September 2005

Grant Results

SUMMARY

Project staff at the Urban Institute worked with experts in the field to develop recommendations for a research and demonstration agenda to improve the recruitment and retention of frontline long-term care workers.

Key Results

  • Project staff drafted a comprehensive 44-page literature review, Who Will Care for Us? A Research and Demonstration Agenda for Frontline Long-Term Care Workers.
  • The Urban Institute's Institute for the Future of Aging Services published Frontline Long-Term Care Worker Project: Summaries of the Three Technical Expert Panel Meetings.
  • The U.S. Department of Health ad Human Services (HHS) included the technical expert panels' recommendations in a May 14, 2003, report to Congress, The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation. The report was issued jointly by HHS and the U.S. Department of Labor. See the Bibliography for details on all publications.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $160,791 from December 2000 to July 2003 in partial support of this unsolicited project.

 See Grant Detail & Contact Information
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THE PROBLEM

In 2000, approximately 1.9 million direct care workers, such as nurses, nurse aides, and home health and personal care workers, provided care to 15 million Americans in long-term care settings, including people's homes. As the population ages, HHS estimates that by 2050 more than 6 million workers will be needed to care for 27 million people. This 242 percent increase in demand will come at a time when HHS expects the supply of workers who traditionally fill these jobs to increase only slightly (HHS Report to Congress, May 14, 2003).

It is difficult to recruit and retain long-term care workers because of

  1. low wages and poor benefits
  2. unattractive physical and emotional aspects of the job
  3. lack of a career ladder and little chance for advancement in the field
  4. few opportunities for workers to get involved in organizational decision-making.

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THE PROJECT

To develop its recommendations, project staff conducted a literature review and established a technical advisory group and three technical expert panels. Meeting in Washington on February 6, 2001, the technical advisory group, made up of representatives from federal and state government, providers, researchers, unions, foundations, consumers and others, recommended that the technical expert panels address three issues relating to frontline workers:

  • Extrinsic rewards and incentives, such as wages and fringe benefits.
  • Workplace culture, such as organizational structure and processes, social factors and physical settings.
  • Labor pool expansion, that is, how the supply of paraprofessional workers may be augmented from new sources, such as older workers, family, students, men, welfare recipients and immigrants.

Three technical expert panels of representatives of health care providers, unions, government and researchers convened for separate one-day meetings to discuss their topics and develop recommendations on June 15, November 30, and December 14, 2001. Background papers, provided either by a panel member, Urban Institute staff or consultants, guided the discussion at the meetings. For a list of the papers and authors, see the Bibliography. For a list of members of both the advisory group and two of the three expert panels, see Appendixes 1 and 2.

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RESULTS

The project accomplished the following:

  • Project staff drafted a comprehensive 44-page literature review, Who Will Care for Us? A Research and Demonstration Agenda for Frontline Long-Term Care Workers, based on the findings and recommendations from the three technical expert panels.
  • The Urban Institute's Institute for the Future of Aging Services published Frontline Long-Term Care Worker Project: Summaries of the Three Technical Expert Panel Meetings.
  • HHS included the technical expert panels' recommendations in a May 14, 2003, report to Congress, The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation. The report was issued jointly by HHS and the U.S. Department of Labor. See the Bibliography for details.

Recommendations

Urban Institute staff compiled the following recommendations for designing a research and demonstration agenda on frontline long-term care workers:

  • A comprehensive research and demonstration strategy on long-term care paraprofessionals should address the following: recruitment and retention, quality of care provided, and quality of life of the long-term care worker.
  • The strategy should address the entire continuum of long-term care services, including nursing homes, agency-directed home care, consumer-directed home care and non-medical residential facilities such as assisted living facilities.
  • The strategy should address issues facing the workforce in both urban and rural settings.
  • The strategy should achieve the following:
    • Collect information about the current status of long-term care workers across the care continuum.
    • Evaluate the impact and cost of interventions on recruitment and retention, quality of care for long-term care consumers, and quality of life of long-term care workers.
    • Test the effectiveness and cost of reform strategies, including raising wages, providing additional fringe benefits, creating career ladders, changing organizational culture, and developing new ways to recruit long-term care workers from groups such as welfare beneficiaries, families, immigrants, students and seniors.

Communications

Project staff distributed Who Will Care for Us? Addressing the Long-Term Care Workforce Crisis, to approximately 7,000 people. A free copy is available online.

Also available free of charge:

  1. the background papers prepared for the technical expert panel meetings
  2. a summary of the technical expert panel meetings
  3. the final paper with recommendations for a research and demonstration agenda
  4. the May 14, 2003, HHS report to Congress.

See the Bibliography for ordering details.

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AFTER THE GRANT

RWJF tapped Robyn Stone, Dr.P.H., who co-authored the literature review and the final report for this project, to serve as national program director for Better Jobs, Better Care: Building a Strong Long-Term Care Workforce. Authorized for $8,000,000 from August 2002 to August 2006, this initiative is a demonstration, research and evaluation project to create changes in policy and practice that will lead to the recruitment and retention of high-quality direct care workers in both nursing homes and home- and community-based settings.

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GRANT DETAILS & CONTACT INFORMATION

Project

Developing Strategies to Recruit and Retain Frontline Workers in Long-Term Care

Grantee

The Urban Institute (Washington,  DC)

  • Amount: $ 160,791
    Dates: December 2000 to July 2003
    ID#:  040522

Contact

Joshua M. Wiener, Ph.D.
(202) 728-2094
jwiener@rti.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Technical Advisory Group Members

Carol Raphael
President and Chief Executive Officer
Visiting Nurse Service of New York
New York, N.Y.

Roger Auerbach
Administrator
Department of Human Resources
Senior and Disabled Services Division
Salem, Ore.

Donald Shumway
Commissioner
New Hampshire Department of Human Services
Concord, N.H.

Jean Marks
Associate Executive Director — New York Chapter
Alzheimer's Association
New York, N.Y.

Mary Ousley
Vice President for Health Services
Marriott Senior Living
Bethesda, Md.

William T. Smith, Ph.D.
President and Chief Executive Officer
Aging in America
Bronx, N.Y.

Chuck Gould
President
Volunteers of America
Alexandria, Va.

Steven L. Dawson
President
Paraprofessional Healthcare Institute
Bronx, N.Y.

Bonnie M. Cramer
Assistant Director
North Carolina Division of Facility Services
Raleigh, N.C.

Mark Montigny
Senator
State of Massachusetts
Boston, Mass.

Carolyn Teich
Program Associate for Economic Development
American Association of Community Colleges
Washington, D.C.

Roberta Lynch
Deputy Director
American Federation of State, County and Municipal Employees (Council 31)
Chicago, Ill.

Tom Moss
Deputy Commissioner
Minnesota Department of Human Services
St. Paul, Minn.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Technical Expert Panel Members

Technical Expert Panel #1 — June 15, 2001

Carolyn Blanks
Vice President of Labor and Workforce Development
Massachusetts Extended Care Federation
Newton Lower Falls, Mass.

Miriam Brewer
Assoc Director, Diversity/Inclusion Outreach
Alzheimer's Association
Washington, D.C.

Michael Cousineau, Ph.D.
Associate Professor
University of Southern California
Los Angeles, Calif.

Diane Findley
Founder
Iowa CareGivers Association
Des Moines, Iowa

Peter Kemper, Ph.D.
Professor
Pennsylvania State University
University Park, Pa.

Thomas Konrad, Ph.D.
Professor
The University of North Carolina
Chapel Hill, N.C.

Joel Leon, Ph.D.
Director, Polisher Research Institute
Philadelphia Geriatric Center
Jenkintown, Pa.

Carol Raphael
President and Chief Executive Officer
Visiting Nurse Service of New York
New York, N.Y.

Donald Shumway
Commissioner
New Hampshire Department of Human Services
Concord, N.H.

Jeffrey Gerber
Director of Workforce Development
American Hotel and Lodging Association
Orlando, Fla.

Technical Expert Panel #2 — November 30, 2001

Barbara Bowers, Ph.D.
Professor
University of Wisconsin
Madison, Wis.

Susan Eaton, Ph.D. (deceased)
Assistant Professor of Public Policy
Harvard University
Cambridge, Mass.

Nancy Eustis, Ph.D.
Professor
University of Minnesota
Minneapolis, Minn.

David Green
Chief Executive Officer
Evergreen Retirement Community
Oshkosh, Wis.

David Lindeman, Ph.D.
Vice President
Mather Institute on Aging
Evanston, Ill.

Steven Lutzky
Chief of the Office on Disabilities and Aging
District of Columbia Medical Assistance Administration
Washington, D.C.

Ingrid McDonald
Spokesperson
Service Employees International Union
Washington, D.C.

Susan Misiorski
Organizational Culture Change Specialist
Paraprofessional Healthcare Institute
Bronx, N.Y.

Linda Morrison
Outreach Program Manager
Wisconsin Alzheimer's Institute
Milwaukee, Wis.

Linda Noelker, Ph.D.
Senior Vice President of Planning and Organizational Resources
Benjamin Rose Institute
Cleveland, Ohio

Rick Surpin
President
Independent Care System
New York, N.Y.

Rose Wormington
Staff Member
National Association of Geriatric Nursing Assistants
Joplin, Mo.

Dale Yeats
Chair, Department of Sociology
University of North Texas
Denton, Texas

Technical Expert Panel #3 — December 14, 2001

Information not available from grantee

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Wiener JM, Stone RI, Tilly J, Frank A and Michael ML. "Who Will Care for Us? A Research and Demonstration Agenda for Frontline Long-Term Care Workers." Unpublished. For a free copy, contact the project director at jwiener@rti.org.

Reports

Stone RI and Wiener JM. Who Will Care for Us? Addressing the Long-Term Care Workforce Crisis. (Literature Review) Washington: Urban Institute and the Institute for the Future of Aging Services, 2001. Also available online.

Bowers B. Organizational Change and Workforce Development in Long-Term Care. (Background Paper) Madison, Wis.: University of Wisconsin-Madison, 2001. Also available online.

Holzer HJ. Long-Term Care Workers and the Low-Wage Labor Market: Current Characteristics and Future Trends. (Background Paper) Washington: Georgetown University, 2001. For a free copy, contact the project director at jwiener@rti.org.

Tilly J and Wilner MA. (Background Paper) Options for Research on Extrinsic Rewards. Washington: Urban Institute, 2001. For a free copy, contact the project director at jwiener@rti.org.

Frontline Long-Term Care Worker Project: Summaries of the Three Technical Expert Panel Meetings. Washington: Urban Institute, Institute for the Future of Aging Services, February 2002. Available free online.

The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation. (Report to Congress incorporating recommendations from the three technical advisory panels) Washington: U.S. Department of Health and Human Services and the U.S. Department of Labor, May 14, 2003. Available online.

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Report prepared by: Linda Bernstein Jasper
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Jane Isaacs Lowe
Program Officer: Wendy L. Yallowitz