From May 2009 through June 2010, Adam Simning conducted 90-minute interviews with 190 residents living in 4 public housing high-rises in Rochester, NY. One in 4 older public housing residents in his study experienced some form of anxiety and depression.
An informal conference call on a recent Friday afternoon convinced representatives of 4 LeadingAge member organizations just how much they had in common.
The LeadingAge Workforce Cabinet has spent a year defining the skills sets for personal care attendants, care coordinators and middle managers to deliver effective supports and services.
Now, the Cabinet wants to make sure that nursing homes, home health agencies and housing properties will use those competencies to strengthen their workforces.
The Workforce Cabinet -- a group of educators, state association executives and LeadingAge provider members -- discussed in March strategies and resources that could help LeadingAge provider members create healthy workplaces and improve the workforce.
Creating Healthy Workplaces
During their March meeting, members of the Workforce Cabinet worried that the current economic downturn could make LeadingAge members too complacent about the need to address persistent workforce challenges facing the aging field. The current economic climate has helped to stabilize turnover rates.
But those rates are likely to rise sharply again as soon as the economy recovers.
An Organizational Readiness Assessment could help a LeadingAge member objectively examine its workplace, identify that workplace’s strengths, and assess how it might be improved. Staff members at all levels could use the tool to record their perceptions of the benefits and challenges of working for the organization.
Those responses could then be used to assign a score to the organization’s work environment and culture.
The Cabinet discussed a package of supplementary materials that could be targeted to an organization’s specific score on an Organizational Readiness Assessment. Those resources could help the organization address and resolve any workplace issues that surfaced during the assessment.
“It’s difficult to attract and retain qualified workers unless your organization supports those workers after they arrive,” says Natasha Bryant, managing director and senior research associate at the Center for Applied Research. “A readiness assessment is really the first step in this process. An organization that carries out this type of assessment will be in a much better position to make full use of the competencies that the Workforce Cabinet will release next fall.”
Improving Staff Training
The Workforce Cabinet plans to help nursing homes, home health agencies and housing providers incorporate its workforce competencies into their hiring and training practices. The Cabinet believes that these providers might benefit from:
- A checklist that would outline specific knowledge and skills that workers would need to meet each competency.
- A package of resources that would guide the organization in helping workers achieve the competencies they lack.
“The Cabinet’s primary goal is to make the competencies easy to use so that providers will use them,” says Bryant. “We would like to offer providers an all-in-one package that takes them from the readiness assessment right through to actually using the competencies to hire, orient, evaluate and train personal care attendants, care coordinators and middle managers.”
About the Workforce Cabinet
The Workforce Cabinet held its first meeting in April 2012 and will serve until April 2014.
The cabinet is co-chaired by Barry Berman, chief executive officer (CEO) of Chelsea Jewish Home Foundation in Chelsea, MA, and Frances Roebuck Kuhns, president and CEO of WRC Senior Services in Brookville, PA.
On the first day of 2011, The New York Times published a front-page article about an innovative palliative care program for older adults with dementia based at Beatitudes Campus, a LeadingAge member in Phoenix, AZ.
The program put the comfort of residents with dementia above all else, even if that meant allowing residents to dine at 2 a.m., eat all the chocolate they wanted, or take an alcoholic “nip at night.”
Two years after that article first appeared, the Palliative Care for Advanced Dementia program—now called “Comfort First”—is spreading to New York City, thanks to the Alzheimer’s Association-New York City Chapter, 3 LeadingAge members and their hospice partners:
- Cobble Hill Health Center in Brooklyn.
- Isabella Geriatric Center in Manhattan.
- Jewish Home Lifecare in Manhattan.
Alzheimer’s Association Role
How did Comfort First show up 2,000 miles from home—and what went into making its cross-country leap a success?
The story begins with the Alzheimer’s Association’s New York City chapter, which has long been seeking ways to improve the way nursing homes care for people with dementia. That quest led to research, the establishment of a Nursing Home Task Force, the launch of an annual conference for local nursing homes, and the hiring of Ann Wyatt as the chapter’s residential care policy & strategy consultant. Wyatt was charged with bringing the chapter’s work with nursing homes to the next level.
Soon after arriving, Wyatt raised the possibility that the New York chapter might want to help New York nursing homes replicate Comfort First. Jed Levine, the chapter’s executive vice president and director of programs and services, says the chapter liked the Beatitudes’ approach because it focused on organizational changes that could be sustained over time.
“Our concern was that this could not just be a training program,” agrees Wyatt. “It really needed to be an implementation program. We wanted to embed process improvements in the nursing homes, not just train frontline staff.”
Wyatt made an early visit to Beatitudes Campus to take the Comfort First training and to confer with the program’s co-directors: Tena Alonzo, director of research at Beatitudes Campus, and Dr. Carol O. Long, principal at Capstone Healthcare.
Over the next year, the new partners designed a multi-pronged replication project with Levine serving as principle investigator. The New York City chapter, in the meantime, put together an impressive group of funders:
- United Hospital Fund.
- The Fan Fox and Leslie R. Samuels Foundation, Inc.
- The Mayday Fund.
- The Milbank Foundation for Rehabilitation.
- 1199SEIU Training & Employment Fund and The Greater New York Education Fund.
- The Caccappolo Family Foundation.
- Matthew Furman and Judy Hecker Furman.
- Daniel and Nancy Finke .
- The Alzheimer’s Association-New York City Chapter.
Research: An evaluation of the training program is at the center of the replication project and the key to spreading palliative care for advanced dementia to other nursing homes in the New York City region and beyond, says Long.
“Great programs have to have evidence-based foundations underneath them,” she says. “The research and evaluation component makes a program real, marketable and practical. Without that research, even the best programs will not be relevant to other organizations.”
The evaluation, which Long is co-directing with Dr. Ed Cisek, director of program evaluation at the New York City chapter, will span the first year of the 30-month project. Long, Cisek and other research partners will assess how the New York City training program has impacted:
- Organizational culture.
- Quality of care.
- Cost and use of medications.
- Operating and care costs. The LeadingAge Center for Applied Research is conducting this evaluation.
- Knowledge about advanced dementia and the beliefs, attitudes and perceptions of staff members.
Training: The training portion of the project began in Sept. 2012 with a 1-day meeting in New York City that introduced Comfort First to leaders from participating nursing homes and hospices as well as other regional stakeholders. A month later, a contingent of program champions from the chapter, and from each nursing home and hospice, traveled to Arizona for onsite training. Alonzo and Long returned to New York City in Nov. 2012 to train frontline and supervisory staff members who weren’t able to attend the Phoenix training. In Dec. 2013, the participants will gather again to focus on how they can spread Comfort First beyond the nursing units where they are currently piloting the training program.
Remote consultations: The New York City and Phoenix teams touch base regularly with their nursing home and hospice partners through remote consultations. These consultations might offer guidance on how to treat pain among nonverbal residents, design comfort-focused activities for people with dementia, or provide comfort foods as part of a liberalized diet.
“We tailor our consultations to the individual organization,” says Alonzo. “We recognize that each organization has its own way of doing things and will also have its own way of changing how things will be done.”
Webinars: The Phoenix and New York City teams are developing a series of interactive webinars that will be broadcast to each of the nursing homes. The first webinar, focusing on pain management, takes place this spring.
The Challenges of Distance
Frequent travel, telephone calls and use of technology like webinars is helping to close the 2,000-mile distance that separates Phoenix and New York City. In addition, the Phoenix team credits Wyatt and Levine with making the New York City replication possible through their local connections and their weekly contact with nursing homes and hospice organizations.
“The Alzheimer’s Association has strong relationships with the nursing homes and the hospices in New York City,” says Long. “So it has been instrumental in building vital partnerships. In addition, Ann is transferring our vision for this program to these organizations through her ‘boots on the ground’ involvement.”
Distance has actually brought a new and beneficial formality to the training program, says Alonzo.
“The webinars must be scheduled,” she says. “We can’t do long-distance consultation on the fly. As a result, some very thoughtful consideration goes into designing the ways we work together. I like that very much.”
Pleased with Progress
Alonzo, Long, Levine and Wyatt are pleased with the progress that their nursing home and hospice partners have made so far in adopting the Comfort First program.
“The work that we do is sacred,” says Alonzo. “It is so exciting to know that we are not alone and that other people can get just as darn excited about all this stuff as we can. Ultimately, people want to make a difference. I get to see that validated over and over again and it never gets old.”
Does the online NurseLEAD training program really improve the skills of nurse leaders in aging services organizations? Over the next year, the LeadingAge Center for Applied Research will be working with LeadingAge Tennessee to conduct a pilot test of the program's effectiveness.
Four European nursing homes are using person-centered dining practices to ensure good nutrition and foster independence among their residents with dementia.
The LeadingAge Workforce Cabinet will spend the next 18 months identifying competencies for 3 staff positions in nursing homes, home health agencies and housing properties.
Members of a newly formed Housing Plus Services Learning Collaborative gathered for the first time at the 2012 LeadingAge Annual Meeting in Denver. LeadingAge and Enterprise Community Partners are piloting the Collaborative, which includes 12 teams of nonprofit affordable housing and service provider partners.
Over the next 2 years, the Collaborative’ s community teams will support each other as they develop strategies to coordinate and deliver health and supportive services to older adults living in affordable independent senior housing communities. Members will also work together to:
- Identify the essential elements and practices of promising Housing Plus Services strategies.
- Develop indicators and mechanisms to measure whether these models can improve health outcomes for seniors while creating cost savings for the health care system.
- Explore how regulatory and financing changes could help bring these models to scale so they can serve the large and rapidly growing population of older Americans.
“We would like Collaborative members to take on a very tangible set of activities that gets into implementation and operational details,” says Alisha Sanders, managing director of the LeadingAge Center for Housing Plus Services and senior policy research associate at the LeadingAge Center for Applied Research. “Every team will be working on Housing Plus Services initiatives in its own community. But, together, we will also be identifying common elements and functions of these initiatives that could be relevant to a range of models and housing providers.”
12 Housing Plus Services Learning Collaborative Teams
Twelve community teams are participating in the Housing Plus Services Learning Collaborative. They include:
- Associated Catholic Charities in Baltimore, MD, working with Greater Baltimore Medical Center as its service provider partner.
- Cedar Sinai Park in Portland, OR, with Central City Concern.
- Cathedral Square Corporation in Burlington, VT, with Visiting Nurse Association of Chittenden and Grand Isle Counties.
- Evangelical Lutheran Good Samaritan Society in Sioux Falls, SD, with its internal service division.
- Housing Authority of Milwaukee in Wisconsin, with SET Ministry Inc.
- Mercy Housing California in San Francisco, with the Institute on Aging and San Francisco Department of Public Health.
- National Church Residences in Columbus, OH, with its internal service division.
- NewCourtland in Philadelphia, PA, with NewCourtland LIFE.
- Peter Sanborn Place in Reading, MA, with Sanborn Home Care and Day Services.
- Presbyterian Senior Living in Dillsburg, PA, with PinnacleHealth.
- Presbyterian Villages of Michigan in Southfield, MI, with Luella Hannan Memorial Foundation.
- Selfhelp Community Services in New York, NY, with SinglePoint Care Network, Jewish Home Lifecare, and New York Hospital of Queens.
Housing Plus Services Collaborative Members: Learning and Sharing
Community teams participating in the Housing Plus Services Learning Collaborative will build their knowledge and capacity through peer-to-peer learning opportunities that include in-person meetings, conference calls, webinars and other virtual activities.
“A lot of the learning is going to come from group members sharing their experience and their knowledge,” says Sanders. “One community team might have a lot of experience conducting assessments of residents. Another team may have some strong experience in developing partnerships.”
In addition to holding formal meetings, members will use a virtual web-based “cloud” platform to share ideas, documents and resources. Members might also take part in smaller work groups that explore specific topics.
“We hope the work of the Collaborative will complement what members are already doing back in their communities,” says Sanders. “But we also want to be able to pull collective knowledge from all of them to build tools and materials that we can share with the broader field.”
For More Information
Participants in a recent Housing Plus Services Study Tour brought home a plethora of information and 6 important lessons.