COVID-19 Exacerbated Long-standing Challenges for the Home Care Workforce.

The purpose of this study was to understand staffing challenges faced by home care (including home health) agencies due to the COVID-19 pandemic and the policies and practices put into place by the federal government, state governments, and home care agencies themselves to mitigate these challenges. This study included a review of federal and state policy changes enacted in reaction to the pandemic from March through December 2020, a review of home care agency practices described in media reports, peer-reviewed literature, and gray literature focused on responses to workforce challenges encountered during the pandemic, and interviews with a variety of stakeholders. Some of the challenges encountered were entirely new and resulted directly from the pandemic.

Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey.

Purpose: To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies.

Design And Methods: Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics.

The home health workforce: a distinction between worker categories.

The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes.

Design and operation of the national home health aide survey: 2007-2008.

This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability.

Nursing home work practices and nursing assistants' job satisfaction.

Purpose: To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes.

Design And Methods: Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants' overall job satisfaction, controlling for personal characteristics and local labor market characteristics.

Why do they stay? Job tenure among certified nursing assistants in nursing homes.

Purpose: This study identifies factors related to job tenure among certified nursing assistants (CNAs) working in nursing homes.

Design And Methods: The study uses 2004 data from the National Nursing Home Survey, the National Nursing Assistant Survey, and the Area Resource File. Ordinary least squares regression analyses were conducted with length of job tenure as the dependent variable.

The National Nursing Assistant Survey: improving the evidence base for policy initiatives to strengthen the certified nursing assistant workforce.

Purpose: This study introduces the first National Nursing Assistant Survey (NNAS), a major advance in the data available about certified nursing assistants (CNAs) and a rich resource for evidence-based policy, practice, and applied research initiatives. We highlight potential uses of this new survey using select population estimates as examples of how the NNAS can be used to inform new policy directions.

Design And Methods: The NNAS is a nationally representative survey of 3,017 CNAs working in nursing homes, who were interviewed by phone in 2004-2005.

Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives.

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers.

An introduction to the National Nursing Assistant Survey.

Objectives: This report provides an introduction and overview of the National Nursing Assistant Survey (NNAS),the first national probability survey of nursing assistants working in nursing homes. The NNAS was designed to provide national estimates and to allow for separate estimates to be calculated for nursing assistants by geographic location of the agency and for workers by tenure at the sampled facility. This report includes a description of relevant research that led to federal interest in sponsoring the NNAS, types of data collected, methodology, linkage between the NNAS and the 2004 National Nursing Home Survey (NNHS), advantages of combining establishment and worker surveys, and potential uses of the data.

The future of Cash and Counseling: the framers' view.

Objective: This paper reflects on the progress of the original Cash and Counseling states, and shows how this model has spread, how it has evolved over time, and what is left to improve. It then discusses the generalizability of the Cash and Counseling approach beyond long-term care and ventures some thoughts on what still needs to be learned. Finally, this paper suggests some of the contingencies that could affect the diffusion of this innovation.

Determining personal care consumers' preferences for a consumer-directed cash and counseling option: survey results from Arkansas, Florida, New Jersey, and New York elders and adults with physical disabilities.

Objective: To assess Medicaid consumers' interest in a consumer-directed cash option for personal care and other services, in lieu of agency-delivered services.

Data Sources/study Setting: Telephone survey data were collected from four states from April to November 1997. Postsurvey focus groups were conducted in four states in 1998.

Cash and counseling and managed long-term care?

This article presents the results of a survey on the interest of managed care organizations (MCOs) in developing a "cash and counseling" (C&C) option for delivering long-term personal assistance services. Forty-five percent of the respondents expressed interest, at least for some clients. Although specific experience with consumer direction did not have an effect, three organizational factors--larger size, non-PACE, and not limited to the elderly--predicted MCOs' willingness to consider this option.

Consumer direction in managed long-term care: an exploratory survey of practices and perceptions.

Purpose: This article presents results of a survey of the attitudes and practices of managed care organizations (MCOs) concerning consumer direction. The study focused on understanding several alternative measures of consumer direction and the factors that are associated with the MCOs concerning those measures.

Design And Methods: The MCOs that were surveyed provided capitated managed long-term care benefits to their Medicaid-eligible clients and were chosen because personal assistance service is a likely area for consumer-direction interest or practice.