The following is a list of PAS Workforce resources related to North Carolina.
The list is provided and maintained by the National
Clearinghouse on the Direct Care Workforce. Each citation contains
an abstract and information about how to obtain the entire version.
North Carolina Divison of Facility Services. (September 2001). Results of a follow-up survey to states on career ladder and other initiatives to address aide recruitment and retention in long-term care settings. North Carolina Division of Facility Services.
Abstract:
The second follow-up to the North Carolina Division of Facility Services' 1999 report, this paper documents recent state-level policy efforts to address paraprofessional recruitment and retention, focusing on career ladder initiatives. Reporting data from 43 states, the paper identifies specific state projects, assesses national trends, and provides a detailed account of initiatives in North Carolina.
Konrad, Thomas R. Where have all the nurse aides gone?. North Carolina Institute on Aging.
Abstract:
Less than half of the 180,000 North Carolinians certified to work as nursing assistants during the last decade are currently employed as paraprofessionals. Even among those currently employed in the field, many apparently work only part-time and supplement their income by working jobs in other industries. Those certified as nursing assistants who left the long-term care industry appear to have more stable jobs at higher wages.
Harmuth, Susan, et al. (March/April 2002). Forum: The crisis in staffing long-term care facilities. North Carolina Medical Journal.
Abstract:
This special journal issue describes the scope of the shortage of direct-care workers and recommends changes in policy and practice. Focusing on North Carolina, these articles document initiatives undertaken by the state and employers to improve recruitment and retention of direct-care workers and analyze how the direct-care workforce and its role have been defined in culture, in the workplace, and in regulations.
Paraprofessional Healthcare Institute and the North Carolina Department of Health and Human Services. (March 2004). Chart of direct-care workforce activities in North Carolina.
Abstract:
This chart describes existing or enacted direct-care workforce initiatives in this state as of March 2004. The information was collected as part of a national survey of state initiatives on the long-term care direct-care workforce. Additional details about this state may be found in the full report.
Madison, Donald L. (March/April 2002). Recognizing the caregivers. North Carolina Medical Journal. North Carolina Institute of Medicine.
Abstract:
This article looks into the day-to-day life of nursing home staff, touching on both the challenges of their job as well as the rewards and recognition that they receive from it. It also includes numerous pictures of nurse aides at work, caring for their patients.
The National Conference of State Legislatures. (April 19th, 2004). Better Jobs Better Care: Retaining long-term care workers. State Health Notes.
Abstract:
This article gives an overview of the Better Jobs Better Care Demonstration projects in Iowa, North Carolina, Pennsylvania, Oregon and Vermont. The authors specifically address the actions in three of the states: Iowa, North Carolina, and Vermont. The authors note the high turnover rates and problems with retention of direct-care workers across the country, and the interventions that are being explored in these five states through the Better Jobs Better Care project.
Obtain the Full Version: To get a copy of this article, go to: www.statehealthnotes.org. Available on the web: www.ncsl.org/programs/health/bjbc.htm
North Carolina Department of Health and Human Services, Health Care Personnel Registry Section Nurse Aide Training and Registry Administration. (2000). Continuing education modules for nurse aides.
Abstract:
These materials were developed to support the WIN A STEP UP certified nursing assistant career advancement program in North Carolina. The ten modules on seven topics cover a mix of clinical and interpersonal/communication skills. They include: infection control; fecal impaction and hydration; pressure ulcers; a more empathetic you; me, myself and I; being part of a team; and advanced communication.
Obtain the Full Version: These materials are available at no cost in compact disc format. Click here for an order form
*"These training materials were developed by the North Carolina Division of Facility Services. As such, these materials are in the public domain and may not be altered without approval from the Division of Facility Services nor may these materials be reproduced for sale."
Anderson, Wayne L., Joshua M. Wiener, Angela M. Greene, and Janet O'Keeffe. (April 2004). Direct service workforce activities of the Systems Change grantees. RTI International.
Abstract:
In 2001 the Centers for Medicare and Medicaid Services (CMS) awarded Real Choice Systems Change (RCSC) Grants to states and other entities working to improve state long-term care systems. Twenty grantees began one or more initiatives to improve the recruitment and retention of direct service workers. This report focuses on the workforce initiatives of these 20 grantees, with an in-depth look at 7. The report strongly recomends that policymakers, providers, and consumers address workforce problems.
Test, David W., Claudia Flowers, Amy Hewitt, and Jill Solow. (August 2003). Statewide survey of the direct support staff workforce. Mental Retardation.
Abstract:
This report looks at recruitment and retention of direct support staff in North Carolina. It examines the effect these issues have on the quality of care given to people with developmental disabilities. The study found that: high turnover and vacancy rates have a negative impact on consumers, direct support staff have many job titles, receive low wages, and often have to work more than one job.
Institute for the Future of Aging Services (IFAS) and Paraprofessional Healthcare Institute (PHI). (June 2003). State-based initiatives to improve the recruitment and retention of the paraprofessional long-term care workforce. U.S. Department of Health and Human Services.
Abstract:
This report identifies a range of workforce improvement initiatives at the state level to reduce high vacancy and turnover rates among direct-care workers and improve the quality of their jobs. The report summarizes the experiences of five states (California, Massachusetts, North Carolina, Pennsylvania, and Wisconsin) that have pursued several strategies to address the serious shortage of direct-care workers.
Thomas R. Konrad. (May 2003). Descriptive results from the annual short turnover surveys conducted for the Office of Long-Term Care of the NC Department of Health and Human Services. North Carolina Institute on Aging.
Abstract:
This report shows that turnover rates of direct-care workers in North Carolina's nursing homes, adult care, home care, home health, and hospice agencies was stable between 2000 and 2002 despite rising unemployment rates statewide. The report concludes that successful initiatives aimed at reducing turnover depended on the priorities set by management in long-term care organizations.
Konrad, Thomas R. and Jennifer Craft Morgan. (April 2006). STEP UP NOW for better jobs and better care: The evaluation of a workforce intervention for direct care workers. Better Jobs Better Care.
Abstract:
This study evaluates the effectiveness of North Carolina's WIN A STEP UP program, which aims to improve job quality and retention among nursing assistants by rewarding workers who complete training and stay with their employers for a specified period. The authors found that the program was successful at improving job performance, job quality and quality of care. They also found that coaching supervision, which aims to help nurse supervisors improve their supervisory and listening skills, was very successful at improving the quality of team care.
Paraprofessional Healthcare Institute (PHI). (April 2006). CMS direct service workforce demonstration grants: Overview and discussion of health coverage interventions. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Abstract:
This report provides an overview of the efforts of six Center for Medicare and Medicaid Services (CMS) grantees to make health care coverage more affordable and accessible to direct-care workers. It discusses the key advantages and disadvantages of three approaches employed by grantees: subsidization of employer-based coverage, combining basic insurance and tax-free accounts, and funding outreach programs, which promote public-private partnerships. An attached spreadsheet provides a description of each intervention, identifying key components, costs, and their potential sustainability.
Morgan, Jennifer Craft and Thomas R. Konrad. (January, 2007). A mixed-method evaluation of a workforce development intervention for nursing assistants in nursing homes: The case of WIN A STEP UP.
Abstract:
As part of a series of reports produced by Better Jobs, Better Care grantees, this article evaluates WIN-A-STEP-UP, a workforce development program for nursing assistants (NAs). WIN-A-STEP-UP features: continuing education, short-term retention contracts, supervisory skills training for supervisors, and bonuses and/or wage increases upon completion of the program. Based on interview and survey data collected from program participants, the report's authors found improved perceptions of quality of care and job among NAs, supervisors, and management.
Teal, Carol. (March/April 2002). Direct care workers—number one quality indicator in long-term care: A consumer's perspective. North Carolina Medical Journal.
Abstract:
This article argues that the only way to provide high-quality long-term care is through high-quality jobs for direct-care workers. Discussions and meetings with direct-care workers from facilities throughout North Carolina revealed that workers want adequate compensation and benefits, sufficient training, a reasonable workload, and respect for their work. The author proposes that the government take the lead in implementing changes around wages, benefits, staffing requirements, and respect in the workforce.
McDonald, Ingrid. (January 2007). Emerging strategies for providing health coverage to the frontline workforce in long term care. Paraprofessional Healthcare Institute (PHI) and the Lewin Group.
Abstract:
This paper provides an overview of health coverage interventions tested by Centers for Medicare and Medicaid Services direct service workforce grantees. Four case studies in North Carolina, New Mexico, Maine, and Washington State are examined and individually assessed. The author then draws out common challenges, key design features necessary for success in providing health coverage to the direct-care workforce, and concludes with a discussion of policy implications in addressing these issues.
North Carolina Institute of Medicine. (February 2007). The long-term care plan for North Carolina: 2007 update on progress. North Carolina Department of Health and Human Services.
Abstract:
In 1999, the North Carolina General Assembly asked the North Carolina Department of Health and Human Services (DHHS) to develop a plan for long term care services in North Carolina. The Department of Health and Human Services partnered with North Carolina Institute of Medicine (NC IOM) to create statewide Task Force on long-term care services to older adults or people with disabilities. This lead to the release of ''A Long-Term Care Plan for North Carolina: Final Report'' in 2001. In February of 2007, the IOM released an update of the progress on implementation of the recommendations.
Lapane, Kate L. and Carmel M. Hughes. (January 2007). Considering the employee point of view: Perceptions of job satisfaction and stress. Journal of the American Medical Directors Association.
Abstract:
In 25 North Carolina nursing homes, LPNs, RNs, and nursing assistants were surveyed to determine levels of job satisfaction and sources of stress that contribute to an average one-year turnover rate. The study aimed to help orient teams set up under the Fleetwood Model in NC long-term care institutions. Suggestions for how to remedy chief causes of stress--staff shortages, heavy workloads, and time pressures--are discussed.
University of Minnesota, Research and Training Center on Community Living and The Lewin Group. (December 2006). CMS direct service workforce demonstration promising practices in marketing, recruitment and selection interventions. Centers for Medicare & Medicaid Services (CMS).
Abstract:
This report identifies promising practices in direct care worker marketing, recruitment, and selection in states receiving Centers for Medicare & Medicaid Services (CMS) grants. Grantees used different techniques to improve recruitment and retention outcomes, including computer-based registration, marketing campaigns, realistic job previews, structured interviewing, and expanded orientation or mentoring of new employees. The report concludes that sustaining and replicating these interventions will require further research about associated costs and benefits and dissemination of this information.
Workforce Development Plan 2004. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, North Carolina Department of Health and Human Services.
Abstract:
This workforce development plan describes goals and strategies for planning for and responding to education and
training needs in North Carolina?s public mental health, developmental disabilities and substance abuse system.
Karidis, Arlene. (March/April 2007). Coalitions harness the power of change. FutureAge. American Association of Homes and Services for the Aging.
Abstract:
This article profiles five Better Jobs Better Care grantees and their accomplishments in coalition building. Collaborations between long-term care providers, policy makers, professional organizations, educators, and other stakeholders succeeded in bringing direct-care workers into the decision making process, developing new training and licensure programs, providing opportunities for career advancement and on-the-job support to caregivers, and creating sustainable culture change.
Obtain the Full Version: This article is part of a special FutureAge issue devoted to ''Better Jobs Better Care: Building a Valued, Committed Workforce.'' It can be viewed in full here or ordered here. Available on the web: www.bjbc.org/content/docs/FA_FEAT_CoalitionsHarnessPowerofChange_V6N2.pdf
Caregivers are Professionals, Too (CAPT). (August 2007). Direct service workforce final summary grant report: Caregivers are Professionals Too (CAPT). Centers for Medicare & Medicaid Services (CMS).
Abstract:
This final report on the Caregivers are Professionals, Too (CAPT) grant offers a summary and evaluation of the demonstration project's grant activities. The report includes a synopsis of the project, PowerPoint presentations, interview summaries, the survey instrument, and relevant research articles.
Hewitt, Amy, et al. (November 2007). Direct support professional work group report. North Carolina Commission for mental health development disabilities, and substance abuse:.
Abstract:
This work group report provides an overview of the direct support professional (DSP) issues faced by the state of North Carolina and challenges in developing a high-quality, direct support service system. It includes research on evidence-based strategies and interventions to improve DSP retention and competence.
North Carolina Foundation for Advanced Health Programs and NC NOVA Partner Team. (September 2007 (Revised)). North Carolina New Organizational Vision Award: Provider information manual.
Abstract:
This document details the New Organizational Vision Award (NC NOVA) program for home care agencies, adult care homes, and nursing homes, which is designed to recruit and retain direct-care workers, improve job satisfaction, and enhance the quality of care provided in North Carolina's long-term care system. Eligibility requirements, as well as the application and review process, are outlined. Specific goals and procedural recommendations for supervision and training are provided.
Health Care for Heath Care Workers. (2007). Coverage models from the states: Strategies for expanding health coverage. PHI.
Abstract:
This report describes successful strategies for expanding health care coverage to direct-care workers. Five strategies are discussed: making employer-based insurance more affordable, expanding public insurance coverage, establishing coverage through collective bargaining, building insurance costs into Medicaid reimbursement, and assisting workers with health care expenses. The report provides examples and models for each strategy that can be adapted by advocates and policymakers in other states.
Edelstein, Steve, and Carrie Blakeway. (Fall/Winter 2007/2008). State initiatives to strengthen the direct support workforce. Impact. Institute on Community Integration, Research and Training Center on Community Living.
Abstract:
This article describes innovative projects in four states-- Kentucky, North Carolina, Pennsylvania, and Washington-- supported by government and foundation programs that have: reduced turnover by using RJPs (realistic job previews) and monetary incentives; developed special licensure for providers supporting career development; created universal, competency-based curricula; implemented a web-based referral registry; and increased retention through health insurance coverage.
This article is from a feature issue of Impact focusing on direct support workforce development.
