Better Jobs Better Care: Building a Strong Long-Term Care Workforce

An RWJF National Program

Field of Work: The long-term care workforce.

Problem Synopsis: Unprecedented vacancies and high turnover among nursing assistants, home health aides and personal care attendants have affected both home- and community-based providers and nursing homes, which have reported annual turnover rates ranging from 40 percent to more than 100 percent. These recruitment and retention problems affect both the quantity and the quality of long-term-care services.

Synopsis of the Work: Better Jobs Better Care was a four-year, $15.5 million research and demonstration program funded by the Robert Wood Johnson Foundation (RWJF) and the Atlantic Philanthropies. Better Jobs Better Care tested new approaches to providing a more stable and qualified long-term-care staff through demonstration grants to coalitions in five states and applied research grants to eight teams across the country. A Pennsylvania State University research team evaluated the demonstration projects and also used the data collected for the evaluation for several baseline studies.

Key Findings

  • The evaluation found no evidence that the practice changes implemented improved direct-care workers' jobs. Based on reports of direct-care workers in surveys at the beginning and end of the demonstration, job satisfaction declined slightly, while likelihood of leaving the job increased slightly.

    Eight applied research teams added to the knowledge base about how to strengthen the quality of the direct-care workforce. They addressed two broad areas: (1) the impact of management and organizational interventions on the culture of the long-term-care workplace; and (2) what attracts and retains direct-care workers.