Experts say that unless something is done, the problem will worsen in coming decades as the baby boom generation of the 1940s and 1950s ages into tomorrow's elderly population. Inadequate staffing translates into worse health and lower quality of life for nursing home residents.
"We're facing a real crisis in this area," said Dr. Thomas R. Konrad, senior fellow at the University of North Carolina at Chapel Hill's Cecil G. Sheps Center for Health Services Research.
UNC researchers are working to improve the employment picture at long-term care facilities through a new and innovative program they have designed and are testing.
"These are the front-line caregivers -- the nurses' aides and people doing similar jobs who bring nursing home patients their meals, help get them to and from the bathroom, get in and out of bed and assist them with whatever therapies they have in long-term care settings," said Konrad, director of the Sheps center's Program on Primary Care and the Health Professions. "Such workers occupy the bottom of the nursing home hierarchy, and while their jobs are never going to be perfect, they are very important and certainly can be improved a lot.
"Both recruitment and retention are big problems, and we're looking primarily at what employers can do to keep good workers on the job."
The Robert Wood Johnson Foundation and the Atlantic Philanthropies support the UNC effort through a new two-year grant totaling almost a half million dollars. Konrad and Dr. Sheryl I. Zimmerman, associate professor of social work, are leading it.
"One of the things we're doing is looking at ways workers are supervised in nursing homes, and we're also looking at the whole organizational culture of these facilities with a view toward improving them," Konrad said. "We're also involved in training workers and evaluating what approaches work best in boosting employee retention."
Among needed improvements an earlier UNC demonstration project known as "Win a Step Up" identified were better pay, increased personal and professional recognition and status, and linking raises to continued training and experience, he said.
"Many of these workers, who are central to patient and nursing home resident care, are making between $8.50 and $9.50 an hour," Konrad said. "After 10 years, most of them are making very little more than when they started so that there isn't career progress, and almost no incentives to encourage them to stay."
Establishing career ladders and providing in-service training -- and establishing ways of making both a key part of nursing home operations -- should ease staffing problems or at least keep them from getting much worse over time, he said.
Among agencies and groups the UNC researchers are collaborating with are the Office of Long-Term Care in the N.C. Department of Health and Human Services, the N.C. Institute on Aging, the N.C. Health Care Facilities Association and the Association for Home and Hospice Care of North Carolina. Also involved are nursing homes across the state, as well as the UNC and Duke University schools of nursing.
Other institutions looking at the nursing home staff retention dilemma from different perspectives are Boston, Brandeis and Cornell Universities, Connecticut College, the Margaret Blenkner Research Institute in Cleveland, Ohio, Operation ABLE of Michigan and the University of California at Los Angeles. The Robert Wood Johnson Foundation and the Atlantic Philanthropies also are supporting their studies and evaluations.