Direct care workers, who provide hands-on care to millions of Americans each day, are the key to ensuring that our nation can deliver quality long-term services and supports (LTSS) to a growing older population.
Yet, this workforce is in crisis, due to high turnover, poor working conditions, inadequate training, and low pay.
More than a decade ago, The LeadingAge Center for Applied Research became a national leader in the effort to address these important issues through Better Jobs Better Care, a $15.5 million research and demonstration program funded by the Robert Wood Johnson Foundation and the Atlantic Philanthropies. This major national initiative launched an ongoing effort by LeadingAge to improve the working conditions and preparation of direct care workers, nurses, and other staff in long-term care settings.
The LeadingAge LTSS Center @UMass Boston is continuing this work. The LTSS Center is committed to disseminating information about workforce-related challenges, and collaborating with employers and policy makers to identify, demonstrate, and assess promising workforce development and improvement practices.
Read more about our work on workforce issues:
Researchers at the LeadingAge LTSS Center @UMass Boston and Virginia Commonwealth University (VCU) in Richmond, VA, have been working for several years to support LeadingAge’s vision of “An America Freed from Ageism.” The work has been supported by 2 grants from the Retirement Research Foundation.
During the project’s first phase, researchers evaluated the effectiveness of a video-based workforce training program focusing on ageism. The project’s second phase, now underway, is designed to develop a toolkit that senior living providers can use to identify and eradicate ageism and ableism in their organizations. This phase of the project is a partnership between LeadingAge, VCU, The Eden Alternative, and the Pioneer Network.
Status: Ongoing
Contact: Verena Cimarolli
Project Resources:
Managing Workforce Ageism: Infographic
Managing Workforce Ageism: Annual Report
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Colorado’s Department of Health Care Policy and Financing enlisted the LeadingAge LTSS Center @UMass Boston to help it collect and analyze data describing the state’s direct care workforce. Researchers also identified best practices from other states in the areas of training, career advancement, scope of practice, and supervision of direct care workers.
Status: Ongoing
Contact: Natasha Bryant
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The LeadingAge LTSS Center @UMass Boston and WeCare ConnectTM are studying the impact of the COVID-19 pandemic on the workforce that provides long-term services and supports (LTSS) and on the recipients of those services and supports.
During the first phase of the project, the LTSS Center analyzed responses to COVID-related questions that WeCare Connect, an employee and resident engagement and management system, added to its employee surveys during May 2020. During the second phase of the project, funded by Aging in America Inc., researchers will identify nursing home employees who answered the COVID-related questions in May and subsequently resigned from their jobs.
The project’s goal is to ascertain the challenges workers are experiencing during the pandemic, how workers perceive the quality of employer preparedness and communication around COVID-19, and COVID-related stresses and challenges associated with the decision to resign. They are also studying how COVID-19 impacts quality of life and health care-related outcomes of LTSS consumers.
Status: Ongoing
Contact: Verena Cimarolli
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LTSS Center Will Study COVID-19’s Impact on LTSS Workforce, Consumers
The LeadingAge LTSS Center @UMass Boston is helping researchers at the University of Kansas (KU) School of Nursing evaluate whether an in-person training program to reduce elderspeak among nursing home staff can be adapted successfully to an online format.
LTSS Center researchers are consultants on the project, which is designed to pilot test an online version of Changing Talk (CHAT), an in-person training program designed to help nursing home team members avoid the “baby talk” commonly used by younger nursing home staff in conversation with older nursing residents.
Preliminary findings show that the online version of the training—called CHATO—is as effective as the original CHAT in-person training. However, researchers want to validate those findings with a larger sample size. The new study will test the effectiveness of the CHATO online modules, and the program’s accompanying implementation guide, in 120 nursing homes. The research is funded by the National Institute of Nursing Research and the National Institute on Aging.
Status: Ongoing
Contact: Natasha Bryant, Robyn Stone
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The LeadingAge LTSS Center @UMass Boston is working to develop recommendations to support a sustainable and skilled home care profession in California.
The 1-year research project, funded by the Gordon and Betty Moore Foundation, is being carried out in partnership with the Health Workforce Research Center on Long-Term Care at University of California San Francisco, and SEIU-United Healthcare Workers West.
The project will culminate in a white paper exploring the training and policy infrastructure necessary to develop a new universal home care worker family of occupations. The new occupation category has been recommended by the California Future Health Workforce Commission as a way to address the increasing demand for home care workers.
After conducting a review of both the current literature and existing workforce policies and initiatives, and interviewing a range of stakeholders, researchers will propose a home care training and certification pilot program that could be implemented in a region or locality in California.
Status: Ongoing
Contact: Natasha Bryant, Robyn Stone
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New Project Will Focus on the Universal Home Care Professional
Adult Americans want to continue living in their homes and communities even when they become unable to perform basic activities of daily living due to chronic disease or disability. Yet, there are widening gaps between the population’s need for home-based care and the availability of direct-care workers to meet those needs.
This project will address the impending health and home care aide workforce crisis. Researchers will review the history of research and policy changes involving community-based direct-care workers, and identify opportunities for developing a direct-care workforce that is prepared and well-positioned to improve care outcomes within interdisciplinary home-based care teams.
Project partners include Massachusetts General Hospital, Mongan Institute Health Policy Center, PHI, the Department of Gerontology at UMass Boston, and the LeadingAge LTSS Center @UMass Boston.
Status: Ongoing
Contact: Natasha Bryant, Robyn Stone
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The LeadingAge LTSS Center @UMass Boston and the University of Wisconsin-Madison are partners with the SEIU 775 Benefits Group on an initiative designed to shed light on the “authentic experience” of home care workers. Researchers will interview and observe 100 home care workers and document their behaviors, needs, and emotions. A final report will explore patterns that emerged during interviews, and will feature insights that can be used to refine training programs and develop strategies aimed at strengthening and supporting the home care workforce.
Status: Ongoing
Contact: Robyn Stone
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The LeadingAge LTSS Center @UMass Boston is working with the Global Ageing Network to explore the role that migrant/immigrant workers can play in delivering long-term services and supports (LTSS) to the world’s growing older population.
Through the project, researchers conducted a comprehensive environmental scan of the migrant/immigrant nurse and direct care workforce in the United States and across the globe.
They also conducted telephone interviews with representatives of 20 LTSS provider organizations located in the United States, Canada, United Kingdom, Germany, Ireland, France, and Australia. Findings from the research will be featured in a forthcoming report.
Status: Completed
Contact: Natasha Bryant
Project Resources:
Filling the Care Gap: Integrating Foreign-Born Nurses and Personal Care Assistants into the Field of Long-Term Services and Supports
A Picture of Foreign-Born Workers in the Long-Term Services and Supports: Research Snapshot
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New Reports Explore Global Expansion of Foreign-Born LTSS Workforce
The LeadingAge Center for Applied Research worked with Social and Scientific Systems, Inc., (SSS) to analyze findings from the 2007 National Home Health Aide Survey (NHHAS) and the 2007 National Home and Hospice Care Survey (NHHCS). The project was funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.
Researchers’ analysis of the characteristics of home care workers yielded new insights about categories of home care workers and factors influencing intent to leave a job among home health workers.
Status: Completed
Contact: Natasha Bryant
Project Resources:
The Home Health Workforce: A Distinction Between Worker Categories
QuickCast: Why Home Health Workers Leave Their Jobs
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Analysis of the National Home Health Aide Survey
The Gerontologist Publishes Findings from CFAR Study of Home Health Workers
What Makes a Home Health Worker Want to Leave a Job?
Exploring the Immigrant Home Health Workforce
Why Hospice Workers Fare Better Than Other Home Health Workers
This project, funded by LeadingAge, identified competencies for 3 categories of workers in the field of long-term services and supports: personal care attendants, including aides working in dietary, activities, and nursing; middle managers who have the responsibility for hiring and firing staff; and care coordinators working in nursing homes, home health agencies, or housing communities.
The project produced 2 competency guides to help providers identify the worker skills that are most important to and appropriate for their organizations, and then to use those competencies to recruit staff, design staff training, and establish criteria for performance evaluations.
Status: Completed
Contact: Natasha Bryant
Project Resources:
Mid-Level Manager Competency Development Guide
Personal Care Attendant Competency Development Guide
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Building Staff Competencies: New Tools Help Providers Evaluate Employees’ Skills
Guides Identify Competencies for Mid-Level Managers and Frontline Staff
The Personal and Home Care Aide Training (PHCAST) program was authorized by the Affordable Care Act to support the development, evaluation, and demonstration of a competency-based and uniform training curriculum for personal and home care aides. Six states used their PHCAST grants to design and operate demonstration projects that developed and implemented curricula and certification programs. The LeadingAge Center for Applied Research worked with Walter R. McDonald and Associates, Inc., to design and implement a national evaluation of the program. The Health Resources & Services Administration funded the study.
Status: Completed
Contact: Natasha Bryant
Read More:
HRSA Grant: Evaluating State Training Programs for Personal and Home Care Aides
How to Build the Personal and Home Care Aide Workforce
How 6 States are Training Personal and Home Care Aides to Provide HCBS
How North Carolina is Breaking Down Workforce Training Silos
The LeadingAge LTSS Center @UMass Boston manages the Joan Anne McHugh Award for Leadership in Long-Term Services and Supports (LTSS) Nursing for LeadingAge.
This annual award, funded by the McHugh Family & Friends, recognizes a director of nursing or assistant director of nursing who creates a supportive and engaged workplace environment by displaying excellent leadership skills while managing nursing and frontline staff.
The winner receives a $1,000 cash award for professional development, and airfare, lodging, and registration for the LeadingAge Annual Meeting and Expo.
Status: Ongoing
Contact: Natasha Bryant
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Jamey Walker Will Receive 2019 McHugh Leadership Award
Angela Jalloh Receives 2018 McHugh Leadership Award
Building a Care Team with Respect and Relationships
Love of Learning Spurs Innovation for Lasell Village Nurse Leader
Other Areas of Work
HOUSING PLUS SERVICES
Assessing the role of housing plus services models in affordable senior housing communities
NURSING HOMES
Identifying evidence-based practices to enhance nursing home quality
FINANCING
Finding new approaches to financing long-term services and supports
AGING & HEALTH
Building a robust evidence base for healthy aging
CONSUMER ENGAGEMENT
Engaging older adults in our work, and encouraging other LTSS organizations to do the same
WORKFORCE
Exploring strategies for strengthening the LTSS workforce