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The Aging Services Workforce: Moving from Accidental to Valued Profession

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

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The Aging Services Workforce: Moving from Accidental to Valued Profession

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  1. The Aging Services Workforce:Moving from Accidental to Valued Profession

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Why Laws of Supply & Demand Don’t Work • Outdated, dysfunctional workplace environments • Inadequate education & training system for this workforce • Uncertainty about immigration policy

  9. Factors Influencing Workforce Recruitment and Retention

  10. 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

  11. Long-Term Trends • The emerging “care gap” • Shift from institutional to in-home and community-based settings • More ethnically/racially diverse older adults and staff • More highly educated, demanding older adults

  12. Long-Term Trends cont. • Greater disparity between “haves” and “have-nots” • Expansion of consumer-directed service systems • Impact of new technologies • Redefining retirement

  13. 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

  14. 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

  15. 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

  16. United States: Occupational Growth Projections, 2010-2020 70% 69% 14% Source: PHInational.org

  17. Implications for Quality • Essential for better quality of care and life • Interdisciplinary team approach linked to quality • Geriatric training linked to higher quality

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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 informalcare in home-based settings

  24. 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

  25. 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, managedLTC, new integrated models)

  26. 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

  27. Phased Model • Core set of competencies • Meaningful career lattice • Educational flexibility • Specialty tracks (geriatric aide, medication aide)

  28. Multiple Trainee Pathways

  29. 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

  30. 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

  31. 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

  32. Demonstration/Evaluation Opportunities • 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

  33. 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

  34. 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

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