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Purpose: The use of consumer-directed services is expected to grow in coming years, and paying family and friends is a key element of these home-based services. The goal of this study was to understand the careers of these "related workers" (family and friends) and their potential role in the long-term care workforce. Design and Methods: We conducted a telephone survey of 383 former paid home care related workers in California's In-Home Supportive Services program. Of these, 203 had left caregiving (Leavers) and 180 had continued in other paid caregiving jobs (Stayers). Questionnaire items covered work histories, current employment, and the initial In-Home Supportive Services work experience. Results: About 85% of the sample was female, 39% was White, and the average age was 48 years. Findings suggest that Stayers were more like career caregivers in terms of work history, education, earnings, and reasons for taking a job. Leavers were more apt to care for a close relative and to feel they had less choice in accepting the job. Surprisingly, more than 40% of Leavers indicated they would consider paid caregiving again, even for someone not related. Less surprisingly, more than two thirds of Stayers indicated they would. Implications: The growing number of programs that pay family members to provide home-based services are attracting relatives and friends who had not considered home care as a career option. With more outreach and targeted information about home care employment options, these related workers may help solve the long-term care workforce shortage. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate (a) whether certified nursing assistants (CNAs) are more committed to nursing home lobs when they perceive their lobs as enhanced (greater autonomy, use of knowledge, teamwork), and (b) whether CNA lob commitment affects resident satisfaction. Design and Methods: A qualitative exploration of management philosophy and practice and of CNAs' views of their lobs in 1 8 Massachusetts nursing homes formed the basis for a survey administered to 255 CNAs in 15 homes. A quality-of-life questionnaire was administered to 105 residents. Logistic regression accounting for clustering estimated the effect of personal characteristics, satisfaction with tangible lob rewards, and aspects of lob design on CNAs' intent to stay in current lobs. A general linear model estimated the effect of job commitment on residents' satisfaction with their relationship to nursing staff. Results: After we accounted for satisfaction with wages, benefits, and advancement opportunities, good basic supervision was most important in affecting CNAs' intent to stay in their lobs. Job enhancements were not significantly related to intent to stay. Residents were more satisfied with their relationships to nursing staff and their quality of life on units where a higher proportion of CNAs were committed to their lobs. Implications: The finding that greater lob commitment of CNAs is associated with better quality of relationships and life for residents implies that better lobs lead to better care. Culture change transformation that increases CNA autonomy, knowledge input, and teamwork may not increase workers' commitment to lobs without improvements in basic supervision. [ABSTRACT FROM AUTHOR]

Purpose: Better Jobs Better Care (BJBC) was a long-term care workforce demonstration that sought to improve recruitment and retention of direct care workers by changing public policy and management practice. The purpose of this article is to document and assess BJBC's implementation, analyze factors affecting implementation, and draw lessons from it for other long-term care workforce initiatives. Design and Methods: We analyzed qualitative data from project work plans and progress reports, and notes from telephone and in-person interviews with project staff, coalition stakeholders, and state policy experts. We abstracted the data, categorized it, and summarized it by state in matrices for analysis. Results: The five BJBC projects did implement their demonstration plans. Factors that affected project implementation included having demonstration resources; strong, stable leadership; strong coalitions that included key stakeholders; a neutral lead agency; clear goals; effective process; and a favorable state history and context. Implications: BJBC demonstrated that recruitment and retention is a long-term care industry problem, not just a nursing home problem. Future initiatives should: recognize that workforce policy and management practice change is difficult and takes time, obtain funding, develop strategies specific to the state history and context, engage key stakeholders, and develop relationships among stakeholders. [ABSTRACT FROM AUTHOR]

Purpose: The study's goals were to understand what changes in management practices would most improve the jobs of frontline workers from the perspective of workers themselves and to analyze differences across settings. Design and Methods: The baseline survey of direct care workers (N = 3,468) conducted as part of the National Study of the Better Jobs Better Care demonstration asked the following: "What is the single most important thing your employer could do to improve your job as a direct care worker?" We coded the open-ended responses and grouped them into categories. We then compared the percentages of workers recommending changes in these categories across settings and interpreted them in the context of previous conceptual frameworks. Results: Across settings, workers called for more pay and better work relationships including communication; supervision; and being appreciated, listened to, and treated with respect. The fraction of workers calling for these changes and additional specific changes differed substantially across nursing facilities, assisted living facilities, and home care agencies. Implications: To increase retention of frontline workers, policy makers should design public policies and management practices to increase pay and to improve work relationships. However, specific strategies should differ across settings. [ABSTRACT FROM AUTHOR]

Presented are arguments for making assets out of tomorrow's elderly. The concept of equivalent retirement ages is used to shed a new light on the old age dependency ratio. In the future, a larger, able aging population could remain in the work force to compensate for the relatively smaller younger labor force. Economic growth as the foundation of economic security is emphasized as the means of lessening the cost of caring for society's dependents. [ABSTRACT FROM PUBLISHER]

Background and Objective The federal government holds nursing homes (NHs) responsible for assessing and addressing resident psychosocial needs. The staff person most responsible for psychosocial care planning is the social worker. However, the federal government requires only NHs with 120+ beds to employ one full-time social worker, and that person need not hold a social work degree. We compare/contrast state laws against federal laws and professional standards in terms of the minimum qualifications of NH social workers to determine in which states NH residents are legally entitled to receive services from a professional social work staff member. Research Design and Methods Qualitative content analysis of language regarding NH social worker qualifications in state (and DC) administrative codes. Results Twelve states do not address NH social worker qualifications. Up to 25 states appear to be out of federal compliance. Only Maine appears to meet the NASW professional standards. Other states approaching the standards include: Alaska, Arkansas, Connecticut, Illinois, Massachusetts, Minnesota, and West Virginia. Discussion The vast majority of the 3 million residents a year served by U.S. NHs are not entitled to social work staff who meet minimum professional standards, despite new federal regulations calling for trauma-informed and culturally competent care planning and the recognition that the needs of residents (including psychosocial needs) have continued to increase over past decades. Changes in federal regulations are recommended so that all NH residents have access to professional psychosocial services provided by a staff person who has earned at least a bachelor’s degree in social work and who carries a reasonable caseload. [ABSTRACT FROM AUTHOR]