The Better Jobs Better Care Management Practice Change Initiatives

Implementation and Effects on Job Outcomes and Turnover

The Program Being Evaluated

The Better Jobs, Better Care: Building a Strong Long-Term Care Workforce demonstration provided grants and technical assistance to coalitions of providers, workers, consumers, and policy makers to improve the quality of jobs of long-term care (LTC) direct care workers (DCWs), improve recruitment and retention, and strengthen capacity to meet future demand.

About the Evaluation

This evaluation was designed to achieve two goals:

  • document and analyze the effect of the coalition activities on state- and market-level outcomes and provider-level change, and articulate the successes and challenges encountered
  • assess the effects of state-level coalition activities and provider-level practice changes on DCWs' jobs.

The lead evaluator for this program was Peter Kemper, Ph.D. of the Pennsylvania State University Department of Health Policy and Administration.

Major Evaluative Questions

  • What were the coalition's goals and did they achieve them?
  • What facilitated implementation and what barriers were encountered?
  • What state-level change happened in the selected states during this time period, and what role did the coalition play?
  • What changes took place at the provider level and how did state-level change help or hinder?
  • What were the barriers and facilitators to making change at the provider level?
  • What effect did these changes have on the direct care workers?

Summary of Methods

Site visits, phone calls, review of work plans and reports, and face-to-face interviews at annual meetings were used to evaluate the first three questions. For the latter three evaluative questions, there were a number of data elements, including monthly reporting of DCWs hiring and termination data; baseline and follow-up surveys of DCWs and managers; and selected case interviews.

Products and Dissemination

Products for this evaluation included annual reports, presentations at annual meeting, and interim and final data analysis. This field has a small research base and the analysis of baseline data manager practices and DCWs turnover rates are of great interest to the field. Research findings from Better Jobs, Better Care were highlighted in a special issue of The Gerontologist, titled “Better Jobs, Better Care: New Research on the Long-Term Care Workforce.” See additional readings.

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