HHS-DoL Symposium Summary
The Lewin Group
The U.S. Departments of Labor and Health and Human Services jointly sponsored an invitational symposium on long-term care workforce issues on May 24-25, 2004 at the Wyndham Washington Hotel, D.C. The first joint effort of its kind between the two departments, the symposium was attended by nearly 140 thought-leaders across the nation representing the long-term care provider community, worker groups, long-term care and workforce development policy officials at the federal, state and local level, long-term care and economic development researchers, and federal and philanthropic funders.
The symposium focused on what can be learned from research and practice to develop the long-term care paraprofessional workforce, enhance its performance and increase its retention. It consisted of a series of plenary sessions, each followed by facilitated, small group discussions. This framework allowed invitees with different perspectives and experiences related to the long-term care paraprofessional workforce and the workforce development sectors to reflect on what had been learned, share ideas, build relationships so that evolving interests in information sharing and research and demonstration ideas can be followed up and nurtured.
Participants were welcomed by John Hoff, Deputy Assistant Secretary for Planning and Evaluation, HHS, and David E. Gray, Acting Assistant Secretary for Policy, DOL. They emphasized the important role of direct care workers and the need to coordinate resources at the federal, state and local levels and to develop policy that promotes a quality workforce and quality care. Robyn Stone, Executive Director of the Institute for the Future of Aging Services, and Steven Dawson, President of the Paraprofessional Healthcare Institute, then set the stage for dialogue between the long-term care and workforce development sectors. They remarked how it had been a dream of theirs to bridge these two worlds and participate in such a venue to facilitate innovative and evidence-based practices.
DOL Secretary Elaine L. Chao reiterated the importance of collaboration and commended participants for tackling the challenges that lay ahead, given the shifting demographics. She expressed the department’s dedication to promoting a demand-driven workforce investment system and described the grants DOL has awarded to promote direct-care jobs as part of the President's High Growth Job Training Initiative. Secretary Chao introduced the keynote luncheon speaker, Idaho Governor Dick Kempthorne. Governor Kempthorne, chair of the National Governors Association, has been a champion of long-term care during his tenure and spoke on a personal level about the need for a quality long-term care workforce that supports the independence and dignity of older adults.
Three themes were highlighted during the plenary and small group sessions: 1) the relationship between the performance of the paraprofessional long-term care workforce and the quality of care and quality of life of long-term care recipients; 2) the potential of workforce development policies and practices to reduce vacancy and turnover rates among direct care workers and improve job performance; and 3) the value of building alliances and stakeholder collaboration to solve workforce shortages.
During the session, “Linking Staffing and Quality”, presenters addressed the relationship between a quality workforce and the quality of care provided. The session featured research and providers’ experience in approaches and lessons learned in building a stable and committed direct care workforce, including several of the Visiting Nurses Service of New York’s (VNSNY) interventions, culture change initiatives, and evidence from the home care arena. They emphasized the need for continued demonstrations and applied research to better understand the link between staffing and quality and what facilitates or impedes quality improvement.
The afternoon session on “Connecting Workforce Development Initiatives, Individual Economic Opportunity and Quality Care” provided an overview of workforce shortages, the workforce investment system and DOL initiatives, highlighting several local collaborations between the long-term care community and workforce development sector. The session emphasized how increasing the supply of paraprofessional workers can benefit the workers and the community. Several collaborative efforts were showcased, including the Good Samaritan Career Lattice Project, a collaborative effort between the Evangelical Lutheran Good Samaritan Society and the South Dakota Department of Labor, the work of the Northern Indiana Workforce Board and the Healthcare Coalition Project, and the Extended Care Career Ladder Initiative (ECCLI) in Massachusetts.
The last session, “The Impact of Workforce Improvement Initiatives on Workforce Recruitment and Retention”, addressed the research and practice experience of initiatives aimed at improving the recruitment and retention of the long-term care workforce. Various HHS initiatives were described, including demonstration projects designed to improve the long-term workplace environment and other interventions focused on improving the recruitment and retention of the long-term care workforce. The session emphasized the continuing need to see evaluation as an important component to building the evidence base for what works as well as the importance of acknowledging the impact of staffing resource issues on building effective systems of care. Presenters highlighted some early successes of Better Jobs, Better Care coalitions in the five demonstration sites and showcased PHI’s National Clearinghouse on the Direct Care Workforce and the Cooperative Home Care Associates’ (CHCA) philosophy and model of recruitment, training and retention.
During the concluding session, participants were asked to share strategies that emerged during the small group discussions that they plan to explore or implement in their own settings. Participant discussed a number of opportunities for collaboration between the long-term care and workforce development sectors.
Among the take-home strategies that emerged from participants are:
Long-term care providers to participate on state and local WIBs and leverage resources;
Workforce investment to work with long-term care providers to develop sectoral strategies, customized training, and on-the-job training (OJT);
Workforce system to do more targeted outreach to direct care community, workers and providers.
Conduct research that shows how quality-of-care outcomes are correlated with linking direct care system to workforce system.
Educate others about statewide worker shortages and initiate action with state policymakers regarding appropriation and funding.
Form coalitions, including consumers, state agencies, researchers, paraprofessional workers, workforce development (WIB) and AARP to work on issues related to changing the jobs themselves and the organizational structure in which they are housed (e.g., language; make more prestigious from a worker viewpoint).