200 likes | 203 Views
Explore the impact of workforce shortages on cost, quality, and access in long-term care, and learn how states are responding to the issue through various strategies and initiatives.
E N D
The Impact of Workforce Shortages on Cost, Quality and Access: How Should We Respond?Robyn I. Stone, Dr. P.H., Executive Director Institutefor the Futureof Aging Services State Long Term Care Programs: Balancing Cost, Quality and Access AHRQ Indianapolis, IN May 7, 2002 Institute for the Future of Aging Services
Current Problem • Severe labor shortage with geographic variation • High turnover rates • High vacancy rates • Intra and inter-sectoral movement • Long time to fill positions • 42 states report significant recruitment and retention problems
Long-Term Outlook • Increased demand for LTC • Potentially less informal care available • Serious concern about future availability of workers • Decreased pool of traditional caregivers • Increased educational levels of minority women • Little relief from softening unemployment
Meta-Level Factors Influencing Supply and Quality of Workers • Value of frontline caregiving • Status of the economy • Health and LTC policy (reimbursement, regulation, program design) • Labor policy • Welfare policy • Immigration policy
Workplace Level Framework • Organize arrangements • goals • administrative policies • reward systems • Social factors • management style • employee interactions • individual personalities
Workplace Level Framework • Physical settings/environment • Technology • job design • training • clinical tools • information systems
What States are Doing to Address Recruitment and Retention • Improving wages and benefits • Task forces/work groups • Efforts to provide career ladder options • Efforts to broaden the pool of potential workers • Public education, awareness and recognition • Training, pilot programs, staffing ratios, etc.
Improving Wage/Benefits • Wage pass throughs (WPT) / wage enhancement (most prevalent strategy) • Increased reimbursement rates • State set shift differentials • Access to health insurance coverage • Tying increased reimbursement to increased performance by providers/staff
Initiative Career Ladder/Training Health Insurance Task Forces/Commissions No. of States 20 14 25 State LTC Workforce Initiatives* Sources: NGA compilation from 1999 and 2001, North Carolina Division of Facility Services Surveys, Stone and Weiner monograph, 2001. *Proposed or implemented as of September 2001
How do Wage Pass Through’s Work? • Designate specific percentage or dollar amount per hour or patient day for wages/benefits • Structured as mandatory or intended use • Provider flexibility varies (i.e. wages only, wages/benefits and/or other uses) • Typically Medicaid but may include other funding streams
CAN to LPN Training Medication Aide MN, MT, NV ME, NC, NJ, OR, WI Major Career Ladder Initiatives
Skill upgrade training Others: Voluntary CNA program Collaboration with community college to create a career ladder MA, VA, WI DE MI Major Career Ladder Initiativescontinued
Broadening the Pool of Potential Workers • Consumer directed care models • Use of single task workers in residential and/or nursing home settings • Web-based training -- including efforts to accommodate immigrants, older workers, other non-traditional employees • Recruit Welfare to Work participants • New job categories, scholarships, promotional/recognition activities
Training • Increase minimum hours for NA’s • Standardize required training for personal care workers across settings and/or competency requirements • Require orientation on specific topics prior to providing hands-on care • Expand scope of duties for NA’s under RN • Web-based training, training scholarships
Pilots • MA -- career ladder pilot effort • NC & WI -- ‘TEACH’ like program for aides combines training with financial and other incentives • MD -- Wellspring model • MI and CA -- funded innovation grants specifically for staff development and training
Massachusetts Case Study • Coalition of Organizations to Reform Elder Care • Direct Care Workers’ Initiatives • Extended Care Career Ladder Initiative ($10 million state-funded demo in 29 nursing homes) • Direct Care Workers Training Scholarship Fund • Dedicated Wage Pass Through for CNA’s in Medicaid funded nursing homes
California Case Study • Interdepartmental and industry workgroup on improving CNA working conditions • Statewide CNA survey • Aging with Dignity Initiative to improve CNA and IHSS worker wages • Caregiver training initiative ($25 million from Work Investment Act and Welfare to Work Grants) • Employment development department “Ladders” program • County-level public authorities (provider registries, training and employer of record)
North Carolina Case Study • NC DHHS and UNC Partnership Pilot linking financial and other incentives to training and retention • Civil penalty fine monies • Supports training and financial incentive efforts • Creates Geriatric Nurse Aide II category • 7 training modules developed by North Carolina Division of Facility Services (NCDFS) available on CD ROM • NC Nurse Aide Registry mailing CHIP program info to all new CNA’s • $500,000 appropriation to develop and evaluate on-site internet CNA training; partnership with community college system
Conclusion • It’s not just a money issue • Many states are considering taking action through a variety of strategies to address this current and long-term workforce issue • Need to continue data collection efforts • Need to track and evaluate range of state efforts