Abstract
Global successes in improving public health and diagnosing and treating diseases have extended the average life span by decades. However, concomitant success in compressing morbidity into a very short timeframe at the end of life has yet to be achieved. As a result, the large majority of people will need assistance managing their health and functioning. Family and other informal or unpaid caregivers provide much of this needed assistance, but as aging populations rise and available pools of informal caregivers shrink, the need for a well-trained and well-supported paid or formal workforce expands. This issue of the Journal of Applied Gerontology focuses explicitly on that formal workforce that provides long-term services and supports (LTSS), both in community and in institutional settings.
Elisabeth Burgess and colleagues address the issue of sexual harassment from residents experienced by staff in assisted living (AL) facilities. In a qualitative analysis of six AL facilities, drawing on both observational and interview data from staff at all levels, they developed a conceptual model to characterize how sexual harassment was perceived and experienced, and how workers responded to it. Staff developed various strategies to handle this very common experience, and the authors highlight next steps for research and policy implications. In light of current attention to sexual harassment in the political, media, and entertainment arenas, this article presents a new venue to consider with a different set of ethical considerations.
Two articles focus specifically on retaining the nursing facility workforce at both the Certified Nursing Assistant (CNA) and administrator levels. Berridge, Tyler, and Miller conducted interviews with a nationally representative sample of nursing home administrators and directors of nursing to investigate whether staff empowerment practices influence retention rates of CNAs. They developed a staff empowerment scale based on published literature which included seven items such as involving CNAs in care planning and offering incentives or bonuses for extra training or education. Both medium- and high-empowerment facilities had significantly better CNA retention rates compared with low-empowerment facilities. The authors conclude that such empowerment practices, which form the basis of culture change, improve CNA job stability and are therefore worth implementing. While frontline staff turnover is a critical problem in the LTSS workforce, turnover at the administration level can be equally disruptive for nursing home residents and families. Myers and colleagues conducted in-depth interviews with licensed nursing facility administrators (LNFAs) with an average of 24 years in practice. Using previously established frameworks of career resilience and competent administrative practice, the authors identified a variety of sources of work stress as well as professional satisfaction. The article identifies a series of strategic principals and administrative practices aimed at reducing stress and increasing career resilience for this key role, which ultimately influence the resident experience.
Like employees in all industries, paid LTSS workers often have informal caregiver responsibilities of their own. DePasquale and colleagues focus on how informal child and/or elder care responsibilities can compound work stress for men working in the nursing home setting. While job satisfaction did not differ, men with “triple-duty” caregiving responsibilities experienced the most work–family conflict. Furthermore, having control over one’s work schedule moderated perceived stress for men with elder care responsibilities at home. The authors apply these findings in their discussion on recruitment and retention strategies.
The final two articles add international perspectives and shift the setting to care provided in community-based homes, both in Canada and in Shanghai, China. King, Holliday, and Andrews conducted focus groups with home care workers (personal support workers and supervisors, physical therapists, and occupational therapists) aimed specifically at understanding challenges that make home care difficult or dangerous. Each group identified challenges with bathing and toileting as the first or second most difficult challenge, reporting that available assistive devices were inadequate to complete these activities safely. This study identifies multiple avenues for the development of improved bathroom space design and assistive devices. In Chen, Ye, and Kahana’s study of Shanghai government direct care workers, the authors find that cultural factors contribute to workers’ attitudes and subsequently to the high quality of care provided. While acknowledging challenges of the work, the participants focused more on the caring relationships they developed with their clients. They invoked the concept of karma in establishing their strong work ethics, noting their hope of receiving good care when they aged.
This diverse set of articles not only addresses an array of challenges but also identifies wide-ranging successful strategies that can improve the work lives of the paid LTSS workforce and consequently benefit the older adults who rely on their kind and competent care.