Educating Direct Care Workers in Transitions of Care
Publication Date: November 2011
This chapter, which appears in the Annual Review of Gerontology and Geriatrics: Pathways Through the Transitions of Care for Older Adults book, highlights the potential role that direct care workers can play in the development, adoption and sustainability of quality transitional care. The chapter summarizes the reasons why direct care workers are critical to the transitional care process and outcomes and why the direct care worker is an essential part of the transitional care team. The authors review the key challenges in recruiting and retaining direct care workers and the barriers to the development of a quality, competent workforce. The status of direct care worker education and training is described with a special focus on the extent to which training programs and materials have addressed the role of the direct care worker in transitional care and the need for better training and organizational support necessary to have the direct care worker be a key part of the transitional care team.

Direct Care Workforce Geriatric Training Opportunities 
Publication Date: March 2011
The SCAN Foundation, through its 2009 themed request for proposals, supported 5 grantees to develop a series of continuing education curricula (in-services) for California's direct-care workforce. LeadingAge Center for Applied Research, in partnership with Aging Services of California and University of Kansas Medical Center, developed training materials on 2 topics: Undertanding and Responding to Behavioral Symptoms of Dementia and The Direct Care Worker's Role in Managing Pain in Older Adults. The training materials are available for employers of direct workers at no charge by visiting SCAN Foundation Direct Care Workforce.

Palliative Care for Advanced Dementia: FutureAge Article 
Author: Natasha Bryant, Tena Alonzo and Carol O. Long
Publication Date: November/December 2010
The Beatitudes Campus developed a palliative care for advanced dementia training program that offers a person-directed approach. This article describes the principles and practices of the program, and the results of an evaluation.  

Evidence for Consistent Assignment: A Critical Evaluation of the Literature and Current Practices
Author: University of Wisconsin-Madison, School of Nursing 
Publication Date: December 2012
This study reviews the literature available on consistent assignment in nursing homes to understand how the practice is being implemented in a small sample of nursing homes. This report is intended to briefly inform the practice and research field. The research has demonstrated that consistent assignment does not universally lead to improved staff and resident outcomes. Staff burnout, low satisfaction, and higher turnover can result. Resident quality of life and quality of care do not always improve, particularly if staff are not provided support and knowledge to improve care practices as well.

 Role of Migrant Workers in Aging Society: Research Findings in the United States
Author: Georgetown University
Publication Date: December 2009
This report investigates migrants' role in eldercare in the United States, particularly as professional caregivers or physicians, dentists, nurses, and therapists, as well as direct care providers or home health aides and lower-skilled providers. This research was undertaken as part of a 2-year, internationally collaborative project, with funding from several sources, involving Ireland, the United Kingdom, and Canada.

Defining Core Competencies for the Professional Long-Term Care Workforce
Author: Mary Harahan and Robyn Stone
Publication Date: April 2009
The goal of this paper is to analyze the gerontological workforce literature, as well as initiatives launched by professional associations and providers, to determine progress in defining the competencies needed by the licensed long-term care workforce. The primary focus is on the core competencies needed by medical directors, agency and facility administrators, nurses, social workers, other mental health professionals and consulting pharmacists who are employed by nursing homes. 

Direct Care Worker Retention: Strategies for Success
Author: AAHSA Talent Cabinet
Publication Date: January 2010
This report documents a wealth  of evidence-based research and successful strategies and programs shown to increase direct care worker retention for aging-services providers.

Retention of Long-Term Care Professionals: Assessing the Challenges
Author: AAHSA Talent Cabinet
Publication Date: January 2010
This report scanned for research and current programs in place for retaining long-term care professionals. The scan found very little research on retention strategies and programs or inverventions aimed at retaining quality professional staff within the long-term care field.

Leadership Teams in Nuring Homes
Author: Helaine Resnick, Barbara Manard, Robyn Stone and Nicholas Castle 
Publication Date: 2009 
This report sought to understand key characteristics of nursing home leadership teams, and to examine if differences in these factors exist between leaders in for-profit (FP) and not-for-profit (NFP) nursing homes (NH). The report examined a nationally representative, cross-sectional sample of 1,174 U.S. NHs that was conducted in 2004. Reported data on tenure, education, and certification of NH administrators, medical directors, and directors of nursing at FP and NFP facilities were explored. The report highlights the findings from the study.

A Guide for States Developing a Special Licensure Program like NC NOVA: Key Steps and Stakeholder Processes 
Author: N.C. Foundation for Advanced Health Programs
Publication Date: July 2009
The North Carolina Foundation for Advanced Health Programs received a grant through the Better Jobs Better Care initiative funded by the Robert Wood Johnson Foundation and the Atlantic Philanthropies. A broad-based coalition, the Partner Team, created a voluntary, special state license designed to promote the recruitment and retention of direct care workers to achieve lasting workplace changes at nursing facilities, adult care homes (also known as assisted living) and home care agencies. NC NOVA is designed to improve workplace practices to create better jobs for employees and better care for residents and clients. The manual provides a framework to guide other states considering the development and implementation of a program similar to NC NOVA. The guide describes the stakeholder process and program development decisions and provides tips and suggestions based on the Partner Team's experience.

 Evaluation of the LVN Leadership Enhancement and Development Program
Author: Center for Applied Research; University of Wisconsin, Mary Harahan and Aging Services of California
Publication Date: 2008
Licensed vocational nurses (LVNs) play a critical role in nursing homes in motivating, teaching and improving the skills and performance of certified nursing assistants (CNAs) who deliver the bulk of hands-on care to residents.Past research has demonstrated that most long-term care nurses are poorly prepared to assume supervisory and leadership responsibilities. Inadequate leadership and supervision is a major contributor to job dissatisfaction and high turnover among frontline nursing home staff.  Many research studies have also linked high vacancy and turnover rates to poor quality nursing home care. The University of Wisconsin and LeadingAge developed, pilot tested and evaluated the impact of a leadership training program for LVNs in four nursing homes in the Oakland California metropolitan area.  This report highlights the findings of the study evaluating the impact of the training program.

Extended Care Career Ladder Initiative Qualitative Evaluation Project Final Report 
Author: Center for Applied Research and Commonwealth Corporation
Publication Date: 2008
This final report is the culmination of an 18-month qualitative evaluation of outcomes of the ECCLI program, conducted by the Center for Applied Research (formeraly IFAS) and the Gerontology Institute at the University of Massachusetts Boston (GI-UMB) for the Commonwealth Corporation (CommCorp). The study found that all 11 organizations implemented career ladders for the certified nursing assistants and home health aides. Select organizations also implemented other training programs, such as communications skills, conflict management, teamwork, basic supervision for supervisors, English as a Second Language classes, person-centered care, and mentoring. The evaluation showed positive outcomes for most if not all of the organizations, with improved communication, soft skills, teamwork, respect and self confidence, wages, retention and recruitment, organizational culture and practice changes, and resident/client quality of care and quality of life.

The Qualitative Evaluation of Extended Care Career Ladder Initiative
Author: Commonwealth Corporation
Publication Date: 2007
This qualitative evaluation brief examines in detail the experiences of 7 nursing homes and 3 home health agencies that received the Qualitative Evaluation of Extended Care Career Ladder Initiative (ECCLI) grants between 2000 and 2004. ECCLI was a state-initiated effort in Massachusetts to address the issue of frontline workforce quality improvement in long-term care.

Stone Presents Testimony at Senate Special Committee on Aging
Author: Stone, R.I.
Publication Date: April 21, 2008
Dr. Robyn Stone, executive director of LeadingAge Center for Applied Research, testified before the Senate Special Committe on Aging. In her testimony, Stone makes recommendations for improving the long-term care workforce crisis. The recommendations include expanding the supply of new people entering the long-term care field; more competitive long-term care jobs through wage and benefit increases; improving the working conditions and quality of long-term care jobs; larger and smarter investments in workforce education and development; and moderating the demand for long-term care personnel.

Senior Living Businss - Robyn Stone Q and A on Long-Term Care Workforce Crisis
Author: Senior Living Business
Publication Date: 2008
Dr. Robyn Stone, executive director of LeadingAge Center for Applied Research, addresses some of the issues surrounding the long-term care workforce crisis in a Q&A in the February, 2008 Senior Living Business newsletter. In the article, the Center's noted expert in aging research characterizes the workforce crisis facing senior providers as "bad and has the potential for getting a lot worse," but also provides short-term solutions.

The Long-Term Care Workforce: Can the Crisis Be Fixed? 
Author: Center for Applied Research
Publication Date: 2007
Center for Applied Research (formerly IFAS) prepared this briefing paper for the National Commission for Quality Long-Term Care to address long-term care workforce problems affecting frail and disabled older adults in nursing homes, assisted living, other residential facilities and home and community-based settings. This briefing summarizes the current workforce crisis, offers a range of options for ensuring an adequate supply of competent long-term care professionals and paraprofessionals and identifies how new research and demonstration projects can give policy makers better information about workforce needs. 

Testimony: January 2007 Meeting of the National Commission for Quality Long-Term Care
Author: Stone, R.I.
Publication Date: 2007
On January 26, 2007, Robyn Stone, LeadingAge Center for Applied Research executive director, testified before the National Commission for Quality Long-Term Care about "how to develop and sustain a committed, quality long-term care workforce." According to Stone, aging services providers are facing a "frontline caregiver crisis" that is characterized by an unstable work environment, high turnover rates, and low employee morale. The Center's research demonstrates that this crisis can be averted with a public/private partnership that provides fellowships and loan forgiveness programs, encourages research on creating a quality long-term care workforce and implements training and career ladders for employees.

Scanning the Field: Nursing Leadership in Long-Term Care
Author: Reinhard, S., and Reinhard, T.
Publication Date: 2006
Recognizing the importance of developing nurse leaders, the Joan Anne McHugh Long-Term Care Nursing Academy commissioned this effort to explore the landscape of existing management training and leadership development programs for nurses in long-term care settings. The report is a product of the environmental scan. The scan was guided by a basic model of methodologies and settings for delivering management training and deployment of leadership development opportunities.  

PREPARE: How can you prepare your long-term care workforce to handle an emergency or disaster?
Author: Mather LifeWays
This brochure provides information on the objectives of Mather LifeWays' PREPARE training program, the topics covered in the trainign workshop and the resources provided as part of the training. Information on workshop registration and funding sources also is provided. PREPARE is a national training program for long-term care health providers to address the consequences of bioterrorism, natural disasters and other public health emergency preparedness challenges.  

Act Now for Your Tomorrow: Final Report of the National Commission on Nursing Workforce for Long-Term Care
Author: Nursing Commission
Publication Date: 2005
Established in 2003, the National Commission on Nursing Workforce for Long-Term Care developed recommendations for practical steps to strengthen the nursing workforce that cares for the nation's frail elderly and disabled people. Responding to the current and projected shortage of nursing staff, the commission began its work with an analysis of current patterns and future trends. It documented best practices to recruit and retain the nursing workforce for long-term care. Commissioners found that recruitment of additional nurses will require partnerships with educational, nursing and public workforce leaders and their organizations. These efforts will require collaboration with those external to the field and will be best initiated at the state and regional levels.

Long-Term Care Workforce Measurement Guide
Author: Center for Applied Research and PHI
Publication Date: 2005
This guide was developed to help providers devise appropriate surveys for measuring direct care workers' opinions about their jobs. It can help organizations understand the importance of accurate measurement in guiding effective direct care worker retention efforts and help them develop a measurement plan to target direct care worker retention strategies.

Why Workforce Development Should be Part of the Long-Term Care Quality Debate
Author: Stone, R.I., Dawson, S.L., and Harahan, M.
Publication Date: 2004
This paper introduces a largely overlooked feature of the long-term care system-direct care workers- into the long-term care quality debate. The authors' thesis is that the quality of long-term care-the recipients' clinical and functional outcomes and quality of life- is influenced significantly by the attributes these workers bring to their caregiving jobs, the education and training they receive and the quality of their jobs. The paper addresses the scope of federal quality initiatives to date, why workforce development should be considered an important dimension of long-term care quality, the key policy and practice constraints that impede linking workforce development issues and long-term care quality, examples of quality improvement initiatives that have incorporated workforce development activities and applied research activities to examine the link between workforce development and long-term care quality.

Recent Findings on Frontline Long-Term Care Workers: A Research Synthesis between 1999 and 2003
Author: Harris-Kojetin, L., Lipson, D., Fielding, J., Kiefer, K., and Stone, R.I.
Publication Date: 2004
This paper synthesizes and discusses the significance of research findings on the frontline long-term care workforce from 1999 to 2003. It builds on Robyn Stone's review (2001) of the practice and policy research related to recruitment and retention of frontline workers in long-term care. This paper updates empirical findings, while focusing on what has been learned between 1999 and 2003. The primary goal is to learn what initiatives have worked to reduce long-term direct care workforce recruitment and retention problems and to provide empirically based insights on the factors that contribute to recruitment and retention problems. It is intended to help policy makers, providers, worker and consumer groups and researchers create a framework for future evidence-based policy, practice and applied research initiatives to address long-term care direct care workforce shortages. 

The Direct Care Worker: A Key Dimension of Home Care Policy
Author: Stone, R.I.
Publication Date: 2004
Home health aides, home care workers and personal care attendants form the core of the formal home care system, providing assistance with activities of daily living and the personal interaction that is essential to quality of life and quality of care for their clients. High turnover and long vacancy periods are costly for providers, consumers, their families and workers themselves. In 2002, 37 states identified worker recruitment and retention as major priority issues. Demographic and economic trends do not augur well for the future availability of quality home care workers. Policymakers in the areas of health, long-term care, labor, welfare, and immigration must partner with providers, worker organizations and researchers to identify and implement the most successful interventions for developing and sustaining this workforce at both policy and practice levels. The future of home care will depend, in large part, on this "third rail" of long-term care policy.  

Federal Workforce Development Programs: A New Opportunity for Long-Term Care Workers
Author: Raynor, C.
Publication Date: 2003
Across the country, long-term care providers are facing a shortage of qualified and committed direct care workers-the certified nursing assistants, home health aides and personal care workers who provide hands-on care to millions of older adults and individuals with physical disabilities. This report highlights three federal workforce development programs-the Workforce Investment Act, the Perkins Act and Temporary Assistance for Needy Families-that long-term care providers and policy makers can leverage to improve recruitment and retention of direct care workers in long-term care.

Keeping Frontline Workers in Long-Term Care: Research Results of an Intervention
Author: Kansas Association of Homes and Services for the Aging, Center for Applied Research
Publication Date: 2003
This collaborative report of LeadingAge Center for Applied Research, the Kansas Association of Homes and Services for the Aging and Witchita State University evaluates the impact of a workplace intervention on staff turnover in Kansas nursing homes. The report documents the impact of a three-part intervention-interpersonal skills and empathy training, biweekly support groups and online supervisory training-on frontline nursing home employee retention and interpersonal relationships and supervisory capabilities. The findings suggest that overall, the intervention caused changes in attitudes and behaviors consistent with its teachings. The intervention demonstrated a willingness to try to continue to implement behavior changes, even in a difficult work environment. The lack of a stronger response to the intervention is primarily attributable to the stress and tension associated with under-staffing. Fundings for this project was provided through a grant from the Sunflower Foundation.

Examination and Evaluation of Recruitment and Retention Practices in California Long-Term Care
Author: Center for Applied Research and Aging Services of California (formerly California Association of Homes and Services for the Aging)
Publication Date: 2003
This collaborative report of LeadingAge Center for Applied Research and Aging Services of California documents the difficulties faced by California's not-for-profit long-term care community in recruiting and retaining a qualified and committed direct care workforce and the causes of these difficulties-from the perspective of administrators, supervisors and workers. It identifies recruitment and retention strategies employed by providers and whether they are perceived as effective in reducing high vacancy and turnover rates among direct care staff. The report also describes some of the most promising approaches developed by a select group of providers to improve the workplace environment for workers and residents. Funding for this project was provided through a grant from the University of California, San Francisco.

An Analysis of State Wage Pass-Through Legislation
Author: Paraprofessional Healthcare Institute
Publication Date: 2003
This issue brief was the inaugural edition of Workforce Strategies, a series of papers focusing on public policies and industry practices affecting the long-term care direct care workforce. Funded by the U.S. Department of Health and Human Services, it was part of a broader initiative on recruitment and retention of direct care workers in long-term care. This issue, published jointly by the Paraprofessional Healthcare Institute and Center for Applied Research, examines state efforts to increase wages for direct care workers.

Who Will Care For Us?
Author: Stone, R.I. and Weiner, J.A.
Publication Date:  2001
Long-term care providers report unprecedented vacancies and turnover rates for paraprofessional workers. The media, federal and state policymakers and the industry itself have acknowledged the labor shortage crisis and its potentially negative consequences for quality of care and quality of life. These shortages are likely to worsen over time as demand increases. This paper, developed with support from the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation, provides a broad overview of the long-term care frontline workforce issues.