Dominance of public LTC financing reduces ability
to compete
Why Laws of Supply &
Demand Don’t Work
 Outdated, dysfunctional workplace environments
 Inadequate education & training system for this
workforce
 Uncertainty about immigration policy
Factors Influencing Workforce
Recruitment and Retention
Local Economy
Industry
Stereotypes
Recruitment
and Retention
Pay and Benefits
Poor Working
Conditions
Additional Factors Influencing Workforce
Recruitment and Retention
 Inadequate/misplaced investments in education
and training
 Limited data on supply and demand imbalances
 Limited dollars to add new personnel
Long-Term Trends
 The emerging “care gap”
 Shift from institutional to in-home and communitybased settings
 More ethnically/racially diverse older adults and
staff
 More highly educated, demanding older adults
Long-Term Trends cont.
 Greater disparity between “haves” and
“have-nots”
 Expansion of consumer-directed service systems
 Impact of new technologies
 Redefining retirement
Special Mental Health Issues
 1 in 5 older Americans has a MH/SU condition
 High prevalence of depressive disorders and
behavioral problems secondary to dementia
 Older veterans are more likely to have MH/SU
conditions than the general older adult population
Special Mental Health Issues cont.
 Looking to the future
 Increase in prevalence of dementia and
associated behavioral and psychological
symptoms
 Use of illicit drugs is likely to increase,
especially marijuana use and non-medical use
of prescription drugs
Why Workforce Matters
 Lack of supply
 Additional 3.5 million health care workers
needed by 2030
 Particular need for geriatric specialists and
generalists across all professions
 Rural areas have significant shortage
United States: Occupational
Growth Projections, 2010-2020
Personal care aides
70%
Home health aides
69%
Nursing aides, orderlies & attendants
20%
All Direct-care workers
All occupations
Source: PHInational.org
48%
14%
Implications for Quality
 Essential for better quality of care and life
 Interdisciplinary team approach linked to quality
 Geriatric training linked to higher quality
Strategies for
Alleviating Crisis
 Expand supply of personnel entering field
 Create more competitive positions through wage
and benefit increases/redesign
 Improve working conditions/quality of jobs
Strategies for
Alleviating Crisis cont.
 Make larger/smarter investments in formal and
continuing education of the LTC workforce
 Develop new models of LTC services organization
and delivery
 Moderate the demand for LTC personnel
Need for Core Competencies
 Demonstrate competencies in basic geriatric care
for all licensing and certification
 All schools and training programs expand geriatric
and gerontological coursework
 Appropriate content to teach needed
competencies across all settings
 Lack of specific attention to LTC settings
Current System Deficits
 Few medical school rotations require clinical
rotations in LTC settings
 86% of medical directors spend 8 hrs or less/wk in
a nursing home
 Only 4% of nursing programs are exemplary in
emphasis on geriatrics, less on LTC
 Most RNs receive no training in management and
leadership skills; less than 1% certified in
geriatrics/gerontology
 Only 6.4% of recent nursing grads
are practicing in LTC
Current System Deficits cont.
 Only 720 out of 200,000 pharmacists have a
geriatric certification
 Lack of palliative care training across the settings
 No information on content and quality of
continuing education
Differences in Competencies
Required to Practice in
Acute/Ambulatory and
LTC Settings
 Regulatory environments are different (e.g.,
survey and certification, MDS and OASIS)
 Need for an interdisciplinary care team
 Reliance on unlicensed staff
 Flat hierarchy with substantially more direct care
workers (delegation issues)
 Essential integration of formal and informal
care in home-based settings
Differences in Competencies
Required to Practice in
Acute/Ambulatory and
LTC Settings cont.
 One-on-one nature between caregiver/client in
home care
 Limited experience with IT
 Typical LTC client is “long stayer” – quality of life
and client/caregiver relationships are paramount
Potential Strategies to Enhance
Geriatric Competencies in LTC
 Teaching Nursing Homes
 Tying survey process for home health and nursing
homes to demonstrated staff competencies
 More clinical placements in community based
settings
 Creation of “Geriatric Nursing LTC Specialists
Program” – aimed at RNs with less than
baccalaureate level
 New models of care (transitions, managed
LTC, new integrated models)
North Carolina Personal Home Care
Aide State Training Program
 Part of PHCAST national demo
 4 Phases
 Job readiness skills, realistic job previewing
 Non-nurse aide personal care tasks, soft skills
 Enhanced nurse aide 1 training
 Advanced nurse aide training in clinical and
soft skills in home care
Phased Model
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Core set of competencies
Meaningful career lattice
Educational flexibility
Specialty tracks (geriatric aide, medication aide)
Multiple Trainee Pathways
1.
Unemployed
persons
re-entering
market
2.
High school
students
3.
Incumbent
workers
looking to
upgrade
Older Persons as Part
of Solution
 Technologies to help retain quality older staff (e.g.
reducing physical burden)
 Work redesign (e.g. job sharing options)
 Retired physicians, nurses, administrators as
volunteer mentors/coaches for younger staff
 Retired geriatric professionals as educators in
colleges, universities, trade schools
Older Persons as Part
of Solution cont.
 Retired CNAs, home health and home care aides
as trainers for new direct care workers and family
caregivers
 Second careers for older persons
 Family caregivers as formal providers
New Research Initiatives
 Better measures of supply, demand and
shortages
 Characteristics of the professional LTC workforce
 Studies of work design/performance across all
staff and settings
 Impact of baby boomers on LTC demand
 Role of immigration
 Relationship between improved working
conditions, recruitment and retention and quality
outcomes
Demonstration/Evaluation
Opportunities
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Comprehensive practice interventions
Effects of wage/benefit enhancements
Comprehensive education and training reforms
Organizational and staffing innovations
Bridging LTC and medical care
Impact of technology
Reasons to be Hopeful
 Increased attention at the global level (e.g.
AARP’s efforts, IAHSA’s Workforce Summit, UN
activities)
 Increased attention to these issues at Federal and
State levels
 National initiatives (Elder Care Workforce
Alliance, QIO efforts, IOM studies, PHCAST
Evaluation)
 ACA initiatives
Reasons to be Hopeful cont.
 Recognition of workforce issues in culture change
efforts
 Exploration of workforce indicators in pay for
performance
 Aging Services is a growing field!
 Workforce seen as quality and economic
development issue