Better Jobs Better Care
Better Jobs Better Care is a 4-year $15.5 million research and demonstration program, funded by The Atlantic Philanthropies and the Robert Wood Johnson Foundation. Its goal is to achieve changes in long-term care policy and practice that help to reduce high vacancy and turnover rates among direct-care staff across the spectrum of long-term care settings and contribute to improved workforce quality. The Robert Wood Johnson Foundation and The Atlantic Philanthropies selected five state-based coalitions Iowa , North Carolina , Pennsylvania , Oregon , and Vermont to receive demonstration grants.

Contact:
Debra Lipson
Institute for the Future of Aging Services
2519 Connecticut Avenue, NW
Washington, DC 20008
t: (202) 508-1215
e: bjbc@aahsa.org

Website: www.futureofaging.org

Contact:
Steve Edelstein, National Policy Director
Paraprofessional Healthcare Institute
349 East 149th Street, 10th Floor
Bronx, N.Y., 10451
t: (718) 402-7413
e: Edelstein@paraprofessional.org

Website: www.bjbc.org

Evaluation of Culture Change in For-Profit Nursing Homes: Business Innovation at Beverly Enterprises
Over the last decade, a grassroots movement within the nursing home industry known as 'culture change' has begun to fundamentally alter the way nursing homes function. This evaluation, funded by The Commonwealth Fund, focuses on a new culture change initiative being implemented in nursing homes owned by the nation's largest for-profit chain, Beverly Enterprises. It measures change that has occurred and identifies factors that impede as well as facilitate improvements at the unit, facility, and corporate levels. Evidence that corporate business interests are furthered through quality innovations would serve as a powerful incentive for their widespread adoption-particularly among for-profit homes, which account for two-thirds of nursing facilities nationwide.

Contact:
Leslie A. Grant, Principal Investigator
t: (612) 624-8844
e: grant004@umn.edu

New Freedom Initiative
President Bush announced the New Freedom Initiative on February 1, 2001, followed by Executive Order 13217 on June 18, 2001. The initiative is a nationwide effort to remove barriers to community living for people of all ages with disabilities and long-term illnesses. It represents an important step in working to ensure that all Americans have the opportunity to learn and develop skills, engage in productive work, choose where to live, and participate in community life.

In 2004, the Demonstration to Improve the Direct Service Community Workforce will grant $1.4 million each to the Virginia Department of Medical Assistance Services; the Home Care Quality Authority, a Washington state agency; and Bridges, Inc. , a non-profit service agency in Indiana. Each of these grantees will be offering health insurance products to direct-service workers during the three-year demonstration. Grants of $680,000 each will go to the Arkansas Department of Human Services and Seven Counties Services, Inc., a service provider in Kentucky, for developing educational materials, training of service workers, mentorship programs and other activities.

Funding for FY03 includes almost $6 million for Demonstration to Improve the Direct Service Community Workforce grants to provide funding for the development and implementation of programs that will test recruitment and retention strategies for the direct-service workforce, targeted recruitment programs, web-based registries, and professional assistance associations. The 'Demonstration to Improve the Direct Service Community Workforce' has awarded $1.4 million each to the New Mexico Department of Health, the Maine Governor's Office of Health Policy and Finance, and Pathways for the Future, a service provider in North Carolina. Grants of $680,000 were awarded to the University of Delaware and the Volunteers of America, Inc.


Real Choice Systems Change (RCSC) Grants

The Centers for Medicare and Medicaid Services (CMS) awarded Real Choice Systems Change (RCSC) Grants to states and other entities working to improve state long-term care systems. Many grantees began one or more initiatives to improve the recruitment and retention of direct-service workers.
States that have initiatives to improve direct-service workforce:
Alaska
Arkansas
Georgia
Kentucky
Maine
Maryland
Montana
Nevada
New Hampshire
New Jersey
Oregon
Vermont


For further information on the workforce activities of the Real Choice grantees go to Direct service workforce activities of the Systems Change grantees

Contact:
Kate King, Centers for Medicare & Medicaid Services
7500 Security Blvd.
Mail Stop S2-14-26
Baltimore, Maryland , 21244-1850
t: (410) 786-2117
e: Kking@cms.hhs.gov

Website: www.cms.gov/newfreedom

Office of the Assistant Secretary for Planning and Evaluation (ASPE) Workforce Initiatives
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is currently funding six initiatives to improve the direct-care workforce:

National Nursing Assistant Survey
In an effort to determine what draws individuals to careers as nursing assistants and to work in nursing homes, and what contributes to their satisfaction and likelihood of staying in their jobs, this first-time direct-care worker survey of Certified Nursing Assistants (a new addition to the 2004 National Nursing Home Survey) will examine wages, working conditions, workers' perceptions of their workplace, job responsibilities, and the role of supervision.

Home Health Aide Survey Design
The design of the Home Health Aide survey will be an adaptation of the Nursing Assistant Supplement for the National Nursing Home Survey. The goal is to develop a survey and design an instrument to obtain data on the size and characteristics of the Home Health Aide workforce.

Home Health Aide Partnership Evaluation
The Home Health Aide (HHA) Collaborative, implemented by the Visiting Service of New York, seeks to enhance the role of home health aides as part of a care team, resulting in: patient services matching need more effectively, better [patient] self-care management, continuity of care, and improved satisfaction for the HHA, patient and staff. The evaluation will measure the impact of the HHA partnership Collaborative on patient outcomes, and on employee and organizational culture.

Frontline Supervisor Survey
The goal of the survey of frontline supervisors will allow policymakers to understand the perspectives and experiences of frontline supervisors participating in workforce development interventions. The survey of these supervisors will be completed in approximately 130 nursing homes, assisted living facilities, home health agencies, and adult day providers that are part of the Better Jobs, Better Care demonstration project.

Suitability of TANF Recipients as Long-Term Care Workers
By analyzing survey data and conducting case studies in selected states, the study will describe the personal characteristics and skills of TANF recipients as they relate to their potential in a LTC setting, lessons learned from programs that have attempted to link TANF recipients with positions in the LTC field, and potential ways that workforce development systems and welfare-to-work policies and practices have facilitated or hindered efforts to link recipients with jobs in the industry.

Follow-up Activities: The National Symposium on the Recruitment & Retention of Direct Care Workers
In spring 2004 a The National Symposium on the Recruitment & Retention of Direct Care Workers was held. In an effort to follow up on the symposium ASPE intends: 1) To disseminate lessons learned with a broad range of users, especially policymakers, employers, and direct-care workers; 2) to convene follow-up conference calls with symposium participants to identify successful activities that have occurred since the symposium and to identify where the gaps remain; 3) to identify innovative partnership activities; 4) to identify resources available in the private sector, and through state and local sources for direct-care workforce improvement activities; 5) and to identify opportunities for additional policy-relevant research and demonstration activities to ensure a committed and qualified long-term care workforce.

Contact:
Emily Rosenoff
US Department of Health & Human Services, Office of Disability, Aging, and Long-Term Care Policy (ASPE)
200 Independence Avenue, SW --Room 424E
Washington, D.C. 20201, t: (202) 690-6443
e: Emily.Rosenoff@hhs.gov

Website: aspe.hhs.gov/_/index.cfm

Pioneer Network
The Pioneer Network is a network of progressive long-term care organizations and individuals committed to transforming the culture of aging and eldercare in America.

Contact:
Rose Marie Fagan
PO Box 18648
Rochester, New York , 14618
t: Direct line: (585) 924-3419 Resource Center: (585) 271-7570
e: RoseMarie.Fagan@PioneerNetwork.net

Website: www.PioneerNetwork.net

Quality Improvement Organizations (QIOs)
Quality Improvement Organizations (QIOs) are private organizations that contract with the federal government's Centers for Medicate and Medicaid Services (CMS) to improve care quality in nursing homes, home health care agencies, and other health care organizations. There is a QIO for each of the 50 states as well as the District of Columbia, Puerto Rico, and the Virgin Islands.

While their focus has traditionally been strictly clinical, QIOs are amending their approach in nursing homes, encouraging organizational and management practices that support direct-care workers and other caregiving staff.

As part of an effort to affect transformational change in nursing homes, The Person Directed Care (PDC) project, lead by Quality Partners of RI, has trained all 53 QIOs to provide information, resources and implementation strategies that will allow QIOs to work with nursing homes on implementing person directed care models. This model encompasses practices and procedures in three domains: workplace practice, care practice and environment.

For the Quality Improvement Organizations' (QIOs) 8th scope work workforce retention has been identified as an important priority. This increased focus on workforce retention stems from nursing home experience during the past two years. In nursing homes, QIOs have found that clinical practices such as pressure ulcer reduction and pain management cannot be significantly improved without the involvement of the CNAs who provide the great majority of the hands-on care.

Contact:
Margie McLaughlin
t: (401) 528-3259
e: mmclaughlin@riqio.sdps.org

Website: www.riqualitypartners.org/nursing_homes/c_change_materials.php

SEIU Home Care Workers Health Insurance Project
The Service Employees International Union (SEIU) has an excellent track record in obtaining health insurance coverage for this population of low wage, older, largely part-time, mostly female workforce. Under a grant from the Robert Wood Johnson Foundation, SEIU is analyzing its past efforts and will create replicable models of coverage that can be used by the union and other organizations in efforts to reduce the high number of uninsured in the home care workforce.

Contact:
Cathie Sullivan, Home Care Policy Analyst, Service Employees International Union
1313 L Street, N.W.
Washington, DC 20005, t: (202) 898-3275
e: sullivac@seiu.org

Website: www.seiu.org

The Center for Personal Assistance Services
The Center for Personal Assistance Services provides research, training, dissemination, and technical assistance on issues of personal assistance services (PAS) in the United States:

• The relationship between formal and informal PAS and caregiving support, and the role of assistive technology (AT) in complementing PAS;
  
  
• Policies and programs, barriers and new models for PAS in the home and community;
  
  
• PAS Workforce development, recruitment, retention, and benefits; and
  
  
• Workplace models of formal and informal PAS and at work.

Contact:
Department of Social and Behavioral Sciences
School of Nursing, University of California
3333 California Street, Suite 455
San Francisco, California, 94118-0612
t: 866-PAS-9577 (866-727-9577) or (415) 502-7190

Website: www.pascenter.org

The College of Direct Support
The College of Direct Support (CDS) is a web-based national training curriculum for direct-support professionals. This curriculum is based on the Community Support Skills Standards. The CDS also offers The College of Frontline Supervision & Management, which helps supervisors and others learn more about hiring, training, and keeping direct support professionals. The CDS is collaboration of the Administration on Developmental Disabilities, the University of Minnesota's Center on Community Living, and MC Strategies. The courses are competency based and provide further opportunity for assessment and development of skills after the on-line training is done.

Contact:
Bill Tapp
111 Center Park Drive, Suite 175
Knoxville , Tennessee, 37922
t: (865) 934-0221
e: bill@collegeofdirectsupport.com

Website: www.collegeofdirectsupport.com

The President's High Growth Job Training Initiative
The goal of the President's High Growth Job Training Initiative is to develop partnerships with the public workforce system, business and industry, education and training providers, and economic development in twelve industries. These partners will work collaboratively to create solutions to the workforce challenges facing these industries and to develop maximum access for American workers to gain the competencies they need to get good jobs in these industries.

Health care is one of the industries which the High Growth Job Training Initiative will focus on. Overall, grants totaling more than $24 million are being funded across the health care industry.

As part of this initiative the Paraprofessional Healthcare Institute has received a nearly $1 million grant that will focus on the multiple workforce challenges related to the recruitment and retention of direct-care workers. The Paraprofessional Healthcare Institute will: 1) develop a recruitment and apprenticeship career-lattice model; 2) create a coaching approach for front-line supervisors, with a curriculum designed for employer-based community colleges; 3) demonstrate a problem solving training curriculum, in partnership with Lancaster's Workforce Investment Board; 4) publish a series of guidebooks, curricula, and teaching manuals, written in English and Spanish, on effective paraprofessional workforce development practices; 5) create strategic relations with faith-based health systems capable of bringing about nationwide change.

Contact:
Laura Ginsburg, US Department of Labor, Employment & Training Administration (ETA)
200 Constitution Avenue, NW
Suite N4671
Washington, DC , 20210
t: (202) 693-2803
e: ginsburg.laura@dol.gov

Website: www.doleta.gov/BRG/Indprof/Health.cfm