The U.S. is desperately short of nurses, personal care aides, and other direct care workers who help frail older adults and younger people with disabilities manage their days. Instead of dealing with the problem, policymakers have, predictably, devolved into their usual partisan blame-mongering. Watch, if you can, this recent hearing of the House Energy and Commerce Committee on the worker shortage.
Minimum staffing requirements recently proposed by the federal government never will succeed without a sufficient pool of willing workers. Fundamentally fixing the problem will require more money—lots more—along with immigration reform, increased support for family caregivers, funding for nation-wide training of paid aides, and a top-to-bottom rethinking of the ways we provide care. In the current political environment, little of this will happen any time soon, at least at the federal level.
But three modest, low-cost experiments may help in small ways today and point the way to bigger, longer-term solutions.
Leveraging Existing Staff
The first two are based on the same premise: If the long-term care industry can’t recruit the hundreds of thousands more workers it needs, perhaps it could better leverage the staff it already has.
In other words, with better training, staff may more effectively care for residents of senior living communities—a potential win for everyone in an extremely difficult environment.
Resident-Centered Care
One idea, designed by a group of creative nursing home operators under the banner of the Center for Innovation, is built around interactive training modules that teach staff how to better provide true resident-centered care.
The program primarily is geared to direct care workers, such as nursing aides. But it is available to all staff, including maintenance, food service, nurses, and administrators.
It starts with four brief online classes on topics such as supporting independence among older residents, teamwork with other staff, and better understanding the power of individual actions. Staff take these 10-15 minute sessions on their own.
Once staffers complete the four modules, they can continue their learning through virtual, live, instructor-led sessions.
The model has been piloted in Florida and Arkansas. The group says participants who completed the program were more likely to get to know residents on a personal level, more likely to agree that older adults have the right to take risks, and less likely to define success as merely completing a daily checklist of tasks.
The center is a joint venture of the Green House Project and the Pioneer Network, recently merged groups representing nursing home and assisted living operators who are focused on providing care tailored to individual residents, sometimes called person-centered care.
Leveraging Maintenance Staff
The second is a demonstration project developed by LeadingAge Maryland, the state arm of a national trade group representing mostly nonprofit senior living operators.
Its goal is to train maintenance staff and property managers at 16 affordable housing communities in Baltimore City, suburban Baltimore County, and rural Harford County, Maryland. They’d learn about the aging process, how to respond to challenging behaviors, how to deliver care targeted to the specific needs of individual residents, and how to better understand the roles of their co-workers.
These staff often have regular, direct contact with residents, but communities rarely think about their roles that way.
Project partners include Catholic Charities Senior Communities, Comprehensive Housing Assistance Incorporated, The Community Builders, CSI Support and Development, and GEDCO. All partners are LeadingAge member organizations.
The project is being funded by two Maryland foundations and will be evaluated by LeadingAge LTSS Center @UMass Boston.
Housing For Aides
The third idea is quite different. Carehaus Baltimore will be a small apartment building that will house 16 older adults and younger people with disabilities and a site manager. When the building opens (scheduled for 2025), residents will receive shared meals, fitness and art classes, physical therapy, and the like. They will pay market rent for apartments in the low-income neighborhood.
But here is the other innovation: The building also will house four paid aides and their families. The aides will not only receive good wages and benefits but also childcare and subsidized housing right in the building. That could be a powerful recruiting tool for direct care workers in a competitive market.
The Baltimore project is a prototype, with the developers planning larger projects in Chicago and elsewhere. Initially, the idea is being funded with philanthropy and it remains to be seen whether it can be financially sustainable. I’ll write more about this and other creative housing ideas for older adults in a future column.
None of these three models will fix the real problem—nursing facilities and senior living desperately need more staff to care for their residents. But by better using the staff they have, and by offering them valuable incentives, these facilities may be able to improve the care they provide for their residents.
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