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Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the commonalities and differences in the perceptions of CNAs and HHAs regarding the initial and continuing education they received to prepare them for their job. More than 80% of HHAs and all CNAs received some initial training. Of these, significantly more HHAs compared to CNAs felt that training had prepared them "very well" for their jobs. The two groups also differed in their assessments of the content of the initial training; for example, more CNAs believed that their training was "excellent" in helping them address patients' limitations in activities of daily living compared to HHAs. The vast majority of HHAs and CNAs received continuing education, and about three fourths in each group assessed this training as being "very useful." In light of the increasing demands for HHAs and CNAs with the aging of America, findings from these national studies could be used to inform educational and training initiatives for this critical workforce. (Contains 5 tables.)

A few geographically limited studies have indicated that training of direct care workers may be insufficient. Using the first-ever nationally representative sample of certified nursing assistants (CNAs) from the 2004 National Nursing Assistant Survey (NNAS), this descriptive article provides an overview of the type of initial training and continuing education received by CNAs working in nursing homes, reports CNAs' assessments of the adequacy of their training, and identifies perceived training needs from the points of view of CNAs. Findings could be used to inform changes to the initial training and continuing education curriculum for this essential labor workforce. (Contains 2 notes and 6 tables.)

Purpose: This research applies a stress and support conceptual model to investigate the effects of background characteristics, personal and job-related stressors, and workplace support on direct care workers' (DCW) job satisfaction. Design and Methods: Researchers collected survey data from 644 DCWs in 49 long-term care (LTC) organizations. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. We examined the influence of components of the LTC stress and support model on DCW job satisfaction. Initially, we ran a multiple regression analysis by entering individual-level DCW predictors with job satisfaction as the outcome. Subsequently, we used hierarchical linear modeling to examine the influence of organizational factors on DCW job satisfaction after controlling for significant individual-level DCW variables. Results: Components of the model explained 51% of the variance in DCW job satisfaction. Background characteristics of DCWs were less important than personal stressors (e.g., depression), job-related stressors (e.g., continuing education), and social support (e.g., interactions with others) in predicting job satisfaction. Results from hierarchical linear modeling analysis showed that nursing homes compared to the two other types of LTC organizations had lower average DCW job satisfaction rates, as did organizations offering lower minimum hourly rates and those reporting turnover problems. Implications: Study findings underscore the importance of targeting both DCW-level and organizational-level factors to increase DCW job satisfaction.

Training of direct care workers (DCWs) varies depending upon the setting in which they work and the state in which they are trained. Evidence points to the importance of adequate training as critical to DCW job satisfaction and reduction in turnover. Several approaches have been taken to enhance the training of DCWs with the objective that as job satisfaction increases, the quality of care provided to consumers will also be enhanced. Based on a sample of 644 DCWs across the nursing home, assisted living, and home health settings, we share DCWs' perceptions and recommendations for better training and continuing education. (Contains 3 tables.)

Purpose: The purpose of this project was to develop a reliable and valid family satisfaction instrument for use in Ohio's nursing homes. Design and Methods: Investigators worked with an advisory council to develop the survey. Purposive sampling techniques were largely used to select 12 small, medium, and large for-profit and proprietary facilities in one large county for the pretest. A total of 239 families who were "most involved" in their relative's care completed an instrument with 97 satisfaction items. Results: Factor analyses identified nine factors that explained 59.44% of the variance in satisfaction. Investigator judgment modified some factors and developed scales. The scales had good internal reliability (alpha = 0.76 and above, except for one), test-retest reliability ranged from 0.49 to 0.88, and differences between families of short- and long-stay residents were in expected directions. A final instrument with 62 satisfaction and 17 background items was recommended for statewide implementation. Implications: Findings from the project can be used to further refine the instrument and protocols for use with larger populations in other states and by the federal government.

Purpose: This research applies a stress and support conceptual model to investigate the effects of background characteristics, personal and job-related stressors, and workplace support on direct care workers' (DCW) job satisfaction. Design and Methods: Researchers collected survey data from 644 DCWs in 49 long-term care (LTC) organizations. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. We examined the influence of components of the LTC stress and support model on DCW job satisfaction. Initially, we ran a multiple regression analysis by entering individual-level DCW predictors with job satisfaction as the outcome. Subsequently, we used hierarchical linear modeling to examine the influence of organizational factors on DCW job satisfaction after controlling for significant individual-level DCW variables. Results: Components of the model explained 51% of the variance in DCW job satisfaction. Background characteristics of DCWs were less important than personal stressors (e.g., depression), job-related stressors (e.g., continuing education), and social support (e.g., interactions with others) in predicting job satisfaction. Results from hierarchical linear modeling analysis showed that nursing homes compared to the two other types of LTC organizations had lower average DCW job satisfaction rates, as did organizations offering lower minimum hourly rates and those reporting turnover problems. Implications: Study findings underscore the importance of targeting both DCW-level and organizational-level factors to increase DCW job satisfaction. Key Words: Aides in nursing homes, Home health agencies, Assisted living

Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data--a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications. doi: 10.1300/J031v19n02_05 KEYWORDS. Consumer satisfaction, long-term care, reliability

Purpose: The purpose of this project was to develop a reliable and valid family satisfaction instrument for use in Ohio's nursing homes. Design and Methods: Investigators worked with an advisory council to develop the survey. Purposive sampling techniques were largely used to select 12 small, medium, and large for-profit and proprietary facilities in one large county for the pretest. A total of 239 families who were 'most involved' in their relative's care completed an instrument with 97 satisfaction items. Results: Factor analyses identified nine factors that explained 59.44% of the variance in satisfaction. Investigator judgment modified some factors and developed scales. The scales had good internal reliability ([alpha] = .76 and above, except for one), test-retest reliability ranged from .49 to .88, and differences between families of short- and long-stay residents were in expected directions. A final instrument with 62 satisfaction and 17 background items was recommended for statewide implementation. Implications: Findings from the project can be used to further refine the instrument and protocols for use with larger populations in other states and by the federal government. Key Words: Long-term care, Domains of satisfaction, Measurement

Life story programs hold promise for improving person-centered care and relationships between nursing home residents and staff. A pilot life story intervention study in 16 nursing homes provided residents with complimentary biographical life story books and summaries, and staff with action plans to enhance care planning. Trained volunteers and program staff collected life stories, and researchers interviewed 170 residents at three points in time. Overall, residents had positive experiences with the program, but were less willing to share their books with others afterwards. They also experienced a decrease in depression (Patient Health Questionnaire-8 [PHQ-8]) over time. Surveys of 92 staff demonstrated increases over time in perceived importance of knowing residents' life stories. Administrator/admissions staff found it conditionally feasible to incorporate the program into admission processes. Practice implications of life story work include opportunities to help staff learn more about residents they care for, improve person-centered care, and honor resident preferences in care planning. [ABSTRACT FROM AUTHOR]

This article describes the evaluation processes employed in the Ohio project to develop and test screening tools and referral protocols on elder abuse and domestic violence. Three focus groups and a Roundtable of experts were utilized to develop the materials in the first year. In the second year, a formal quantitative evaluation that involved 160 practitioners in Ohio was implemented to review the materials and to use them with clients. Findings from the quantitative evaluation were incorporated to make changes that led to a final document that was much simpler, less lengthy, and more relevant to beginning practitioners. KEYWORDS. Evaluation of tools and protocol, focus groups, quantitative methods

Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans: A Guide for Service Providers (STRP) represents the product of an 18 month project aimed at improving the identification and reporting of elder abuse and domestic violence in late life. This article presents each component of STRP, describing it in detail and suggesting when and how it can be used. Recommendations also are offered for the replication of STRP in other locales as well as for its further evaluation. (Full set of materials including Appendices can be obtained from The Benjamin Rose Institute.) KEYWORDS. Elder abuse, domestic violence in late life, screening tools, referral protocols

Purpose: This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities. Design and Methods: We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver depression. Results: Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident-caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors. Implications: These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes. Key Words: Caregiver depression, Family caregiver adjustment, Nursing home placement

This study used a cross-sectional design to interview 133 cognitively alert residents from 13 nursing facilities to examine the predictors of Advance Directives (ADs). A logistic regression examined the effect of Locus of Control (LOC) in predicting the presence of ADs, after controlling for residents' background characteristics and organizational factors. The findings suggested that LOC was not significant. Rather, two background characteristics, religious affiliation and knowledge of ADs, predicted having ADs. More specifically, Jews and Catholics compared to Protestants, and those with more knowledge of ADs had implemented ADs. From a practice perspective, educational programs geared at examining differences in religious affiliation and knowledge of the subject are likely to impact residents' implementation of ADs. As a note of caution, the findings from the study need to be tested with larger, more generalizable samples. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: ] KEYWORDS. Locus of Control, nursing home residents, religious differences, end-of-life

The Problem: Personal care aides (PCAs), along with other direct care workers, provide the majority of hands-on care, including helping with activities of daily living (ADLs), for individuals living in assisted living facilities and similar residential care communities (RCCs); however, direct care workers in various long-term care settings have demonstrated that recruitment and retention is a great challenge because of low pay, inadequate training, high work demands, and lack of benefits. Residential care communities are increasingly becoming an important source of long-term care for older Americans, particularly for those with dementia. More than 95% of residential care communities had one or more personal care aide, yet little is known about personal care aides working in residential care communities. Analysis: Using data from the Department of Health and Human Services' National Survey of Residential Care Facilities (NSRCF), this descriptive study estimates the number of personal care aides employed by residential care communities in the U.S. and the distribution of the aides by residential care communities' operating, geographic, and resident acuity characteristics. It examines personal care aide staffing levels, the types of tasks routinely performed by them beyond activities of daily living assistance, and employment benefits offered. It also explores how staffing levels, tasks, and benefits differed by community characteristics. Key Findings: Results indicated that personal care aide staffing levels and their tasks performed varied by residential care community characteristics, as did benefits they offered to the aides. Compared to other residential care communities, a higher percentage of small, non-chain, and for-profit residential care communities had their aides routinely perform a variety of tasks beyond assistance with activities of daily living, yet a lower percentage of these communities offered the aides selected job benefits. Findings from this study identify an interesting association between the array of services provided by and benefits offered to aides in communities with different characteristics. [ABSTRACT FROM AUTHOR]

Objective: This research was guided by a stress and support model to examine the effects of frontline workers' background characteristics, personal stressors, job-related stressors, and workplace support on satisfaction with supervision. Method: Survey data were collected from 644 workers in 49 long-term—care settings that employed them. Regression analysis were used to determine the effects of worker level and then Hierarchical Linear Modeling (HLM) and organizational factors on the outcome. Results: Although all four variable categories made significant contributions to explaining satisfaction with supervision, the most powerful were personal stressors and job-related stressors. Results from HLM analysis showed frontline workers in nursing homes and those employed in for-profit organizations had lower levels of satisfaction with supervision. Discussion: Findings suggest organizational interventions to address workers' financial and health issues and management practices such as better training programs and peer mentoring could enhance workers' satisfaction with supervision. [ABSTRACT FROM AUTHOR]

Describes a step-by-step process for implementing restraint reduction programs in two-skilled nursing facilities in the United States. Emancipation of nursing home residents from physical restraint as an advance in humanistic care practices; Background of the restraint reduction partnership; Utilizing existing guidelines for restraint reduction; Customization of the program.

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services-funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.