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Workforce Issues in Long-Term Care - Future Directions

job nursing nursing home staffing national

To upgrade the quality of the long-term care workforce, and to solve the problems of recruiting and retaining enough qualified workers, several options have been proposed.

Increasing minimum staffing requirements. One solution to staffing problems is to increase the number of caregivers in nursing homes. There is considerable consensus among researchers that higher staffing levels are positively associated with better outcomes for nursing home residents. This is particularly the case with RN staffing, but is also applicable to CNAs. Increasing staffing in nursing homes is likely not only to improve the quality of care but also to benefit staff morale, satisfaction, and retention by reducing the stress of providing care (Harrington et al.).

Increase and upgrade training. Although a body of rigorous evaluation research is lacking, there is evidence that training programs of various kinds improve the performance of CNAs and thus leads to improved outcomes for residents (Beck et al.).

Improve salaries and benefits. Many nursing homes and home health agencies have very devoted, long-term employees. However, some individuals do not consider long-term care work, or leave it after trying it, because the salaries are inadequate. Raising the salaries of workers and improving benefits is now a goal in many states.

Expand the range of roles. A number of experts suggest reexamining the official role of the frontline worker, and expanding what is now a monolithic job category into a career ladder of increasing responsibilities. In particular, new job categories can be developed in the nursing home, ranging from an entry-level resident attendant position, to several categories of CNAs. Workers can then can advance to positions of greater responsibility within the facility.

KARL PILLEMER MARK S. LACHS

See also GERONTOLOGICAL NURSING; HOME CARE AND HOME SERVICES; LONG-TERM CARE; NURSING HOMES.

BIBLIOGRAPHY

BECK, C.; ORTIGARA, A.; MERCER, S.; and SHUE, V. ‘‘Enabling and Empowering Certified Nursing Assistants for Quality Dementia Care.’’ International Journal of Geriatric Psychiatry 14 (1999): 191–212.

Bureau of Labor Statistics. ‘‘Health Services.’’ In Occupational Outlook Handbook, 2000–01 Edition. Bulletin 2520. Washington, D.C.: U.S. Government Printing Office, 2000.

Bureau of Labor Statistics. 1998 National Occupational Employment and Wage Estimate. http://stats.bls.gov

COHEN-MANSFIELD, J. ‘‘Stress in Nursing Home Staff: A Review and a Theoretical Model.’’ Journal of Applied Gerontology 14 (1995): 444–466.

Congressional Budget Office. Projections of Expenditures for Long-Term Care Services for the Elderly. Washington, D.C.: U.S. Government Printing Office, 1999.

DUNCAN, M. T., and MORGAN, D. L. ‘‘Sharing the Caring: Family Caregivers’ Views of Their Relationships with Nursing Home Staff.’’ The Gerontologist 34 (1994): 235–244.

FRANK, B. W., and DAWSON, S. L. Health Care Workforce Issues in Massachusetts. Boston: Para-professional Health Care Institute, 2000.

GABREL, C. S. An Overview of Nursing Home Facilities: Data from the 1997 National Nursing Home Survey. Division of Health Care Statistics, Advance Data no. 311. Washington, D.C.: National Center for Health Statistics, 2000.

HARRINGTON, C.; KOVNER, C.; MERZEY, M.; KAYSER-JONES, J.; BURGER, S.; MOHLER, M.; BURKE, R.; and ZIMMERMAN, D. ‘‘Experts Recommend Minimum Nurse Staffing Standards for Nursing Facilities in the United States.’’ The Gerontologist 40 (2000): 5–16.

HELMER, F. T.; OLSON, S. F.; and HEIM, R. I. ‘‘Strategies for Nurse Aide Job Satisfaction.’’ Journal of Long-Term Care Administration 21 (1993): 10–14.

LITWAK, E. Helping the Elderly: The Complementary Roles of Informal Networks and Informal Systems. New York: Guilford, 1985.

OLSON, L. K. ‘‘Public Policy and Privatization: Long-Term Care in the United States.’’ In The Graying of the World: Who Will Care for the Elderly? Edited by L. K. Olson. New York: Haworth Press, 1994. Pages 25–58.

PILLEMER, K. Solving the Frontline Crisis in Long-Term Care. Cambridge, Mass.: Frontline Publishing, 1996.

PILLEMER, K.; HEGEMAN, C. R.; ALBRIGHT, B.; and HENDERSON, C. ‘‘Building Bridges Between Families and Nursing Home Staff: The Partners in Caregiving Program.’’ The Gerontologist 38 (1998): 499–503.

STEPHENS, M. A. P.; OGROCKI, P. K.; and KINNEY, J. K. ‘‘Sources of Stress for Family Caregivers of Institutionalized Dementia Patients.’’ Journal of Applied Gerontology 10 (1991): 328–342.

U.S. Bureau of the Census, Population Division, Population Projections Branch. National Households and Families Projections. 2000. www.census.gov

WILNER, M. A. ‘‘Working It Out: Support Groups for Nursing Assistants.’’ Generations 23 (1994): 39–40.

WUNDERLICH, G.; SLOAN, F. A.; and DAVIS, C. K., eds. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate? Washington, D.C.: National Academy Press, 1996.

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