Nursing Aides - Appendix G

Nursing Aides, Home Health Aides, and Related Health Care Occupations -- National and Local Workforce Shortages and Associated Data Needs

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Appendix G. Annotated Bibliography

In addition to the national database, several states and private entities also collect or analyze data related to direct care workers. This appendix presents the following examples.
National
Crown WH, Ahlburg DA and MacAdam M. (1995). The demographic and employment characteristics of home care aides: A comparison with nursing home aides, hospital aides, and other workers. The Gerontologist, 35(2), 162-170.
Based on the 1987-1989 CPS March Supplement data, this article describes demographic characteristics and work conditions of home care aides, nursing home aides, hospital aides, and other workers.
General Accounting Office (2001). Nursing workforce: Recruitment and retention of nurses and nurse aides is a growing concern. Washington, DC: Author.
This report addresses the concerns about recruitment and retention of nurses and nurse aides. It contains CPS and OES data that are relevant to direct care workers Note that the definitions of direct care workers in CPS data are different from those by Crown et al. (1995).
Leon J and Franco SJ. (1998a). Home and Community-Based Workforce. Bethesda, MD: Project HOPE.
Part of this report shows results of telephone interviews with 623 home care workers, mostly paraprofessionals, throughout the country. Respondents of Medicare Current Beneficiary Survey identified the sample. The report provides a profile of workers and compares them by employment type (agency vs. self-employed) as well as occupation title.
North Carolina Division of Facility Services (1999). Comparing state efforts to address the recruitment and retention of nurse aide and other paraprofessional aide workers. Author.
The author conducted a survey of State Medicaid agencies and State Units on Aging in 50 states to collect information addressing policy issues related to aide wages and benefits and actions underway or being considered to address aid worker shortages. Forty-eight states responded. The majority of states said that aide recruitment and retention was a major workforce issue, and a number of states have either taken action or are considering action to address the issue. Actions include wage pass through, enhanced incentives, shift differentials, transportation reimbursement, career ladders, training, and establishment of work groups.
North Carolina Division of Facility Services (2000). Results of a follow-up survey to states on wage supplements for Medicaid and other public funding to address aide recruitment and retention in long-term care settings. Author.
This is a follow-up study of the survey conducted a year before. This report focuses on implementation of wage pass through. The impact of wage pass through was different among states; some reported positive effect while others reported negative and no effects.
State
Florida
Florida Department of Elder Affairs (2000). Recruitment, training, employment and retention report on certified nursing assistants in Florida's nursing homes. Tallahassee, FL: Author.
This report reviews existing literature on recruitment and retention of CNAs in nursing homes. Key issues include: severity of CNA shortages, training, screening, as well as need for more data.
Salmon JR, Crews C, Reynolds-Scanlon S, Jang Y, Weber SM, and Oakley ML. (1999). Nurse aide turnover: Literature review of research, policy and practice. Tampa, FL: Florida Policy Exchange Center on Aging.
This report, produced for Florida Department of Elder Affairs, reviews existing research on turnover of nurse aides. Key issues include: worker profile, wages and benefits, job design, burnout, and training.
Iowa
Hill SB. (1998 and 1999). Certified nursing assistant recruitment and retention pilot project. Des Moines, IA: Iowa Caregivers Association.
This project was funded by Iowa Department of Human Services to conduct a CNA recruitment and retention pilot project. The project has four phases: a mail survey of CNAs in the State to identify factors potentially related to turnover, two focus groups of CNAs, pilot project interventions, and evaluation of the intervention. The results of phases 1 (survey) and 2 (focus groups) are available at Iowa Caregivers Association.
New York
New York Association of Homes and Services for the Aging (2000). The staffing crisis in New York’s continuing care system: A comprehensive analysis and recommendations. Albany, NY: Author.
The report consists of literature review, results of a survey of 672 nursing home providers throughout the states (250 responded), and telephone survey results of 86 randomly selected association members in different settings. The report demonstrates the serious worker shortages in the long-term care system in New York State and makes several policy recommendations.
New York State Long-Term Care Policy Coordinating Council (1988). New York State home care worker study: Phase 1: agency survey. Albany, NY: Author.
A mail survey was conducted with 1,144 home care agencies and programs in New York State (final sample n=523). The report contains information on agency characteristics, client characteristics, staff organization, wages, benefits, promotional opportunities, worker training, worker recruitment, worker shortage, and worker turnover.
New York State Long-Term Care Policy Coordinating Council (1990). Recommendations for action: Recruitment, training and retention of home care workers. Albany, NY: Author.
Based on their studies on home care agencies, home care labor market, and home care workers, the authors make recommendations to improve recruitment and retention of home care workers.
Ohio
Glock P. (1995). Home health aide and homemaker survey report. Columbus, OH: The Ohio Department of Aging.
This report gives results of a mail survey of 453 home care agencies. The study covers such issues as: wages and benefits, career track of paraprofessionals, reasons for leaving, shortage of workers, and training of workers.
Straker JK and Atchley RC. (1999). Recruiting and retaining frontline workers in long-term care: Usual organizational practices in Ohio. Oxford, OH: Scripps Gerontology Center at Miami University.
Telephone interviews were conducted with administrators of 112 nursing homes and 100 home health agencies in Ohio to understand more about long-term care employers’ recruitment and retention practices. The study found that most agencies dramatically underestimated the extent of their turnover problem and did not collect adequate data on the extent and cost of turnover. It was also found that organizational climate rather than economic factors have more impact on turnover rates. Also, employers with high turnover rates are found to conduct different interventions from those with lower turnover rates.
Pennsylvania
Pennsylvania Intra-Governmental Council on Long-Term Care (2001). In their own words: Pennsylvania's frontline workers in long-term care. Harrisburg, PA: Author.
This report shows results of 15 focus groups of frontline workers in different long-term care settings. Key issues surrounding recruitment and retention of direct care workers are discussed from workers' perspectives.
Pennsylvania Intra-Governmental Council on Long-Term Care (2001). Pennsylvania's frontline workers in long-term care: The provider organization perspective. Harrisburg, PA: Author.
This report shows results of 901 telephone interviews with administrators in different long-term care settings throughout the state. The study covers a wide variety of issues surrounding recruitment and retention of frontline workers, including: worker profile, severity of the shortage, consequences of shortages, strategies for handling shortages, and barriers to recruitment and retention.