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PRESS RELEASE: Investing in Direct-Care Jobs Improves Outcomes at Long-Term Care Organizations

June 28, 2011

New PHI Publication Series Documents Innovations That Improve Quality of Care and Jobs

Bronx, NY — Long-term care providers across the nation are investing in their direct-care workers as part of their efforts to improve the quality of care and quality of life for elders and people with disabilities. Their innovative approaches to transforming their industry are showcased in a new PHI series of case studies and best practices.

The series offers concrete examples of how long-term care employers — nursing homes, home care organizations, and residential long-term care facilities — are achieving their visions of relationship-centered care, in which consumers and the caregivers closest to them have greater control over everyday decision making.

These employers use a "high investment, low turnover" approach to their direct-care staff, which results in better quality care.

Each of the featured employers recognizes that the key to delivering quality individualized care is its frontline workforce. These employers have reversed the industry's usual strategy of low investment and high turnover among direct-care workers and instead use a high investment–low turnover approach that results in better quality care. They are both raising the floor — by providing better training and higher wages — and building career ladders that give direct-care workers greater opportunities for professional growth.

Today there are more than 3 million direct-care workers, and an additional 1.1 million will be needed by 2018. It is nearly the largest occupational group and fastest-growing workforce in the nation, but also one of the most poorly paid. Many employers are now realizing that attracting a stable, quality workforce requires a different approach to workforce development.

"These employers are operating with a 'quality care through quality jobs' framework that truly values the contributions of all employees — especially direct-care workers, who provide the lion's share of hands-on long term care in this country," said Marcia Mayfield, PHI director of evaluation and project director for the series.

"Investing in this workforce, these employers assert, provides a multitude of benefits for their organization, for their employees, and for the individuals they serve and support," Mayfield said. "These case studies and best practices back up those claims with measurable results for each of these stakeholders. Taken together, they contribute to the growing body of evidence that investing in one's workers makes good business sense."

"The aging population and stagnant growth in other industries have made direct-care workers more essential than ever," said Barbara Dyer, president and CEO of the Hitachi Foundation, which funded the case studies and best-practice profiles.

"And yet," Dyer continued, "too many direct-care jobs are low-quality with sharply limited career options. The person-centered health care providers profiled by PHI demonstrate that investing in the training, compensation, and career opportunities of direct-care workers can provide considerable competitive advantages in the years to come."

Case Studies

The Business of Caregiving, a series of eight in-depth case studies, focuses on overarching management philosophies that have led to better-quality jobs for direct-care workers and better-quality care for consumers.

The organizations profiled are diverse, including a newly-developed Green House® in the South, a PACE program in upstate New York, nursing homes from the East and West coasts, retirement communities, and both rural and urban home care services.

The common thread uniting the featured organizations is that they have all implemented practices designed to attract and retain a strong direct-care workforce, resulting in positive changes for the business, the workers, and the consumers.

Among the practices highlighted are The PHI Coaching ApproachSM, which builds communication and problem-solving skills and provides a strong foundation for relationship-centered caregiving; accessible and affordable education and career advancement opportunities; peer mentor programs; and participatory management styles, including self-managed teams.

Several of the nursing facilities featured report that investing in frontline staff is essential to their efforts to implement changes such as consistent assignment, self-managed households, and individualized care.

Several of the case studies, which are available online, also include a multimedia component, such as podcasts, photo slideshows, video clips, and downloadable charts.

Best Practices

The series' 20 "best practice" profiles highlight specific approaches to reducing turnover, promoting job satisfaction, and implementing relationship-centered care. These profiles are intended to offer enough detail to encourage other long-term care providers to adapt the practices within their own organizations.

Each of the best practices provides details on:

  • Practice implementation
  • Outcomes of the new initiatives
  • Lessons learned — both challenges and successes
  • Background on the organization and contact information to learn more

For example, St. Peter Villa, a long-term care facility in Memphis, succeeded in reining in sky-high turnover among its certified nursing assistants (CNAs) by introducing a career ladder in 1999. Since then, turnover is down considerably, as CNAs have a way to learn new skills, advance their careers, and earn more money without having to get a different job.

Sectoral Workforce Development

PHI was funded by the Hitachi Foundation because of its industry role as a sectoral workforce development organization. PHI is the only national organization focused solely on improving jobs for direct-care workers as a strategy for strengthening long-term care businesses and improving care for elders and people with disabilities.

PHI's sectoral strategy is described in a new paper, entitled "Improving Jobs and Care: a National Sector Strategy." Authored by PHI President Steven Dawson, the paper provides workforce development practitioners with a deeper understanding of how PHI has succeeded in influencing the fields of long-term care and workforce development — and the challenges and opportunities going forward.

The paper was presented in late May at the "Building Ladders and Raising the Floor Conference," sponsored by PHI and Jobs for the Future in Washington, DC.

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PHI ( is a national organization that works to improve the lives of people who need home or residential care — and of the direct-care workers who provide that care. PHI's work is grounded in the philosophy that quality jobs for direct-care workers will lead to quality care for long-term care consumers.

Karen Kahn, PHI Communications Director

Deane Beebe, PHI Media Relations Director

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