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Meet PHI’s New Director of Policy Research

June 26, 2017

Kezia Scales, PhD, recently joined PHI as its Director of Policy Research, where she will oversee our national research agenda, ensuring that long-term care leaders and policymakers have the data they need to improve the quality of jobs in direct care and the quality of care we all receive.

Tell us a bit about yourself.
I’ve been studying direct care workers for almost 10 years with the goal of demonstrating their value to long-term care. My approach to this research is “interdisciplinary,” meaning that I combine different approaches including policy studies, sociology, health services research, and nursing science. I think of this work as rooted in social justice as well as clinical best practice, because it’s about ensuring that everyone who provides or receives long-term care is treated with respect and fairness. I’ve collaborated with a lot of dedicated researchers and advocates through my research and I’m excited to bring that collective enthusiasm and expertise to my work at PHI.

What drew you to PHI?
Since I first began researching the direct care workforce, I’ve looked to PHI for up-to-date workforce data, insightful policy analyses, and promising best practices. I’ve particularly admired how PHI addresses job quality at every level, from pre-service training for direct care workers through federal policymaking – because changes at every level are required if we are to achieve lasting improvements. For these reasons, I truly can’t imagine where else I’d rather be!

Prior to PHI, you became a nursing assistant to more closely study the experiences of nursing assistants. What did you learn from this experience?
That’s right – in fact, during my research career, I’ve spent quite a lot of time conducting “participant observation” as a nursing assistant in different settings. Providing hands-on care has given me many valuable insights into nursing assistants’ knowledge and experiences. For one thing, I have seen the diverse skills that nursing assistants and other direct care workers bring to their daily work – skills which are critically important but in many cases invisible to the “outside world.” For example, direct care workers often serve as the key link between individuals, their families, and other members of the health-care team – a role which requires considerable skills in communication, negotiation, and relationship-building as well as flexibility and adaptability. My research has convinced me that we need to better recognize – through training, supervision, and compensation – the full range of skills that direct care work requires.

You’ve also been published extensively in journals such as Sociology of Health and Illness, Ageing and Society, Social Science and Medicine, and the Journal of Interprofessional Care, to name a few. What are a few topics you’ve studied?
A key focus of my research has been the concept of “person-centered care,” or care organized around an individual’s needs, preferences, and goals. In some of my publications, I’ve highlighted the essential role of direct care workers in delivering person-centered care, while also drawing attention to the obstacles they face. For example, in nursing homes, we’ve seen valuable efforts to “empower” nursing assistants to provide person-centered care through promoting choice, independence, and autonomy. However, nursing assistants often don’t have enough time to encourage independence, or they struggle to balance autonomy with safety – or they still feel disempowered within the larger health-care team. I’ve argued that if we want to see person-centered care in practice, we have to partner with frontline workers to identify and address these broader challenges.

What are some initial areas of work you’d like to tackle at PHI?
Overall, I’m looking forward to working with PHI to continue building the case for improving long-term care services through a focus on the direct care workforce. There are a lot of issues that I’m eager to tackle, but one timely priority is to incorporate direct care workers into conversations about “health-care transformation” in more meaningful ways. Whether we’re talking about care coordination, values-based payment, or person-directed care, direct care workers should be an integral consideration, not an afterthought. To advocate for their meaningful inclusion in these conversations, we need to continue building the evidence base about what direct care workers do, what they can or could do, and why it matters.

Why is research important to the future of direct care?
The future of direct care is now: we are already seeing a growing gap between the need for long-term care and the availability of workers to provide that care. But to develop sustainable solutions, we need reliable evidence about “what works” – such as, what strategies are most effective for attracting new applicants into the direct care workforce, or for encouraging direct care workers to remain in their jobs? By evidence, I mean quantitative data but also individual stories. These stories help bring the numbers to life and remind us that long-term care is about real people, not just statistics and policies and financial bottom lines.

On a personal level, what’s in store for you this summer?
As well as diving into my new role at PHI, in my spare time this summer I will be helping my husband design and construct a “tiny office” in the backyard of our home in Durham, North Carolina. That will allow us to transform my existing office space into a nursery for our new daughter, who we look forward to welcoming in September!

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