Money-or a lack of it-may not be the sole cause of the tough employee-recruiting environment for long-term-care providers.
In the case of assisted-living facilities, providing better career advancement opportunities could be a better way to keep and recruit caregivers than boosting pay, a recently publicized national survey report indicates.
Only 30% of 569 direct caregivers who were surveyed agreed that they have "good advancement opportunities," according to the survey report, High Service or High Privacy Assisted Living Facilities, Their Residents and Staff. The report, first issued in November 2000 but recently highlighted by HHS in a news release, was one in a series of reports issued as part of HHS' national study of assisted-living facilities, which began in 1994. It focuses on facilities that provide extensive help to residents or a high level of privacy or both.
The caregivers who were surveyed indicated more satisfaction with their pay and benefits than their career prospects. More workers-45%-agreed with the statement, "My pay is good," the survey showed, while 59% agreed with the statement, "Fringe benefits are good."
"We need to show that we really appreciate these people," says Karen Wayne, president and chief executive officer of the Assisted Living Federation of America, Fairfax, Va.
Individual companies are developing advanced training programs that can help caregivers move into management, Wayne adds, but the industry as a whole is failing to address how it can keep caregivers interested. "But I think after this study, we're certainly going to look at it. It has become a priority," she says.
The views of residents and their family members on staffing issues indicate where there is room for improvement. Only 42% of residents and 48% of family members said adequate staff was always available, while only 28% of residents thought their facility did a good job retaining quality workers.
Overall, residents' responses indicated high satisfaction with interactions with caregivers, with 79% saying caregivers "always treated them with dignity and respect" and 61% agreeing that caregivers "always were affectionate and caring."
Wayne notes that caregivers also gave their employers high marks for hiring competent supervisors, providing good job security and training and expecting a reasonable workload (See chart).
The survey also showed that only 30% of residents were aware of the discharge policies of their facility. Many did not understand that they could be transferred out of the facility if they no longer could afford the rates. The survey estimated a median base rate of $1,900 per month.
Karen Love, co-chairman of the board of the Consumer Consortium on Assisted Living, an Arlington, Va.-based resident advocacy group, says assisted-living providers could do more to explain their policies and contracts. Moreover, they should ensure that residents and their families have that information well in advance of a move-in date, so a lawyer or other expert could review the materials.
The need for improved training also is highlighted in the survey. "Despite widespread reporting of training, staff involved in providing or supervising resident care exhibited abysmal knowledge of what constitutes normal aging," the survey report said. Too often, the report said, caregivers indicated they would accept problems such as incontinence or memory loss as symptoms of aging without looking to see if a treatable medical condition was causing the functional decline.
The report also indicated that, while 77% of the surveyed staff members help residents with their medication, only about half correctly answered all three questions designed to test their knowledge about monitoring patients.
The lack of knowledge about aging goes hand in hand with the difficulty in monitoring patient medication use, Love says.
"It's very problematic, because if you don't understand what is normal aging, then you don't have any indicators as to what is not normal," she says. "(Caregivers) don't know what is behind a change in behavior."
The federation's Wayne agreed that "medication management is a big responsibility" for caregivers. In at least 17 states where that task may be delegated to noncertified caregivers, Wayne says the group is working with nursing associations to improve training.
Love says her organization would like to see a common set of training standards developed, including a requirement that caregiver training be as extensive as the 72-hour course required for certified nursing assistants who work in nursing homes. Her group doesn't support federally mandated standards through federal regulations, but believes that states can look to the standards when adopting their own assisted-living laws and regulations.