Workforce solutions from your peers: a new information resource offers examples of ways owner/operators have addressed the staffing issue. (Feature Article).

Long-term care providers don't need to be told that the problem of high turnover among nursing assistants and home health aides is of grave concern. What they do need are field-tested solutions that can help build and maintain a stable, high-quality workforce.

A new online resource, the Practice Profile Database, lets providers access information about programs that have been working for their peers. The database is a searchable list of practices that have been linked to increased retention, reduced turnover, elimination of "pool" workers, decreased overtime, increased worker satisfaction, and other positive outcomes.

Created as part of two federally funded projects aimed at helping providers recruit and retain qualified direct-care workers, the database is a collaboration between two nonprofit organizations: the Paraprofessional Healthcare Institute (PHI), a national healthcare employment and advocacy organization based in the South Bronx, New York, and the Institute for the Future of Aging Services (IFAS), a policy research center within the American Association of Homes and Services for the Aging (AAHSA). The database is housed on the Web site of PHI's National Clearinghouse on the Direct Care Workforce (at www.directcareclearinghouse.org/practices).

Each profile in the database describes a program's objective, key components, and other main features, including contact information for someone who is closely involved in implementing the practice and can answer questions for those who want more detail. Profiles also link to published articles and other printed materials describing the practices. Visitors may view all entries or search the database by provider type (home-and community-based or nursing home), by category (recruitment, entry-level training, etc.), or by typing in any keyword.

"Providers want to know what works," says PHI President Steve Dawson, "and so the database provides concrete answers from across the spectrum--in nursing homes, home-care agencies, and personal-care programs."

To identify successful programs, the research team contacted scores of experts around the country, distributed a call for nominations through trade shows and other outlets, and conducted a literature review. An expert panel developed the criteria for inclusion, ruling that practices must have been in place for at least six months and must show quantitative or qualitative evidence of having positively affected the direct-care workforce.

Although few of the programs included have been formally evaluated, all show some improvement in such indicators as retention of newly trained workers, worker satisfaction, turnover rates, the use of temporary agencies (see sidebar, "Mercy Health Partners' Staffing Solution"), or quality of care. Profiled are community collaborations to recruit and train new workers; career-advancement and peer-mentoring programs; supervisory training programs; culture-change initiatives that empower workers and improve the quality of care; and programs that have improved wages, benefits, and social supports available to workers.

Although the initial funding from the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services has expired, IFAS and PHI will continue to update and add to the database, which currently holds about 40 profiles. Meanwhile, providers are encouraged to use what's there--and to suggest other practices for inclusion. As Dr. Robyn Stone, executive director of IFAS, puts it, "It's an opportunity for aging-service professionals to share the creative and practical methods they are using to address the serious recruitment and retention issues they are facing now and in the future."

RELATED ARTICLE: Mercy Health Partners' Staffing Solution

Mercy Health Partners is an integrated healthcare delivery network in Southwest Ohio and a member of Catholic Health Partners. It includes four long-term care facilities, all Located in the Greater Cincinnati area:

* Mercy Franciscan at Schroder, which provides independent living, assisted living, respite care, Alzheinier's care, and long-term and skilled nursing

* Mercy Franciscan Terrace, which provides independent living, assisted living, long-term and skilled nursing, outpatient rehabilitation, and an Alzheimer's unit

* Mercy Franciscan at West Park, which provides independent living, assisted living, respite care, and long-term and skilled nursing

* Mercy St. Theresa Center, which offers independent living, assisted living, Alzheimer's assisted living, general nursing care, transitional care, and a unit specializing in Alzheimer's and dementia care

In the mid-1990s, the management of Mercy's Senior Health and Housing Services Division noticed that the division was spending $60,000 a week (more than $3 million a year) on temps from CNA staffing agencies. This figure spurred the Mercy organization to focus on staffing issues in its four nursing homes, setting a goal of eliminating the use of temporary labor within six months.

Mercy hired an organizational-development consultant to assess the causes of the problem and help draft a plan for systematic change based on employee input. With the consultant's help, the staff started by identifying six primary causes of turnover:

* Poor employee selection

* Ineffective orientation

* Lack of fun

* Inflexible scheduling

* Poor supervision

* Megative staff attitudes

Mercy's managers were already familiar with some of the findings, but others came as a surprise. The most startling discovery was that insufficient orientation was responsible for 36% of all employee turnover. In a related finding, management learned that 75% of the employees who quit had decided to leave during their first three days on the job.

The next step was to form a "talent group" of exemplary CNAs to discuss how to overcome the identified problems. The group met for three months, brainstorming ideas. A plan based: on their suggestions was created.

When the plan was implemented, the following changes were made in four of the main problem areas, which in turn improved the remaining two ("Lack of fun" and "negative staff attitudes"):

* Employee selection. Mercy identified the performance characteristics of outstanding CNAs and changed its advertising and selection to reflect these criteria.

* Orientation. The orientation program was changed to create a positive retention environment and stress Mercy Health Partners' core values: a chance to serve, love, care, be compassionate, be with other people, and help others. New CNAs were "buddied" with experienced CNAs, and supervisors made sure to contact all new CNAs three times during their first three days on the job. As a result, supervisors found that CNAs began to smile, laugh, and enjoy their jobs more.

* Scheduling. Employees were allowed to schedule themselves, requesting the hours that suited them best.

* Supervision. All nurses in charge of units must now take a supervisory training program that focuses first on their own self-awareness and acceptance of their roles as supervisors, and then on team building, employee development and discipline, solution orientation, and personal organization.

Although Mercy did not necessarily resolve all of its staffing problems, it did solve two of them: Within six months of implementing these systematic changes in February 2000, all four long-term care facilities had eliminated the use of, temporary staff. In addition, their already better-than-average turnover of 32%, had decreased to 25%. This began an improvement process that management hopes will continue to upgrade the quality of staffing. Mercy Health Partners believes that the cost of these programs was more than compensated for by the savings realized from the elimination of hiring temp staff and from reduced recruiting costs.

To read the Practice Profile Database's description of this practice, go to www.directcareclearinghouse.org/practices/r_pp_det.jsp?res_id=47710.

Vera Salter is the director of the National Clearinghouse on the Direct Care Workforce (www.directcarecLearinghouse.org).A project of the Paraprofessional Healthcare Institute (www.paraprofessional.org), the Clearinghouse provides up-to-date information related to the direct-care workforce nationwide. To nominate a practice for inclusion in the Practice Profile Database, contact Salter at [phone] or [e-mail]. To comment on this article, send e-mail to [e-mail].