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North Carolina a model for other states?

The number of Americanswho will need long-term care is projected to double from 13 million in 2000 to 27 million in 2050. In the past,families could provide much of the caregiving needs. However, the pool of available family caregivers has decreased because families have fewer children, families are more geographically dispersed and the traditional caregivers (women) are more often employed. The growing aging population and the decrease in family caregivers place a greater demand on the need for direct-care workers. The Bureau of Labor Statistics estimates an increase of 56 percent of home health aides and 22 percent increase of nursing aides between 2004 and 2014.


A common challenge among long-term care providers are high vacancies and turnover rates among direct-care workers. High turnover rates and vacancies have negative effects on workers, consumers and long-term care providers. They affect providers and the quantity and quality of long-term care. A 2004 analysis calculated that a minimum direct cost of turnover per worker is $2,500. The direct costs are separation, vacancy, replacement, training and orientation, and increased worker injuries. The indirect costs include lost productivity until a replacement is trained, reduced service quality, lost client revenues and reimbursement, lost clients to other agencies, deteriorationin organizational culture and employee morale.

The problems of recruitment and retention of direct-care workers was the impetus for the Better Jobs Better Care program. Better Jobs Better Care is a 4-Year-old, $15.5 million research and demonstration program funded by the Robert Wood Johnson Foundation and The Atlantic Philanthropies. Its goal is to achieve changes in long-term care policy and practice that help reduce high vacancy and turnover rates among direct-care staff in long-term care and contribute to improved workforce quality. The program had five demonstration programs in Iowa, North Carolina, Oregon, Pennsylvania and Vermont and eight research projects.

Through a BJBC grant to the North Carolina Foundation for Advanced Health Programs, the North Carolina demonstration project developed the North Carolina New Organizational Vision Award, a first in the nation, to reduce high turnover among nurse aides and other direct-care workers.

NC NOVA is a voluntary program and the goal is to reward providers that invest in their workers and improve their workplace culture. NC NOVA standards fall under four major areas or domains: supportive workplaces, training, career development and balanced workloads. The domains identified for the NC NOVA designation are job practices known to contribute to high turnover in the direct care workforce. The domains are weighted as follows:

* Supportive Workplace-45 percent

* Balanced Workloads-25 percent

* Training-20 percent

* Career Opportunities-10 percent

The supportive workplace domain has six elements--orientation, peer mentoring, coaching supervision, management support, reward and recognition, and worker empowerment.

The partner team created a manual that describes the domains and the expected criteria within each domain. Providers have the flexibility to determine how the organization will change its culture to meet the criteria.

The Carolinas Center for Medical Excellence, North Carolina's designated quality improvement organization, reviews the applications to determine whether the standards have been met. The provider must have an operating license in good standing to apply for the NC NOVA designation. The reviewer team from CCME conducts an on-site review and interviews direct-care workers and supervisors to ensure consistency between the information in the application and the programs at the organization.

The consumers, providers and workers can all benefit from this program in the following ways:


* More stable, satisfied and quality direct-care workforce for current clients and residents

* Stable quality direct-care workforce available across all long-term settings for the future


* Improved retention of quality direct-care workers to care for clients and residents

* Improved staff relationships and communication

* A marketing and recruiting boost from NC NOVA designation


* Better workplace environment and job satisfaction

* Opportunities for personal and professional growth

* Improved staff relationships/ communication

* Recognition of and appreciation for the essential role direct-care workers play in the delivery of quality long-term care services

When the North Carolina project first created the NC NOVA program in 2005, 60 pilot sites were selected to participate--20 nursing homes, 20 adult care homes and 20 home health agencies. The criteria were set high so the designation would be meaningful. During the pilot phase of the project, two providers received the NC NOVA designation--Well-Spring, a continu-ing-care retirement community, and Silver Bluff Village, a family-owned nursing facility. Many of the providers have not applied and are still working toward their goal. It is expected to take time for the providers to be eligible and receive the designation.

The NC NOVA program went into effect on Jan. 1, 2007, and is open to all licensed home-care agencies, adult-care homes and nursing facilities statewide. The goal of the program is to provide reimbursement for organizations that obtain the license.

Natasha Bryant is the managing director of the Better Jobs Better Care program and senior research associate at the Institute for the Future of Aging Services.
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Author:Bryant, Natasha
Publication:Policy & Practice
Geographic Code:1U5NC
Date:Jun 1, 2007
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