Understanding Decision Making Among Direct Care Workers in Assisted Living

2016 ◽  
Vol 10 (4) ◽  
pp. 369-390 ◽  
Author(s):  
Sara E. Bowman ◽  
Wendy A. Rogers
Keyword(s):  
Decision Making ◽  
Assisted Living ◽  
Critical Incident ◽  
Adult Population ◽  
Well Being ◽  
Direct Care ◽  
Direct Care Workers ◽  
Assisted Living Facilities ◽  
Term Care ◽  
Care Workers

An increase in the older adult population will likely be associated with an increased need for long-term-care communities, such as assisted living. A primary goal of assisted living communities is to help residents maintain their health and well-being. To accomplish this goal, direct care workers employed in these settings are responsible for monitoring residents for cues that might signal problems and then responding appropriately. However, very little is known about these workers’ decision making. To gain a better understanding, direct care workers from assisted living facilities took part in a critical incident interview and a scenario-based interview. The interview data revealed various cues that were categorized as cognitive, physical, or emotional in nature. Specific explanations for the scenarios were primarily that the situation was the result of a cognitive/emotional/social issue or a physical health issue. The type and number of explanations varied widely from scenario to scenario. Of the actions participants described taking to handle the scenarios, gathering and using information was discussed more than any other action. This research has implications for training of formal and informal caregivers and also highlights the potential need for decision support systems in this domain.

scholarly journals Prevalence of Insomnia Symptoms and Need for an Intervention Among Direct-Care Workers in Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 700-700
Author(s):  
Soomi Lee ◽  
Taylor Vigoureux ◽  
Kathryn Hyer ◽  
Brent Small
Keyword(s):  
Assisted Living ◽  
Behavioral Therapy ◽  
Well Being ◽  
Early Morning ◽  
Direct Care ◽  
Direct Care Workers ◽  
Willingness To Participate ◽  
Term Care ◽  
Care Workers ◽  
Insomnia Symptoms

Abstract This study examined the prevalence of insomnia symptoms among direct-care workers at an assisted-living community and their perceived need for a sleep intervention. Thirty-five participants reported their main sleep-related concerns, willingness to participate in a sleep intervention, and preferred delivery forms/content of the intervention. They also reported nightly sleep characteristics via ecological momentary assessment (EMA) for 2 weeks. 80% reported any sleep-related concern; insomnia-related concern was most prevalent (57%). This was also evident in their EMA reports of waking up in the middle of the night or early morning for 72% of the days. Most (66%) expressed interest in participating in a sleep intervention either online or in group sessions. Mindfulness strategies were most preferred, followed by cognitive-behavioral therapy, and sleep hygiene education. The high prevalence of insomnia symptoms in direct-care workers needs to be addressed by future interventions for their well-being as well as for the quality of care.

Organizational Factors Associated With Retention of Direct Care Workers: A Comparison of Nursing Homes and Assisted Living Facilities

2020 ◽  
Author(s):  
Katherine A Kennedy ◽  
Robert Applebaum ◽  
John R Bowblis ◽  
Jane K Straker
Keyword(s):  
Nursing Homes ◽  
Assisted Living ◽  
Long Term Care ◽  
Direct Care ◽  
Retention Rates ◽  
Direct Care Workers ◽  
Retention Strategies ◽  
Term Care ◽  
Care Workers

Abstract Background and Objectives Low retention of direct care workers (DCWs), either certified nursing assistants in nursing homes (NHs) or personal care assistants in assisted living (AL), continues to be an unresolved problem. While numerous studies have examined predictors of DCW retention in NHs, little attention has been paid to differences between settings of long-term care. This study compares the predictors of DCW retention rates across both settings. Research Design and Methods The 2017 Ohio Biennial Survey of Long-Term Care Facilities provides facility-level information from NHs and ALs (NHs = 739; ALs = 465). We compare the factors that predict retention rates of DCWs utilizing regression analysis. The factors are structural, financial, resident conditions, staffing, and management characteristics, as well as retention strategies. Results Average DCW retention rates were 66% and 61% in ALs and NHs, respectively. Not-for-profit status was significantly associated with higher retention rates across settings. While the percent of residents with dementia and less administrator turnover were associated with significantly higher DCW retention in NHs, these were not significant for ALs. However, in the AL context, a higher county unemployment rate and DCWs’ participation in resident care planning meetings were positively related to DCW retention after controlling for all other covariates, while DCW cross-training was negatively associated. Discussion and Implications Retention strategies for DCWs may need to differ by setting, as a result of differing working environments, resources, and regulations.

Prevalent Insomnia Concerns and Perceived Need for Sleep Intervention Among Direct-Care Workers in Long-Term Care

2020 ◽  
pp. 073346482097861
Author(s):  
Soomi Lee ◽  
Taylor F. Vigoureux ◽  
Kathryn Hyer ◽  
Brent J. Small
Keyword(s):  
Long Term Care ◽  
Well Being ◽  
Direct Care ◽  
Direct Care Workers ◽  
Sleep Onset Latency ◽  
Term Care ◽  
Perceived Need ◽  
Care Workers ◽  
Long Sleep

This study examined sleep concerns among direct-care workers in long-term care and their perceived need for a sleep intervention. Thirty-five participants reported their sleep concerns and willingness to participate in a sleep intervention with preferred delivery forms/content. Multiple sleep characteristics were assessed via ecological momentary assessment and actigraphy for 2 weeks. Eighty percent reported at least one sleep concern with insomnia-related concerns being most prevalent. Those with insomnia-related concerns tended to have long sleep onset latency, frequent awakenings, suboptimal (long) sleep duration, and long naps. Most participants (66%) expressed interest in participating in a sleep intervention either online or in group sessions; interest was higher in those with insomnia-related concerns. Mindfulness strategies were most preferred, followed by cognitive-behavioral therapy and sleep hygiene education. The high prevalence of insomnia-related concerns in direct-care workers needs to be addressed for the well-being of these workers and for the quality of geriatric care delivery.

scholarly journals It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care

2020 ◽  
Author(s):  
Kezia Scales
Keyword(s):  
Long Term Care ◽  
The United States ◽  
Direct Care ◽  
Direct Care Workers ◽  
Term Care ◽  
Home Health Aides ◽  
Emerging Trends ◽  
Care Workers ◽  
Direct Care Workforce

Abstract Nearly 4.6 million direct care workers—including personal care aides, home health aides, and nursing assistants—provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce. Recent events and emerging trends have converged, however, to produce new opportunities to address this longstanding workforce crisis, including the unprecedented attention generated by the coronavirus disease 2019 (COVID-19) pandemic and the systemic shifts to managed care and value-based payment in LTC. This Forum article outlines the pressing direct care workforce challenges in LTC before describing these potential levers of change, emphasizing the importance of not just expanding the workforce but also maximizing direct care workers’ contributions to the delivery of high-quality services for a growing and evolving population of LTC consumers.

scholarly journals DIRECT CARE WORKERS EMPLOYED BY PRIVATE HOUSEHOLDS: A DISTINCT LABOR FORCE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S702-S702
Author(s):  
Christopher M Kelly ◽  
Jerome Deichert ◽  
Lyn Holley
Keyword(s):  
Health Insurance ◽  
Labor Force ◽  
Home Health Care ◽  
Direct Care ◽  
Direct Care Workers ◽  
Full Time ◽  
Term Care ◽  
Private Households ◽  
Care Workers ◽  
The U.S

Abstract Purpose: This study tracks the growing number of direct care workers (DCWs) employed by private households and describes the differences between this often ignored labor force and DCWs employed by agencies. Design and Methods: Data were from the 1% Public Use Microdata Sample (PUMS) of the 2000 and 2017 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed by private households and DCWs employed by agencies, which include outpatient care centers, home health care services, and individual and family services. Results: Between 2000 and 2017, the number of DCWs employed by private households in the U.S. increased 32% and the majority of this growth was since 2007. Compared to DCWs employed by agencies, DCWs employed by private households were more likely to be over age 65, white, unmarried, have higher educational attainment, be more likely to be in poverty, receive health insurance from Medicare or direct-pay. DCWs employed by private households were less likely to be under age 25, nonwhite, Hispanic, speak a language other than English, work year-round and full-time, receive health insurance from an employer or through Medicaid, and have a disability. Implications: DCWs employed by private households represent a small, but growing proportion of the long-term care (LTC) workforce in the U.S. Further, these workers are distinct within the LTC workforce. This has important implications both for DCWs and for families, particularly those with limited LTC options due to location, financial resources, family support, or other factors.

scholarly journals Feasibility of a Mobile Meal Assistance Program for Direct Care Workers in Long-Term Care Facilities in South Korea

2020 ◽  
Vol Volume 15 ◽  
pp. 2019-2029
Author(s):  
Dukyoo Jung ◽  
Jennie C De Gagne ◽  
Minkyung Lee ◽  
Hyesoon Lee ◽  
Kyuri Lee ◽  
...  
Keyword(s):  
South Korea ◽  
Long Term Care ◽  
Direct Care ◽  
Direct Care Workers ◽  
Assistance Program ◽  
Term Care ◽  
Care Workers ◽  
Care Facilities

scholarly journals Aging services workers in the pandemic: Voiced experience of senior center staff & case workers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 968-968
Author(s):  
Esther Okang ◽  
Siobhan Aaron ◽  
Katherine Supiano ◽  
Abdul Osman
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Psychosocial Support ◽  
Well Being ◽  
Direct Care ◽  
Direct Care Workers ◽  
Senior Center ◽  
Senior Centers ◽  
Center Staff ◽  
Care Workers

Abstract The pandemic necessitated immediate shutdown of senior centers, requiring a rapid pivot in the delivery of services to older adults by direct care workers. We provided psychosocial support to older adult service personnel-including Aging and Adult Services case workers and Senior Center Staff, and conducted focus groups with staff at intervals to capture the mid-point of the pandemic (peak of older adult deaths), onset of vaccine availability and the re-entry phase as programs re-opened. We evaluated coping and self-efficacy of workers and discerned sustained high levels of coping and perceived job performance. Using a phenomenological lens, we analyzed transcribed recordings, generated codes, and created categories of experiences. Several themes emerged: personal and professional resilience, passion for serving older adults, motivation to perform their job well, stress of not having face-to-face contact with clients, insufficient resources-especially in rural areas, lack of essential training, feeling disjointed as a team, and work-life balance. Over the course of the pandemic, workers expressed increasing resiliency and skills to navigate the pandemic, oscillations in their fears for their clients’ well-being, and gratitude that they kept their jobs and gained additional State resources. As the vaccine was available and utilized, and as senior centers were reopening, senior center staff were enthusiastic, yet case workers remained apprehensive about long-term consequences of the pandemic. This study affirms the role of direct care workers as essential and valuable. Yet, their expressed need for more education, psychosocial support, and community awareness of their service remains to be addressed.

scholarly journals Voices From the Frontlines in Longterm Care During COVID-19: Narratives of Direct Care Workers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 962-962
Author(s):  
Christin Wolf ◽  
Andrea Freidus ◽  
Dena Shenk
Keyword(s):  
Assisted Living ◽  
Direct Care ◽  
Direct Care Workers ◽  
Retirement Communities ◽  
Structured Interviews ◽  
Formal Caregivers ◽  
Longterm Care ◽  
Global Pandemic ◽  
Care Workers ◽  
Memory Care

Abstract Our study draws from the narratives of 30 staff caring for residents in congregate care communities in central North Carolina from June-September 2020. It is part of phase 2 of an on-going 3-phase rapid qualitative appraisal of workers providing longterm care to older adults with the purpose of disseminating findings to key stakeholders to inform policy, programming, and funding decisions. The 3-phase project involves semi-structured interviews with 60+ participants that were videorecorded using a web-based platform. We report on the emotional and visceral experiences of these direct care workers providing care during the pandemic. We organize the data into four affect categories: fear/anxiety, sadness/grief, anger/frustration, and trauma/stress. The 30 participants include nurses, activities staff, med techs, CNAs, housekeepers, dining staff, chaplains and administrators at nursing homes, assisted living communities, memory care units and continuing care retirement communities. We amplify the voices of these formal caregivers in order to demonstrate how their sensorial and emotive experiences can speak to the human suffering they bore witness to, the underlying ageism that permeates our culture, and the social hierarchy that devalues their labor and their worth as they serve on the frontlines during this unprecedented global pandemic.

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