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Researchers Highlight Long-Term Care Workforce Research—and Gaps

By Kezia Scales, PhD (she/her) | December 2, 2019

In November 2019, I attended the Annual Scientific Meeting of the Gerontological Society of America (GSA) to share the findings from PHI’s newly released report, Envisioning the Future of Home Care. My presentation was part of a symposium on the intersection between long-term care workforce issues and care quality outcomes. The symposium showcased a range of diverse research, including on changes in regulatory requirements for assisted living staff, on staff experiences providing end-of-life care, and on the role of direct care workers in “convoys of care.”

After the symposium, I asked the co-chairs—Lindsay Schwartz, Associate Vice President of Workforce Quality and Improvement for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), and Candace Kemp, Professor at the Gerontology Institute at Georgia State University—to share with PHI’s readership their analysis of the rich content that was presented and discussed. (The symposium was also co-chaired by Howard Degenholtz from the University of Pittsburgh, and the Eldercare Workforce Alliance’s Amy York served as the discussant.)

Kezia Scales: What inspired you to plan this symposium on the long-term care workforce?

Lindsay Schwartz: I was particularly inspired by this year’s conference theme, which was “Strength in Age: Harnessing the Power of Networks.” At AHCA/NCAL, we know that a strong workforce is key to ensuring quality outcomes for long-term care consumers. And I think that it is imperative to reach out to other individuals and organizations to collaborate—as a network—in developing and implementing strategies to achieve that goal.

Candace L. Kemp: Research shows that long-term care delivery is complex and dynamic and involves a myriad of care partners. Research also shows that those who provide the bulk of hands-on paid care—direct care workers—have a distinct influence on the nature and quality of long-term care. The care they provide is critical to care outcomes. But these workers have physically and emotionally demanding jobs and require various types of support to provide the best care possible. Like Lindsay said, this symposium was a way to bring together different perspectives and to collaboratively unpack and understand these complex issues.

KS: What were your goals for the session?

LS: I hoped to bring awareness to some of the workforce challenges facing long-term care and acknowledge research gaps—and ultimately, to inspire collaboration to fill these gaps.

CLK: Raising awareness was definitely key, as well as inspiring dialogue and thinking critically and strategically about workforce challenges. Another important goal was to highlight potential policy and practice recommendations and, as Lindsay notes, to identify areas where more research and knowledge are needed.

KS: What important themes emerged from across the three presentations, from your perspective?

CLK: For me, the overarching theme was the centrality of relationships in understanding long-term care and how to improve it. Rightfully so, tremendous emphasis is placed on person-centered care. But we also need to be thinking about those who provide care and understanding their situations, needs, and experiences. The relationships they have with those they care for are essential to their work-related quality of life and to care outcomes. Recognizing the conditions under which care is given and received is essential to addressing workforce challenges.

LS: The importance of addressing the gaps in workforce research to improve retention and turnover stood out for me. We lack critical workforce data, including data on current workforce shortages and on the impact of workforce interventions. Policymakers and advocates need these data in order to develop meaningful solutions. Data on the impact of efforts to increase wages and benefits (even informal benefits, like paying for oil changes, as one innovative example) is vital, to determine if better compensation is more cost-effective than turnover. Other themes included the importance of training and supportive employment practices for direct care workers, and the need to provide opportunities for workers to provide feedback on what training or support they need to be successful in their role.

KS: Was there anything in the symposium that surprised you or stood out for you?

CLK: I think this session really drove home the importance of recognizing direct care workers in big and small ways and enhancing the intrinsic and extrinsic rewards associated with the hard and meaningful work they do. They are so important to care quality and need to be seen, heard, recognized, respected, and valued.

LS: I was struck by the research on how staff are impacted by the death of residents [in assisted living]. Like I said, when thinking about workforce issues and how we can support our direct care workers, we need to make sure we are asking what they need to do their jobs successfully. Hearing directly from workers not only helps us develop effective support and training programs but also lets workers know that they matter and their voice is important.

This symposium was organized by the Assisted Living and Research in Quality Care interest groups at GSA. Details of all the research presented in the symposium can be found on page 85 of the conference program.

Kezia Scales, PhD (she/her)
About The Author

Kezia Scales, PhD (she/her)

Vice President of Research & Evaluation
Kezia Scales leads PHI’s strategy for building the evidence base on state and national policies and workforce interventions that improve direct care jobs, elevate this essential workforce, and strengthen care processes and outcomes.

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