Making meaningful improvements to direct care worker training through informed policy: Understanding how care setting structure and culture matter

Creating age-friendly nursing homes: The time is now

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Insights and Innovation: How a Local Public-Private Partnership is Building Home Care

Recent national reports asserted an urgent imperative for transforming working conditions for the direct care workforce in the US. These clarion reports identified key influencers in reform as federal and state governments, workers' unions and coalitions, individual and organizational employers. Equally essential and well-positioned local actors have been overlooked in the conversation-namely, municipalities, area agencies on aging, higher education, philanthropic entities, and community. Although deemed "essential," direct care workers have been disproportionately affected by the COVID-19 pandemic. This paper examines an early public-private partnership initiative designed to recruit and train PCAs in Virginia.

Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports

The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected. Long-standing direct care job quality concerns are linked to high turnover and job vacancy rates in this workforce, which in turn compromise the availability and quality of essential care for older adults and people with disabilities-which has never been more evident than during the COVID-19 pandemic. This special article makes the case for transforming direct care jobs and stabilizing this workforce as a centerpiece of efforts to reimagine long-term services and supports system in the United States, as a public health priority, and as a social justice imperative. Drawing on research evidence and examples from the field, the article demonstrates that a strong, stable direct care workforce requires: a competitive wage and adequate employment benefits for direct care workers; updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, while also enhancing career mobility and workforce flexibility; investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles; and an elevated position for direct care workers in relation to the interdisciplinary care team. The article concludes by highlighting federal and state policy opportunities to achieve direct care job transformation, as well as discussing research and practice implications.

Toward a learning-to-performance program for interprofessional long-term care teams: Team Essentials to foster engagement, reciprocity, and meaningful, sustained practice change

This paper presents the design, delivery, and preliminary evaluation of a gerontological learning-to-performance program. An interprofessional educational team sought to integrate leading clinical and educational practices into Team Essentials to engage long-term care teams in learning to improve performance. Although the association between skilled, trained staff and quality of care is well-established in research, how best to engage learners from an increasingly diverse workforce is less well understood. This paper outlines the context, framework, methods, and preliminary evaluation of the program. Data from participant surveys, interviews, and field notes suggest that program content and delivery positively impacted participants. Four major themes emerged: Enabling engagement through experiential learning; Valuing reciprocity in long-term care training; Creating meaningful change through significant learning; and, Fostering sustained practice change through leadership involvement. The paper concludes with implications for LTC workforce training.

Factors Associated With Nurses' Job Satisfaction In Residential Long-term Care: The Importance of Organizational Context

OBJECTIVES

We examined demographic, individual, and organizational context factors associated with nurses' job satisfaction in residential long-term care (LTC) settings. Job satisfaction has implications for staff turnover, staff health, and quality of care.

DESIGN

A cross-sectional analysis of survey data collected in the Translating Research in Elder Care program.

SETTING AND PARTICIPANTS

N = 756 nurses (registered nurses: n = 308; licensed practical nurses: n = 448) from 89 residential LTC settings in 3 Western Canadian provinces.

METHODS

We used a generalized estimating equation model to assess demographic, individual, and organizational context factors associated with job satisfaction. Job satisfaction was measured using the Michigan Organizational Assessment Questionnaire Job Satisfaction Scale.

RESULTS

Demographic, individual, and organizational context factors were associated with job satisfaction among nurses in residential LTC settings. At the demographic level, hours worked in 2 weeks (B = 0.002, P = .043) was associated with job satisfaction. At the individual level, emotional exhaustion-burnout (B = -0.063, P = .02) was associated with lower job satisfaction, while higher scores on empowerment (meaning) (B = 0.140, P = .015), work engagement (vigor) (B = 0.096, P = .01), and work engagement (dedication) (B = 0.129, P = .001) were associated with higher job satisfaction. With respect to organizational context, culture (B = 0.175, P < .001), organizational slack-space (eg, perceived availability and use of adequate space; B = 0.043, P = .040), and adequate orientation (B = 0.092, P < .001) were associated with higher job satisfaction.

CONCLUSIONS AND IMPLICATIONS

We identified previously unexamined modifiable organizational features (organizational slack-space and adequate orientation) as factors associated with LTC nurses' job satisfaction in the Canadian context. Our findings support future efforts to improve job satisfaction through improvements in organizational space and provision of adequate workplace orientation.

Autism aging

Many people perceive autism spectrum disorder (ASD) as a childhood disorder, yet ASD is a lifelong condition. Although little is known about the mental and physical health issues of aging individuals with ASD, there are increasing numbers of older adults being diagnosed with ASD. Although there has been a recent "call to action" (to address lack of knowledge and the dearth of services and programs for aging individuals with autism, the authors think it is also important for those who are involved in educational programs related to gerontology and geriatrics settings to be aware of "autism aging." This term conceptualizes the demographics, person and contextual factors, and intellectual awareness of the trends and patterns of ASD as a life course challenge and opportunity for well-being and quality of life. The purposes of this article are to (1) provide a general overview of autism issues and to examine several dimensions of ASD in the context of the emergent and relevant scholarship in the adult and aging domain, (2) propose how to address the "gap" in the literature on autism and aging in terms of a conceptual model and by improving the methodology, and (3) to discuss the implications of these dimensions for educators in gerontology and geriatrics, and for those professionals who work in clinical and health care services. It is the goal of the authors to have this article represent a general introduction to ASD and to be a part of the foundation for educational awareness for educators in gerontology and geriatrics.

A Profile of the Assisted Living Direct Care Workforce in the United States

Background and Objectives: The purpose of this article was to develop a profile of direct care workers (DCWs) in assisted living (AL). Research Design and Methods: We used data from 2014 American Community Survey (ACS) to identify the demographic and employment characteristics of AL DCWs. We collected state training requirements for AL DCWs from the administrative rules of state agencies and interviews with state officials. Results: AL DCWs were more likely than other DCWs to be younger, male, White, English speaking, U.S.-born, never married, and to have attended college. Two Affordable Care Act (ACA)–designated training topics (self-care and the role of the personal care aide) were not required in any state. Discussion and Implications: AL has tapped a unique pool of workers (i.e., younger, male as well as female, and with some college education) but needs to address its workforce needs via training, improvements to overall job quality, and the development of career opportunities.