National Project Creates Database of Direct-Care Practices

Article excerpt

A couple of years ago, as part of two research projects on how to recruit and retain direct-care workers in long-term care, the U.S. Department of Health and Human Services proposed creating a database of replicable practices that providers and others could search for ideas. Sounds simple enough, right? But it took a village to make it happen.

Two groups were assigned to the task. The Paraprofessional Healthcare Institute (PHI), a national nonprofit organization based in New York City whose focus is strengthening the direct-care workforce in long-term care, ran the program through its National Clearinghouse for the Direct Care Workforce, which now houses the database on its website. Collaborating with PHI was the Institute for the Future of Aging Services (IFAS), Washington. D.C.. the policy research center of the American Association of Homes and Services for the Aging. About a dozen people at PHI and IFAS conducted the planning, research and writing. Dozens more, both inside and outside the two organizations, helped shape the project by suggesting candidates, critiquing nominations and hashing out the criteria for inclusion.


One of the first lessons of the project was that finding good practices has at least one thing in common with finding good workers: It's important to set standards as high as possible while taking care not to require things that are unrealistic or unreasonable. One challenge was that organizations submitting practices had to demonstrate effectiveness, but providers rarely compile data that would meet academic standards for research. So the main trick to setting up the database was deciding how to define success. In the end, the expert panel that developed the selection criteria kept the definition loose: Practices had to show either quantitative or qualitative evidence of having positively affected the direct-care workforce.

Once the project partners established the criteria, they started looking for practices. Scores, maybe hundreds of leads turned up from colleagues of project participants, interviews with more than 200 long-term care experts nationwide, calls for nominations placed in trade publications and at professional conferences, a literature review and a search for online sources.

Some leads led to dead ends, often because there was no evidence that the practices were effective, but others emerged as clear winners. After a few months of research, rewrites and debate, the project came up with the 40 or so streamlined profiles currently housed the Practice Profile Database at

Not many of these practices have been formally evaluated, but all are linked to improvement in retention, turnover rates, use of agency workers or other tangible measures. Among the practices listed in the database are programs for recruitment, career advancement and peer mentoring. Others focus on improving wages and benefits or on training direct-care workers or their supervisors.

IFAS executive director Robyn I. Stone stressed that the database "goes beyond feel-good stories." She explained, "The practices documented in this database have clearly demonstrated positive effects on a range of staff and consumer outcomes." The goal, she added, is "to create a shared learning network that will deter practitioners and policymakers from reinventing the wheel."


Examples of practices in the database are:

Cooperative Home Care Associates (CHCA) created a well-integrated recruitment, training and retention program has that contributed to the success of this homecare agency in New York City's South Bronx. Founded in 1985, CHCA now employs more than 700 homecare aides, 25% of whom have been with the rapidly growing agency for more than five years. CHCA's annual turnover rate is less than 30%. The agency attributes the stability of its workforce to five factors:

* Offering extended entry-level training, which includes modules on managing work and personal problems in addition to clinical skills;

* Identifying the candidates most likely to succeed as caregivers rather than accepting virtually anyone who wants to enter the training program (only about a third of those who interview are accepted);

* Providing workers with employment counseling, peer mentors and a coaching style of supervision to help workers overcome obstacles to success on the job;

* Presenting workers with opportunities for personal and professional growth through such things as peer mentoring and moving into training or patient services;

* Offering guaranteed hours (after three years with the agency, all aides who agree to certain conditions are paid for at least 30 hours a week), higher wages than other area agencies, and other wage and benefit enhancements, including affordable health insurance. …