Pathway to the Future: How Workforce Development and Quality Jobs Can Promote Quality Care Conference Package. Linking Workforce Development to Long-Term Care Quality

05/01/2004

Robyn I. Stone, Dr.P.H.
American Association of Homes and Services for the Aging

WORKFORCE FACTORS INFLUENCING LTC QUALITY

  • Attributes the workers bring to the job
  • Education and training
  • Quality of the job
    • Compensation and other benefits
    • Job design
    • Organizational and management culture

CASE FOR LINKING WORKFORCE DEVELOPMENT AND LTC QUALITY

  • Workforce issues generally afterthought in quality debate
  • New interest in workforce/quality links
    • 2001 IOM Nursing Home Quality Report
    • CMS Staffing Quality Study
    • Provider-initiated Quality First
  • Central importance of human interaction in LTC
    • Caregiver/care recipient relationships
    • Supervisor/direct care worker relationships
    • Peer relationships

BARRIERS TO INTEGRATING WORKFORCE DEVELOPMENT INTO LTC QUALITY ASSESSMENT AND IMPROVEMENT

  • Providers lack motivation to invest in workforce
  • Race and class barriers
  • Hidden nature of consumer/worker relationship
  • Workers lack a strong voice
  • Regulatory system does not address workforce issues
  • Models of successful workforce development are limited

QUALITY IN AGING SERVICES

  • Quality of services/care outcomes
  • Quality of “caring”/quality of life
  • Quality for whom
    • Residents, home care consumers
    • Families
    • Staff

HEALTH DIMENSION OF QUALITY

  • Medical/clinical
  • Technical aspects of care
  • Quality indicators capture clinical processes and outcomes
    • MDS
    • OASIS

SOCIAL DIMENSION OF QUALITY

  • Quality of the physical environment
  • Quality of the social supports
  • Relationship between care recipients and caregivers
  • Measures more sensitive to the needs and preferences
    • Life satisfaction
    • Satisfaction with interactions
    • Sense of autonomy/control

QUALITY OF WORKLIFE

  • Key to quality of care and life in aging services
  • Focus on staff, particularly direct care workforce
  • Interaction between care recipient and caregiver from staff perspective

INTEGRATED MODEL IS REQUIRED

  • Good quality aging services combine a focus on both the clinical and social/environment
  • Also focuses on work environment and quality outcomes for caregivers
  • Clinical and social aspects are intertwined
  • Requires organizations that have management structure and philosophy conducive to promoting quality of care and life.
  • Appropriate for all settings from independent living to skilled nursing facilities

CULTURE CHANGE IN LTC TO IMPROVE QUALITY

  • Focus on where people live and work
  • Culture change is comprehensive -- not just one intervention
  • Focus on empowering staff and residents/clients

ORGANIZATION-LEVEL INTERVENTIONS

  • Flattening management hierarchy
  • Creating resident-centered environment
  • Mentoring and coaching rather than supervising
  • Creating meaningful, rewarding training experiences for all staff
  • Focus on intra-staff communication and staff/resident relationships
  • Fostering and enhancing community

FUTURE OF CULTURE CHANGE

  • Can we move beyond the pioneers?
  • What is just rhetorical and what is real?
  • Need for evidence-based research
    • What works?
    • Who benefits?
    • What are the costs?
  • Building culture change into the Quality Debate
  • Making culture change the norm rather than the exception

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