The One-Two Punch of High Wages and Empowerment on CNA Retention

Objectives: The objective of this study was to examine the relationship between high wages and empowerment practices on certified nursing assistant (CNA) retention, necessary for providing high-quality care for nursing home (NH) residents. Methods: Measures of provider-level CNA empowerment and wages from the 2015 Ohio Biennial Survey were used to estimate two regression models on retention ( n = 719), one without and one with an interaction term of high wages and high empowerment. Results: Only in the context of the interacted model were NHs that provided both high wages and high empowerment associated with a 7.09 percentage-point improvement in the CNA retention rate ( p = .0003). Individually, high wages and a high empowerment score were not statistically significant in either regression model. Discussion: Retaining CNAs in NH communities requires a combination of empowerment practices (e.g., involving CNAs in decision-making about hiring other staff) and high hourly wages.

Short-stay admissions and lower staffing associated with larger COVID-19 outbreaks in Maryland nursing homes

Objectives: Identify facility factors associated with a larger COVID-19 outbreak among residents in Maryland nursing homes (NHs). Design: Observational Setting and Participants: All Maryland NHs. Methods: Resident COVID-19 cases were collected for each Maryland NH from January 1, 2020 through July 1, 2020. Cumulative COVID-19 incidence through July 1, 2020 was collected for each county and Baltimore City. Facility characteristics for each Maryland NH were collected from time periods prior to January 1, 2020. NH outbreaks were defined as larger when total resident COVID-19 cases exceeded 10% of licensed beds. Descriptive and multivariable analyses were conducted to assess the strongest predictors for the primary outcome of larger COVID-19 outbreak. Results: NHs located in counties with high cumulative incidence of COVID-19 were more likely to have larger outbreaks (OR 4.5, 95% CI 2.3-8.7, p<0.01). NHs with at least 100 beds were more likely to have larger outbreaks, especially among facilities with >140 licensed beds (100-140 beds vs <100 beds: OR 1.9, 95% CI 0.9-4.1, p=0.09; >140 beds vs <100 beds: OR 2.9, 95% CI 1.3-6.1, p<0.01). NHs with more short-stay residents (OR 2.2, 95% CI 1.1-4.8, p=0.04) or fewer Certified Nursing Assistant hours daily (OR 2.6, 95% CI 1.3-5.3, p<0.01) also were more likely to have larger outbreaks. Resident race and gender were not significant predictors of larger outbreaks after adjustment for other factors. Conclusions: Large NHs with lower staffing levels and many short-stay residents in counties with high COVID-19 incidence were at increased risk for COVID-19 outbreaks. Understanding the characteristics of nursing homes associated with larger outbreaks can help us prepare for the next pandemic.

Short-Stay Admissions Associated With Large COVID-19 Outbreaks in Maryland Nursing Homes

At the beginning of the COVID-19 pandemic, some nursing homes (NHs) in Maryland suffered larger outbreaks than others. This study examined how facility characteristics influenced outbreak size. We conducted a retrospective analysis of secondary data from Maryland NHs to identify characteristics associated with large outbreaks, defined as when total resident cases exceeded 10% of licensed beds, from January 1, 2020, through July 1, 2020. Our dataset was unique in its inclusion of short-stay residents as a measure of resident type and family satisfaction as a measure of quality. Facility characteristics were collected prior to 2020. Like other studies, we found that large outbreaks were more likely to occur in counties with high cumulative incidence of COVID-19, and in NHs with more licensed beds or fewer daily certified nursing assistant (CNA) hours. We also found that NHs with a greater proportion of short-stay residents were more likely to have large outbreaks, even after adjustment for other facility characteristics. Lower family satisfaction was not significantly associated with large outbreaks after adjusting for CNA hours. Understanding the characteristics of NHs with large COVID-19 outbreaks can guide facility re-structuring to prevent the spread of respiratory infections in future pandemics.

Preserving the Activities of Daily Living Independence in Late Life

Levels of Assistance (LoA) is an effective caregiving intervention for maintaining activity of daily living (ADL) independence. It is a structured, almost prescriptive, approach to encourage completing ADLs as independently as an elder’s capabilities permit. With appropriate prompts and assistance during dressing, elders can overcome disability, express retained competencies, and experience success. Simultaneously, caregivers learn to view their functions as maintaining the quality of life of able elders, and they receive reinforcement from elders who are more confident and happier. This study is a continuation of a previous project that created and tested a computer application training program for LoA in nursing homes. We refined the app to include grooming LoA and tested on 10 certified nursing assistant (CNA)/resident dyads at a local nursing home. The pilot results showed, although we did not see consistent improvement in CNA’s dressing LoA, we achieved 10% to 30% improvement in grooming LoA. This indicates that the dressing assistance training is able to transfer to grooming LoA. With only an average of one-hour app training, this improvement is cost effective as compared to training provided by care professionals. Future studies should consider incorporating a culture change strategy to improve CNAs’ intention for assisting elders. In addition, the training program should be offered in the initial hire to achieve maximum effect.

Certificate-Of-Need Regulation and Healthcare Service Quality: Evidence from the Nursing Home Industry

This quantitative study investigates the effect of certificate-of-need (CON) regulation on the quality of care in the nursing home industry. It uses county-level demographic data from the 48 contiguous US states that are extracted from the American Community Survey (ACS) and cover the years 2012, 2013, and 2014. In doing so, it employs a new set of service quality variables captured from a variety of county-level data sources. Instrumental variables results indicate that health survey scores for nursing homes that are computed by healthcare professionals are about 18–24% lower, depending on the type of nursing home under consideration, in states with CON regulation. We also find that the presence of CON regulation leads to a substitution of lower-quality certified nursing assistant care for higher-quality licensed practical nurse care, regardless of the type of nursing home under consideration.

Health Assets, Vocation and Zest for Healthcare Work. A Salutogenic Approach to Active Coping among Certified Nursing Assistant Students

People’s health assets (HA) mapping process and design dynamization strategies for it are paramount issues for health promotion. These strategies improve the health heritage of individuals and communities as both the salutogenic model of health (SMH) and health assets model (HAM) defend. Connecting and mobilizing HA and strengthens the ‘sense of coherence’ (SOC) are both related to enhancing stress active and effective coping strategies. This study aims to describe the HA present in a population of certified nursing assistant students (n = 921) in Spain and then to explore their relationships with the SOC, the motivation to choose healthcare studies and their academic performance. A great variety of HA were identified and mapped. Findings showed that individuals with greater motivation towards self-care and ‘caring for others’ as internal HA, possessed higher SOC levels and a strong vocation for healthcare work. Differences in HA were identified according to gender, age and employment situation. Consistent connections between the care–relation factor and vocational factor with interpersonal and extrapersonal HA were reported. Evidence and results substantiated the salutogenic and asset-based approach as a proper strategy to strengthen SOC, dynamize their HA map, reinforce the sense of calling and enable Certified Nurse Assistant (CNA) students to buffer against caregiving-related stress and thrive in their profession.

ONE-TWO PUNCH OF HIGH WAGES AND EMPOWERING PRACTICES FOR MAINTAINING CARE NETWORKS IN NURSING HOMES

Stabilizing certified nursing assistant (CNA) employment is necessary for maintaining care networks and providing high quality of care for nursing home (NH) residents. This study’s objective was to examine the relationship of high wages and empowerment practices on CNA retention. We used the 2015 Ohio Biennial Survey to construct a facility-level dataset of 547 NHs and estimated multivariable linear regressions. NHs that provided both high wages and high empowerment were associated with a 12.95 percentage-point improvement in the CNA retention rate (SE = 4.53, t-value = 2.86, p = 0.0045). High wages and a high empowerment score did not have significant effects individually (p &gt; .05). Retention rates were similar between NHs that lacked high wages and scored low on the empowerment scale, and NHs that provided one at a high level but not the other. Implications for better retaining CNAs require multiple empowerment practices combined with high hourly wages.

ASSESSING APATHY IN LONG-TERM CARE RESIDENTS WITH DEMENTIA: COMPARING SELF-EVALUATION WITH PROXY RATINGS

Background: Apathy affects most individuals with dementia in long-term care. Apathy assessment is fundamental for appropriate treatment. Apathy involves subjective feelings thus individual’s self-evaluation may offer important perspectives for assessment. However, it is unclear whether self-evaluation is a valid assessment approach for this population. This study compared apathy ratings from resident self-evaluation to assessments from family, clinicians, and research staff. Methods: This pilot study enrolled 8 residents from two long-term care facilities in Pennsylvania. One family member, one certified nursing assistant (CNA), and one nurse or activity staff were also enrolled for each resident. Researchers interviewed each resident using the Apathy Evaluation Scale (AES) and rated their apathy levels. Family, CNAs, and nurses/activity staff independently rated the resident’s apathy level using the AES. Direct observations were conducted by researchers using the Person-Environment Apathy Rating (PEAR). Results: Correlation analysis revealed a discrepancy across raters in assessing apathy. While self-evaluation and family ratings where moderately positively correlated (r=0.48, p=.23), there was a moderate correlation in the opposite direction between self-evaluation and CNA ratings (r=-0.64, p=.09). Resident self-evaluation did not correlate with nurses/activity staff ratings (r=0.01, p=.99) or researcher observations (r=-0.08, p=.86). Discussion: These findings may reflect residents’ cognitive impairment and lack of insights, family and clinicians’ lack of understanding of apathy, or nurses’ and researchers’ lack of acquaintance with the resident. It remains undetermined whether self-evaluation provides valid information for apathy assessment for this population. Additional research is necessary to identify the most valid assessment approach for long-term care residents with dementia.