Exhibit 2 is a list of potential outcome variables for workers and employers for an evaluation of LTC RAPs. Some of these outcomes, such as wages and turnover, can be obtained from employers or from administrative records without having to ask the apprentices and the comparison group. Other outcomes, such as intent to leave, job satisfaction, and relationship with supervisor can be obtained only by gathering directly through focus groups or surveys with the workers themselves. Finally, some outcomes, such as skill proficiency, would be exceptionally very hard to obtain because of the lack of agreed upon measures and the difficulty and expense of data collection. Data on skill proficiency would need to be obtained either through direct observation of individual workers, an opinion ranking by supervisors, or by the completion of some test, and could be challenged as biased or not measuring true skill levels.
|EXHIBIT 2. Potential Outcome Variables for Workers and Employers|
Given their policy importance, quality of care outcomes at the level of the firm deserve special mention. Quality of care data in a standardized format is readily available for nursing homes and home health agencies, but not for other long-term care providers (Wiener, Freiman, and Brown, 2007 ). The Centers for Medicare and Medicaid Services (CMS) routinely posts detailed quality of care information for these two providers on their Nursing Home Compare and Home Health Compare web sites. Most of these measures are derived from resident and patient level data that is routinely and periodically collected on functional status and medical condition. In addition, for nursing homes, CMS regularly calculates summary measures, the Five Star Rating System, that includes information from the resident and patient assessments, staffing levels, and the health inspections. Data are not available on services for people with intellectual disabilities or for residential care facilities, such as assisted living facilities. Developing quality measures for these providers would be a major task and beyond the scope of a LTC RAP evaluation. In addition, even with the largest occupation, CNAs, there are currently only 56 employer sponsors, a sample size too small to detect differences in quality of care across nursing homes. Moreover, LTC RAPs are likely to have significant facility/agency-wide impacts only where apprentices account for a significant proportion of workers; it is probably unrealistic to expect a few apprentices in an organization to affect the overall quality of care.