Guidebook: Retention and Recruitmentof the Direct Service worker

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EXECUTIVE SUMMARY This project, funded through the Demonstration to Improve the Direct Service Community Workforce from the Centers for Medicare and Medicaid Services under the New Freedom Initiative, sprang from many sources and involved the skills, expertise and perspective of many individuals, agencies, and organizations. This Guidebook is designed to offer other trainers of direct service workers the opportunity to utilize the materials that we developed and to learn from our challenges and successes. The partners who were so integral to the success of this project came from many areas, each adding unique perspectives and assistance as we moved forward. There was a unique and rich history of cooperation over more than a decade that contributed to the success of this project. The primary partners for this project were:

The Virginia Department of Medical Assistance Services (VDMAS); The Virginia Geriatric Education Center (VGEC) in the Department of

Gerontology at Virginia Commonwealth University (VCU); The VCU School of Nursing; The Virginia Center on Aging at VCU; The Partnership for People with Disabilities at VCU; SkillSource Group, Inc. (SSG); AGES, Inc.

In order for this project to be successful there were many other partners who will be noted in the project overview section, partners without whom we could not have been successful. In preparing this Guidebook, we wanted to make sure that the materials that we used and revised so many times, would be easily accessible to any trainers who may wish to use them in the future. Thus we have included the materials in printed format, as well as, on disks so that trainers could more easily modify and personalize them for their use. This Guidebook includes the following materials:

• a history of the evolution of this project spanning a period of over a decade. It was important to us to make clear that these collaborations develop over long periods, building trust and mutual respect that ultimately allows for new partnered innovations and interventions. This history and overview section of the Guidebook also includes a comprehensive description of the training modules and their evolution, as well as, the preliminary findings from our on-going evaluation;

• a compilation of all of the power point slides for the training of the direct care workers, their supervisors, the families, and the team building training ECAT II). In addition, this compilation includes a disk with the same slides and threes slides enhanced by notes for the trainers, so that they may understand the insights that guided our training interventions. There is also a short annotated bibliography of some of the training materials that we found useful in the designing of our training curriculum;

• a compilation of the evaluation materials that were used for this project. We also included a listing of the references for our team publications and a compilation of a group of references in the area that we found to be seminal;

• a DVD of the actual training videos for each of the groups: direct service workers, supervisors, families and the team building training;

• a CD with a photo gallery presenting a direct service worker caring for an elder home care client. These materials are made available for trainers to utilize in any of their training presentations or brochures that they may develop for project implementation.

• copies of the four brochures designed by the SkillSource Group, for our recruitment initiative.

Finally, the Editors would like to note that this is still a work in progress. We are continuing our work in this area and learn more each and every day that we have the honor of working with such incredible front-line workers, workers committed to making the quality of life better for our elders and their families.

Introduction,Editors

PROJECT EVOLUTION AND HISTORY

This project, funded through the Demonstration to Improve the Direct Service Community Workforce from the Centers for Medicare and Medicaid Services under the New Freedom Initiative, sprang from many sources and involved the skills, expertise and perspective of many individuals, agencies, and organizations. This Guidebook is designed to offer other trainers of direct service workers the opportunity to utilize the materials that we developed and to learn from our challenges and successes. The partners who were so integral to the success of this project came from many areas, each adding unique perspectives and assistance as we moved forward. There was a unique and rich history of cooperation over more than a decade that contributed to the success of this project. The primary partners for this project were:

The Virginia Department of Medical Assistance Services (VDMAS); The Virginia Geriatric Education Center (VGEC) in the Department of

Gerontology at Virginia Commonwealth University (VCU); The VCU School of Nursing; The Virginia Center on Aging at VCU; The Partnership for People with Disabilities at VCU; SkillSource Group, Inc. (SSG); and AGES, Inc.

In order for this project to be successful there were many other partners who will be noted throughout this introduction, partners without whom we could not have been successful. History of Cooperation in Training and Policy Work. Since 1994 the Virginia Geriatric Education Center has collaborated with VDMAS on a series of training and policy development efforts that served as the roots of this partnership, including the prevention of pressure ulcers and innovative ways to utilize Civil Money Penalty Funds to enhance quality of care in long term care in Virginia. Opportunities such as these fostered a great deal of mutual respect between the two organizations. During the same period, the VGEC had on-going contracts with the Virginia Department of Social Services to train direct care workers in medication management and other topics critical to direct care workers working in licensed assisted living adult day care facilities. And with funds garnered through funding of the VGEC through HRSA over this period, all of this work was enhanced. Our experiences from working with the Alzheimer’s Association added to both the training and research efforts presented in this Guidebook. Our efforts with the Alzheimer’s Association began in 2001, with an appropriation from Virginia’s General Assembly (through the Virginia Department of Social Services) to the Alzheimer’s Association of chapters in Virginia. A collaborative dementia-training program was implemented to address the staff shortages and inadequate training about the treatment and optimal care strategies for individuals with Alzheimer’s disease. Mounting evidence suggested that dementia-specific training had the potential to affect turnover and reduce staff burnout. It was reasoned that promoting a greater understanding of person-centered care techniques among providers, would also assist in attracting, training, and retaining direct care workers. Person Centered Care: Skill

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Building for Caregivers of People with Dementia, the 12-hour multidisciplinary program, emphasizes a team approach and was recommended for all levels of staff in a variety of long-term care settings. Evaluation data were collected from 832 participants who attended training across the Commonwealth during the first year of funding. Although the majority of participants worked in assisted living, training recruitment was intended to span the full spectrum of long term care. The Virginia Center on Aging was subcontracted to provide an evaluation of the initiative with in-kind support from the Virginia Geriatric Education Center. The training not only increased knowledge levels about person-centered care, but also provided trainees with a better understanding of individuals with dementia. The initiative illustrated the benefits of top-down collaboration among organizations combined with the involvement and commitment of key individuals at the grassroots level.

The next year, immediately following the first training initiative, the Virginia Department of the Aging implemented a train-the-trainer program for nursing assistants with funds from the U. S. Administration on Aging (DHHS), as part of the Alzheimer’s Disease Demonstration Grants to States Project. Because the first dementia training program focused on changes in skills development, this new phase was designed to measure improvements in job performance. Nursing aides and assistants who had participated in the earlier dementia care training across the Commonwealth of Virginia, were recruited to be trained as trainers, and were expected, in turn, to teach their peers important information on the care of residents with Alzheimer’s and related dementias. The important skills that were identified for this training were related to: 1) person-centered care and communication, 2) minimizing difficult behaviors in the delivery of care and involving residents in meaningful and appropriate activities, and 3) stress management. Again, the Virginia Center on Aging with in-kind support from the Virginia Geriatric Education Center was subcontracted to provide an evaluation of the initiative. Nursing assistants who were identified to serve as trainers and deliver in-services to peers in their facilities were expected to show improvements with respect to two fundamental concepts: Job Satisfaction and Career Commitment (which encompasses a sense of professionalism). Results revealed an increase in extrinsic job satisfaction and a decrease in career commitment. Decreases in career commitment were attributable to participants who failed to show a deeper involvement in aging concerns with respect to their future employment or those who were not positively influenced by the training to pursue employment in the area of long term care. Importantly, as a consequence of the training, approximately 30% of participants considered themselves to be more likely to stay in geriatric or long term care as they pursued their careers. The next step was the initiation of a series of partnerships with the Virginia Department of Medical Assistance Services to develop additional training curricula; these new programs were the direct result of the partnerships established through the completion of these very important initiatives. Other Partners: Putting the Project Team Together. The project presented in this Guidebook was made possible by a partnership among the Virginia Department of Medical Assistance Services, the Virginia Geriatric Education Center, the SkillSource

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Group, and the Partnership for People with Disabilities. Each partner played an integral part in the overall success of this project by accepting leadership of various interventions of the demonstration. The recruitment brochures that are included in this Guidebook were developed by the SkillSource Group and are presented in four languages. Additionally, more than 35 individuals were recruited and placed into DSW positions through the SkillSource Group. The recruitment and placement model employed for this intervention was recommended for replication by the Governor Kaine’s Health Reform Commission in its September 2007 report “Roadmap for Virginia’s Health.” Another part of the recruitment intervention was the development of a website through the Virginia Partnership for Nursing to outline the basic details of the direct care field of work and provide information on how to enter the workforce for various direct support positions. The Partnership for People with Disabilities, a university center of excellence for developmental disabilities at Virginia Commonwealth University, was a partner in evaluating and assessing changes in retention and turnover as a consequence of the demonstration project and the leader in the evaluation to explore the impact of health insurance benefits on the recruitment and retention of direct care workers. They developed a four-page survey about employer-sponsored health insurance availability and the extent to which health insurance is important gaining and retaining workers. They also developed a three-page direct care worker survey that identified the utilization of available health insurance options as well as health insurance needs of Virginia’s direct care workforce. The Development of the Training: History of ECAT II. The desire to perfect our training intervention and develop ECAT II had its roots in all of the work mentioned above, but the primary designers of the curriculum intervention came from the VCU School of Nursing. In the summer of 2001, one of the authors (Dr. Rita Jablonski) completed an independent project as a doctoral student at the University of Virginia. The project, under the supervision of Dr. Iris Parham, was to develop a nursing assistant training program. At the time, there was a local movement in Virginia to create “enhanced” nursing assistants by training them in tasks usually performed by licensed practical nurses. Dr. Jablonski, a former nursing assistant herself, suspected that stronger interpersonal skills and enhanced abilities to handle stressors may better serve nursing assistants. With that in mind, she began her project by conducting two focus groups with nursing assistants at an urban nursing home. She asked the nursing assistants about their jobs, what they found to be most challenging. She asked all of them this question: “If you could design a training program, what topics would you want? What things would help you do your job better?” She took notes and analyzed the information. Six major themes emerged from the focus group feedback: working with difficult families; working with residents who exhibited disruptive and resistive behavior; death and dying; burnout; sexuality in the nursing home; and building good working relationships with peers and supervisors. The six themes provided the backbone of the first draft of the curriculum, The Nursing Assistant Curriculum (TNAC). Dr.Jablonski added two others, spirituality and ethical issues, to complement the content on death and dying and disruptive behavior.

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The end result was eight self-contained modules that could be used singularly or as part of a larger program. All of the modules, with the exception of spirituality, were written solely by Rita Jablonski. Dr. Alexander Tartaglia was the primary author of the Spirituality Module. Dr. Connie Coogle and Alexander Tartaglia offered their critique and suggestions throughout the project. Other important persons lending significant comments and feedback included Ms. Stephanie Hamilton and Mr. Harry Baldwin. In 2002, the Virginia Geriatric Education Center (VGEC) received a subcontract from the Virginia Department of Medical Assistance Services (DMAS) under a “Real Choice Systems Change” Grant from the Centers for Medicare and Medicaid Services. A DMAS-VGEC Joint Project Advisory Task Force was formed. Part of the role of the Task Force was to provide additional feedback, critique, and information regarding community-based care. For almost a year, the DMAS-VGEC Joint Project Advisory Task Force provided additional feedback, critique, and information regarding community based care. The Task Force requested that the original TNAC content be expanded to include information pertinent to caring for younger adults with chronic physical and mental disabilities. This initial collaboration of pertinent stakeholders was crucial to the development of the training program. Bringing together the strengths and interests of multiple parties in academia, provider agencies, and professional associations garnered statewide support for the effort and ensured that concerns were addressed. The advisory group provided valuable guidance while using progressive problem solving and consensus-building strategies to solidify group cohesion. From these efforts, the “Recognition, Respect, and Responsibility: Enhanced Care Assistant Training” (ECAT I) curriculum was born. It was piloted in the summer of 2003. It was through the work of the Task Force that the methods and procedures for both ECAT I and ECAT II were developed. The selection of the training sites considered both equal geographic distribution across the state and locations with the highest concentration of Medicaid waiver claims. Since no registry of home care aides exists, potential training participants could not be recruited directly. Instead, recruitment materials were mailed to the administrators of all the home care agencies providing Medicaid services to clients under Virginia’s Elderly and Disabled Home and Community Based Waiver. The Virginia Department of Medical Assistance Services provided the list of approximately 250 agencies to be contacted and provided mailing envelopes so that the involvement of the state agency was clear. Agency administrators were asked to distribute the materials so that the employees who could most benefit from the training would be targeted. The training recruitment packets highlighted the learning objectives of the training and its benefit to agencies and home care aides. Since administrators were the cornerstone of the marketing plan, the recruitment packets also included all of the materials needed to promote the training opportunity among selected employees. Agency administrators were provided with a poster to hang in the employee common area, as well as pay stub inserts with training information and the training application forms for distribution. The application form asked home care aides to provide their contact information and a short paragraph on why they wanted to attend the training. Administrators were asked to collect the completed applications, make a decision about which employees would benefit most from the training, designate on the application if the employee was recommended or not recommend for the training, and

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forward the applications to the Virginia Geriatric Education Center. The VGEC directly notified home care aides about their acceptance and admission into the training program. The series of four training sessions were scheduled for alternate Saturdays and was conducted twice during each consecutive year of the subcontract. As mentioned earlier, the original Nursing Assistant Curriculum was composed of eight modules, listed below in Table 1. The first module, the Team Module, required 8 hours for implementation. The remaining modules required 4 hours each. The original curriculum was designed for delivery in 4-hour segments. The home-care agencies participating in the pilot program were unable to release their staff for nine 4-hour seminars. The original eight modules were streamlined and the content was reformatted into four 7-hour modules. Table 1 illustrates how the original Nursing Assistant Curriculum modules were modified in the ECAT I curriculum. Table 1: Comparison of Modules for the Nursing Assistant Curriculum and the ECAT I Curriculum

The Nursing Assistant Curriculum Modules

Hours Enhanced Care Assistant Training Curriculum

Hours

Team Module (communication, working with others)

8

Legal and Ethical Issues 4

“Talking the Talk: Ways to Smooth Out Problems Without Getting Into More Trouble”

7

Dementia Spirituality 4 Sexuality 4

“Mind, Body, & Soul: Challenges for Caring for Clients with Cognitive, Sexual, and Spiritual Needs”

7

Loss and Bereavement 4 Death and Dying 4

“It’s OK to Become Attached to Your Clients: Dealing with Loss, Death, and Mourning”

7

Caring for the Caregiver/Stress Management

4 “Avoiding Burnout: Caring for Others by Caring for Ourselves”

7

The ECAT I curriculum was designed with as much detail as possible to allow for

trainers to pick up the manual and deliver the modules. This included overall objectives for the program as well as concomitant objectives for the individual modules. Both sets of objectives are listed in Table 2.

Table 2: Module and Course Objectives for ECAT I

Module Module Objectives Corresponding Course Objectives I

“Talking the Talk: Ways to Smooth

Out

1. Describe the home care team. 2. Describe the contributions of other Team

members. 3. List contributions specific to NAs. 4. Describe ways to surmount barriers to

becoming part of the Team.

1. Demonstrate the ability to manage challenging situations with specific communication strategies.

2. Explain the importance of professional behavior.

3. Work effectively with families and

5

Problems Without Getting

Into More Trouble”

5. Relate daily job performance to overall client care within the context of the team concept.

6. Describe the difference between assault and battery.

7. List instances of negligence as applicable to NAs.

8. Define ethics. 9. Describe ways to resolve an ethical dilemma. 10. Verbalize the impact of violence on the care

of community residing clients.

supervisors 4. Describe methods to prevent or resolve

specific legal and ethical problems encountered in the home care setting.

5. Identify strategies to minimize the effect of violence on clients and caregivers within the home care community.

II “Mind,

Body, & Soul:

Challenges for Caring for Clients

with Cognitive, Sexual, and

Spiritual Needs”

1. Explain the link between disruptive behavior, dementia, and clients’ needs.

2. List 5 situations in which clients are at risk for engaging in disruptive behavior.

3. State 5 interventions to prevent and de-escalate disruptive behavior in cognitively impaired or angry clients.

4. Define spirituality. 5. List methods to assess the spiritual needs of

clients. 6. Describe resources for helping clients

maintain their spirituality. 7. Verbalize the difference between supporting

clients’ spirituality and proselytizing. 8. State how aging and disability affect normal

male and female sexual responses. 9. Discuss additional factors that impact

sexuality in older and/or disabled individuals. 10. Verbalize how the caregiver’s own feelings

about sexuality impact his or her reaction to sexual behaviors by clients.

11. Discuss how sexuality should be addressed in the home care setting.

1. Anticipate disruptive behavior based on assessments.

2. Describe strategies for preventing and de-escalating disruptive behaviors in agitated adults with dementia and other individuals.

3. Provide members of the Team with NA-derived strategies for minimizing disruptive behavior.

4. List methods to assess the spiritual needs of clients.

5. Describe how NAs can be a resource to clients who require spiritual support.

6. Identify strategies for successfully managing sexuality within the context of the client’s home.

III “It’s OK to

Become Attached to

Your Clients: Dealing

with Loss, Death, and Mourning”

1. Describe potential and actual losses sustained by older and/or disabled individuals.

2. List signs that the client may be grieving a potential or actual loss.

3. List ways in which the NAs can mitigate the losses experienced by older and/or disabled individuals.

4. Describe the dying trajectory. 5. List 3 physical signs of death. 6. List 3 psychosocial indicators of

death. 7. Describe ways in which formal

1. Identify clients at risk for experiencing loss and bereavement.

2. Integrate knowledge of clients into care planning in order to minimize the effects of the loss and promote adaptation.

3. Explain the physical and psychological signs of death.

4. List ways to help others cope with the deaths of significant others.

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caregivers can help selves and others cope with death.

IV “Avoiding Burnout:

Caring for Others by Caring for Ourselves”

1. List strategies for caring for the physical self. 2. List strategies for caring for the psychological

self. 3. List strategies for caring for the social self. 4. Describe ways to recognize stress. 5. Describe ways to modify reactions to stress. 6. Discuss specific care situations that may place

additional stress on nursing assistants or personal care assistants.

1. Describe methods necessary for caregivers to maintain optimal physical, psychological, and emotional health while working with elderly and/or disabled individuals.

2. Describe methods necessary for caregivers to maintain optimal physical, psychological, and emotional health while working with specific care situations in the community.

Because the curriculum development was grounded in an intention to encourage a

more career-focused orientation, additional content was included to enhance professionalism. The ultimate goal was to empower the direct care worker not just in terms of skills enhancement but to increase their overall perception of self-worth.

One of the unique aspects about ECAT I is the use of many exercises and

discussion questions to keep the personal care assistants engaged throughout the modules. The use of multiple discussion points and exercises kept the participants focused and also helped them to realize that they, too, possessed useful knowledge and experience. Sometimes, a participant would pose a question about a client situation that frankly stumped the trainer. She encouraged other members of the seminar to offer possible ideas and solutions. The personal care assistants, as a group, always provided multiple potential solutions to the question at hand. This sharing helped solidify the groups over time and crossed the barriers of geography and ethnicity. The ECAT I training series was conducted twice. First, during year one of the grant, utilizing a network of “real-time” compressed video-teleconferencing broadcasts to six satellite sites statewide. Then, during the second grant year, videotaped sessions from the first year were broadcast to the different sites via satellite transmission, with individual site monitors at each site. To replace the simultaneous discussions and exercises led by the original trainers between the didactic portions of training in the first year, trained moderators at each of the six sites led these same scripted exercises and discussions in the second year. Site coordinators were selected based on their experiences in home or long term care as well as their abilities as trainers of nurse aides. The evaluation results were encouraging and indicated that training substantially increased the likelihood that workers would stay in their current jobs and improved their job satisfaction to some extent, even when asked six to twelve months after the completion of training. A comparison of pre-training and post-training scores among participants providing follow-up data revealed a statistically significant improvement in the participants’ abilities to resist career disruption in the face of adversity.

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During the 2004-2007 three-year period, the VGEC received another grant to expand the curriculum to personal care assistants, families, and home care supervisors. Dr. Anthony DeLellis joined the team, bringing expertise in the areas of respect and administration. The part of the training program specific to PCAs was again revised based on feedback from ECAT I participants, new findings in the literature, and from the experiences of both Drs. DeLellis and Jablonski. Table 3 reflects the revisions and maps the changes in the modules from ECAT I to ECAT II. The new objectives are listed in bold.

ECAT I Module Title ECAT II Module Title ECAT II Module

Objectives I

“Talking the Talk: Ways to Smooth Out Problems Without Getting Into More Trouble”

I “Seeing the Person, Not the

Illness”

1. Explain the link between disruptive behavior, dementia, and clients’ needs.

2. List 5 situations in which clients are at risk for engaging in disruptive behavior.

3. State 5 interventions to prevent and de-escalate disruptive behavior in cognitively impaired or angry clients.

4. Describe person-centered care

5. Provide 2 examples of how you can incorporate person-centered care in the care of your clients

II

“Mind, Body, & Soul: Challenges for Caring for Clients with Cognitive, Sexual, and Spiritual Needs”

II: “Between a Rock and a Hard Place: Legal and Ethical Challenges Faced by PCAs”

1. List instances of negligence as applicable to NAs.

2. Define ethics. 3. Describe ways to

resolve an ethical dilemma.

4. Verbalize the impact of violence on the care of community residing clients.

5. Define elder abuse

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6. List at least 3 types of elder abuse

7. Describe signs and symptoms of potential elder abuse

III “It’s OK to Become Attached to Your Clients: Dealing with Loss, Death, and Mourning”

III “It’s Like Losing a Piece of

My Heart: Dealing with Loss, Death, and

Mourning”

1. Describe potential and actual losses sustained by older and/or disabled individuals.

2. List signs that the client may be grieving a potential or actual loss.

3. List ways in which the NAs can mitigate the losses experienced by older and/or disabled individuals.

4. Describe the dying trajectory.

5. List 3 physical signs of death.

6. List 3 psychosocial indicators of death.

7. Describe ways in which formal caregivers can help selves and others cope with death.

IV “Avoiding Burnout: Caring for Others by Caring for Ourselves”

IV “Avoiding Burnout: Caring for Others by Caring for Ourselves”

1. List strategies for caring for the physical self.

2. List strategies for caring for the psychological self.

3. List strategies for caring for the social self.

4. Describe ways to recognize stress.

5. Describe ways to modify reactions to stress.

6. Discuss specific care situations that may place additional stress on personal care assistants

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An examination of evaluation ratings across the four training sessions showed a significant increase in the likelihood that training would change the way participants performed their jobs in the future. However, one of the findings from ECAT I was that levels of job satisfaction declined from the time of pre-training to the time of post-training. We concluded that this may have resulted from placing the changed PCAs back into agencies and homes that had remained the same. The team was determined to address this by changing the work environments and providing family caregivers and supervisors with complementary skills and knowledge. Drs. Jablonski and DeLellis added a 4-hour module for supervisors to parallel the content covered with personal care assistants; a 4-hour module for family caregivers; and a 4-hour module for both personal care assistants and supervisors to experience together. The training session for families focused on methods to help them care for their loved ones, especially those with cognitive or behavioral problems. The training session also covered communication techniques and provided content on the challenges of having paid caregivers, often from different ethnic and socioeconomic groups, in one’s home. The combined training sessions concentrated on communication patterns between supervisors and PCAs, offering multiple opportunities for group work.

At the time of this writing, we are in the midst of analyzing the data. Results

from the mailed follow-up survey, however, showed that 89% of responding PCAs who participated in ECAT II believed that the training improved the likelihood that they would stay in their current job. We found at follow-up, that in terms of retention, 92% of respondents were still employed as direct service workers, more than three-quarters (78.1%) were still working at the same agency.

Examination of the 159 PCAs providing training data indicated that there was a

statistically significant increase from the time of pre-training to the time of post-training in the extent to which PCAs anticipated an emphasis on long term care over the course of their careers.

.

Anticipate Career Emphasis on LTC Change over Time (p < .03)

3

4

5

1 2Pre-Training Post-Training

Aver

age

Ratin

gs

10

In addition, statistically significant increases in job satisfaction were found among PCAS who extensively agreed with that statement.

Anticipate Career Emphasis on LTC Group Difference (p < .005)

70

80

90

1 2 Pre-Training Post-Training

Tota

l Job

Sat

isfa

ctio

n

Less thanExtensivelyExtensively

Preliminary data from the home care supervisors shows that the training was well-received and promised to have a substantial effect, influencing their intentions to provide more feedback to employees and make an effort to recognize employees that are exceeding expectations (see Tables 1 & 2).

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Table 1. Likely outcomes of the Training for Home Care Supervisors (June 2005 & January 2006; N=61)

Item As a consequence of the training …

Mean

S.D.

Agree

I plan to provide more feedback to my employees. 4.59 0.62 93.2% I will make an effort to recognize employees that are exceeding expectations. 4.58 0.70 91.5%

I can now employ new techniques that will help me communicate better with employees who are not meeting expectations. 4.44 0.70 88.1%

I have a better understanding of the skills I need as a supervisor. 4.25 0.92 83.1% I feel better prepared to discuss challenges with clients and their families. 4.22 0.81 83.1%

I feel better prepared to communicate with both clients and employees. 4.22 0.81 79.7% I can better define and describe leadership 4.19 1.01 84.8% I can better define and describe management. 4.16 0.86 82.5% I can now employ new techniques to help with conflict management. 4.10 0.82 83.0% I better understand how to use both leadership and management skills in the workplace. 4.10 0.98 78.0%

I have a better understanding of how my employees may perceive me. 4.05 0.99 76.3% I can now employ new techniques to help with anger management. 4.02 0.95 75.9%

*1 = Strongly Disagree; 5 = Strongly Agree

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Table 2. Impact of the Training for Home Care Supervisors (June 2005 & January 2006; N=61)

Item To what extent…

Mean

S.D.

Agree

Did the content of this course meet your expectations? 4.15 0.69 86.7% Will this training help you use problem-solving techniques? 4.07 0.83 79.7% Has this program increased the chances that you will take more training classes in geriatrics? 4.07 0.88 75.0%

Did the training increase your knowledge of geriatrics? 3.85 1.02 70.0% How much will this training change the way you do your work? 3.82 0.98 68.4% How much did this training change the way you view your patients’/clients quality of life? 3.68 1.23 61.7%

*1 = Not at All; 5 = Extensively

13

14

In summary, this project is the product of an elaborate and many times fortuitous series of partnerships. None of what we have achieved could have been accomplished without many hours of work by committed and hard-working individuals and their supporting agencies and organizations. We sincerely hope that the Guidebook that we are presenting here will be useful in fostering more training and more effective recruitment and retention efforts for this workforce so critical to the quality of all of our futures. Acknowledgments N. Diana Thorpe, Karen Lawson, Vivian Horn, Deborah Skalsky, Marcia Tetterton, Kathy Miller, Kathleen Watson, Katie Young, Lucy Lewis, Dr. Joanne Henry, Dr. Ayn Welleford, Harry Baldwin, Bonnie Gordon, Susie Brown, Marilyn Pace Maxwell, David Hunn, Dr. Fred Orelove, Parthy A. Dinora, Dr. Susan J. Murdock, Quynh-Trang Montgomery, Nancy Bynum, Colleen Head Rachel. This project was supported by several generous funding agencies:

Demonstration to Improve the Direct Service Community Workforce under the New Freedom Initiative from the Centers for Medicare and Medicaid Services

A John A. Hartford Foundation’s Building Academic Geriatric Nursing Capacity Scholarship offered through the American Academy of Nursing [awarded to R. Jablonski];

A fellowship grant from the National Institute of Nursing Research, Grant Number 5 F31 NR07571-03 [awarded to R. Jablonski];

The Division of Interdisciplinary Community-Based Programs (DICom), Bureau of Health Professions (BHPr),Health Resources and Services Administration (HRSA),Department of Health and Human Services (DHHS), Grant number ID31HP70126, Virginia Geriatric Education Center Grant (VGEC), for $1,079,213; A subcontract from the Virginia Department of Medical Assistance Services

under a “Real Choice Systems Change” Grant from the Centers for Medicare and Medicaid Services.

Supported in part by the Alzheimer’s Association, National Capital Area with funds appropriated to the Commonwealth of Virginia, Department of Social Services (July 1, 2001-June 30, 2002).

Also supported by the Commonwealth of Virginia, Department for the Aging under the Alzheimer’s Disease Demonstration Grants to States project funded by the Administration on Aging, DHHS (July 1-December 31, 2002).

Enhanced

Care

AssistantTraining

(EC

ATII)Enhanced Car Assistant Training(ECATII)

Dr. Rita JablonskiDr. Anthony Delellis

�� Personal Care Trianing�� Personal Care Training

with Trainer Notes�� Supervisor Training�� Supervisor Training

with Trainer Notes�� Family Training�� Family Training w/Notes�� Team Building Training�� Team Building Training

with Trainer Notes�� Annotations for Training

Materials References

Research Instruments and Materials

Dr. Constance CoogleDr. Iris ParhamMs. Parthy Dinora

Research Instruments and Materials

Dr. Constance Coogle

and

Dr. Iris Parham

Part I. Training of Direct Service Providers (DSPs)

The goal of the DSP training was to enhance professional development through a

job-focused intervention, ultimately improving job retention. To document the

effectiveness of the training, Baseline and Post-Training Questionnaires were designed to

collect data on several important constructs that could be improved through the ECAT

training. Baseline data was collected at the first session, while post-training data was

collected at the last session. In addition to demographic measures and indicators related

to previous/current caregiving experience and prior training, items measured the

following constructs: career commitment (12 items), job satisfaction (20 items), and goal

instability (10 items).

Recognition, Respect, Responsibility: Enhanced Care Assistant Training II

Baseline Questionnaire All individuals should complete this questionnaire when they first receive the training. When you come for your last training session, we will ask you to complete it again. Your answers are extremely valuable. Please provide an answer for each of the questions asked, unless instructed otherwise. Please also be sure to provide your Participant Identification Number. If responses on this survey can't be matched up with your other paperwork, it will be impossible for us to make important comparisons about the value of this training. This and any other forms you complete related to this project are strictly confidential. Your responses will not be linked with your name in any database. The data will be used for the purposes of evaluation only and all results will be grouped, so that no single person or organization may be distinguished. Your participation is completely voluntary. You have the right to withdraw at any time or refuse to answer any questions. Participant Identification Number (LAST six digits of your social security number) Agency/Facility Affiliation _______________________________________________________ 1. What is your gender? Male Female 2. What is your racial background? (Check ONLY one) American Indian or Alaska Native Hispanic or Latino Under-represented Asian subgroup* Native Hawaiian or Other Pacific Islander Asian (not under-represented) White or Caucasian Black or African American Other (please specify) * Refers to any Asian other than Chinese, Filipino, Japanese, Korean, or Asian Indian 3. In what county or city do you work or practice? Code Number_________ (Refer to the County Code Sheet) 4. What is your approximate age? 5. What is your marital status? Single Married Separated Divorced 6. What degrees/certifications do you currently hold? (Mark all that apply) H.S. B.A. B.S. B.S.W. B.S.N. R.N. C.N.A.

N.P.-C. A.N.P. M.A. M.S. __ M.S.N. M.S.W. M.Ed.

M.P.H. M.D. M.Div. Ph.D. Ed.D. D.P.H. D.S.W.

D.N.Sc/N.D. D.Pharm. D. Min. D.D.S. Psy. D. Other _______ (specify)

7. On the average, for how many hours per week are you employed in your current position? hours/week 8. For how long have you been employed in your current position? years 9. For how long have you been employed in your current career field? years 10. Do you work predominantly with older persons (Age 60+)? Yes No 12a. If yes, for about how many years have you been doing this? years 11. Are you currently paid to provide direct care for someone with Alzheimer's disease? Yes No 13a. If yes, how often do you provide this care over the normal course of your work day? Infrequently Constantly 1 2 3 4 5 13b. If no, have you ever provided direct care for someone with Alzheimer's disease? Yes No If yes, how often did you provide this care over the normal course of your workday? Infrequently Constantly 1 2 3 4 5 12. Outside of any Alzheimer's care you may provide at work, would you consider yourself to be the primary caregiver for a friend or relative with Alzheimer's disease? Yes No a. If no, have you ever been a primary caregiver for a friend or relative with Alzheimer's disease? Yes No 13. Have you received any formal training in gerontology/geriatrics? Yes No a. If yes, please mark all that apply. Passed ANA Gerontological certification exam Obtained graduate certificate in aging studies Through the VGEC or Department of Gerontology at VCU? Completed Bachelors Degree in Geriatrics/Gerontology Completed Master's Degree in Geriatrics/Gerontology Completed requirements for a Minor in Geriatrics/Gerontology Completed some individual courses in Geriatrics/Gerontology Offered by the VGEC or Department of Gerontology at VCU? Attended conferences, workshops, or other continuing education programs in aging Previously attended "Person Centered Care" training offered by the Alzheimer's Association Previously attended “Train the Trainer” training offered by the Alzheimer’s Association __ Previously attended other training related to Alzheimer's disease Mentoring/Support program participation (e.g., through the Nursing Assistant Institute) Other (please specify) 14. To what extent do you anticipate an emphasis on long term care across the course of your career? 15. When looking for your next position, how will the opportunity to work in the area of long term care influence your decision?

Not at all Extensively 1 2 3 4 5 Negatively Positively 1 2 3 4 5

16. This survey asks questions about your line of work or career field in which you are currently employed. You may consider line of work/career field as having the same meaning as occupation, profession, or vocation. When completing this survey, ask yourself: How satisfied am I with this aspect of my job? Please answer using the scale below and circle the number that corresponds with your response for each item: VS = I am very satisfied with this aspect of my job. S = I am satisfied with this aspect of my job. N = I can’t decide whether I am satisfied or not with this aspect of my job. DS = I am dissatisfied with this aspect of my job. VDS = I am very dissatisfied with this aspect of my job. On my present job, this is how I feel about: VDS DS N S VS

1. Being able to keep busy all the time

1 2 3 4 5

2. The chance to work alone on the job

1 2 3 4 5

3. The chance to do different things from time to time

1 2 3 4 5

4. The chance to be “somebody” in the community

1 2 3 4 5

5. The way my boss handles his men

1 2 3 4 5

6. The competence of my supervisor in making decisions

1 2 3 4 5

7. Being able to do things that don’t go against my conscience

1 2 3 4 5

8. The way my job provides for steady employment

1 2 3 4 5

9. The chance to do things for other people

1 2 3 4 5

10. The chance to tell people what to do

1 2 3 4 5

11. The chance to do something that makes use of my abilities

1 2 3 4 5

12. The way company policies are put into practice

1 2 3 4 5

13. My pay and the amount of work I do

1 2 3 4 5

14. The chances for advancement on this job

1 2 3 4 5

15. The freedom to use my own judgment

1 2 3 4 5

16. The chance to try my own methods of doing the job

1 2 3 4 5

17. The working conditions

1 2 3 4 5

18. The way my co-workers get along with each other

1 2 3 4 5

19. The praise I get for doing a good job

1 2 3 4 5

20. The feeling of accomplishment I get from the job

1 2 3 4 5

Adapted from Weiss, D. L., Dawis, R. V., England, G. W., & Lofquist, L. H. (1967). Manual for the Minnesota Satisfaction Questionnaire (Minnesota Studies in Vocational Rehabilitation: XXII). Minneapolis/St. Paul, Minnesota: University of Minnesota, Industrial Relations Center.

17. Please answer the following questions as honestly as you can. Circle the number to the right of each statement that best corresponds to your level of agreement. Strongly Strongly Disagree Agree

1. My line of work is an important part of who I am. 1 2 3 4 5 2. This line of work has a great deal of meaning to me. 1 2 3 4 5 3. I do not feel “emotionally attached” to this line of work. 1 2 3 4 5 4. I strongly identify with my chosen line of work. 1 2 3 4 5 5. I do not have a strategy for achieving my goals in this line

of work. 1 2 3 4 5

6. I have created a plan for my development in this line of work.

1 2 3 4 5

7. I do not identify specific goals for my development in this line of work.

1 2 3 4 5

8. I do not often think about personal development in this line of work.

1 2 3 4 5

9. The costs associated with my line of work sometimes seem too great.

1 2 3 4 5

10. Given the problems I encounter in this line of work, I sometimes wonder if I get enough out of it.

1 2 3 4 5

11. Given the problems in this line of work, I sometimes wonder if the personal burden is worth it.

1 2 3 4 5

12. The discomforts associated with my line of work sometimes seem to great.

1 2 3 4 5

Adapted from Carson, K., & Bedeian, A. (1994). Career commitment: Construction of a measure and examination of its psychometric properties. Journal of Vocational Behavior, 44, 237-262. 18. Please answer the following questions as honestly as you can. Circle the number to the right of each

statement that best corresponds to your level of agreement. Please Note: For this scale, the response scale is reversed in comparison with the one above. That is, for the questions which follow, choosing “1” means you Strongly Agree and choosing “6” means you Strongly Disagree.

Strongly Strongly

Agree Disagree 1. It’s hard to find a reason for working. 1 2 3 4 5 6 2. I don’t seem to make decisions by myself 1 2 3 4 5 6 3. I have confusion about who I am. 1 2 3 4 5 6 4. I have more ideas than energy. 1 2 3 4 5 6 5. I lose my sense of direction. 1 2 3 4 5 6 6. It’s easier for me to start than to finish projects. 1 2 3 4 5 6 7. I don’t seem to get going on anything important. 1 2 3 4 5 6 8. I wonder where my life is headed. 1 2 3 4 5 6 9. After a while, I lose sight of my goals. 1 2 3 4 5 6 10. I don’t seem to have the drive to get my work

done. 1 2 3 4 5 6

Adapted from Robbins, S. B., & Patton, M. J. (1985). Self-psychology and career development: Construction of the Superiority and Goal Instability scales. Journal of Counseling Psychology, 32, 221-231. Thank you for your participation in this important and timely project. If you have any questions or comments, please contact the VGEC Evaluator, Constance L. Coogle, Ph.D. (804/828-1525).

Recognition, Respect, and Responsibility Enhanced Care Assistant Training

Post Training Survey All individuals who have participated in the training should complete this questionnaire. Your answers are extremely valuable. Please provide an answer for each of the questions asked. For reasons of confidentiality, we ask that you be sure to provide your Participant Identification Number. If responses on this survey can't be matched up with your previous paperwork, it will be impossible for us to make important comparisons about the impact of the training. This and any other forms you complete related to this project are strictly confidential. Your responses will not be linked with your name in any database. The data will be used for the purposes of evaluation only. Your participation is completely voluntary. You have the right to withdraw at any time or refuse to answer any questions. Participant Identification Number (LAST six digits of your social security number) Name of Your Agency/Facility_________________________________________ 1. What is your gender? (Circle one) Male Female 2. What is your racial background? (Check ONLY one) American Indian or Alaska Native Hispanic or Latino Under-represented Asian subgroup* Native Hawaiian or Other Pacific Islander Asian (not under-represented) White or Caucasian Black or African American Other (please specify) * Refers to any Asian other than Chinese, Filipino, Japanese, Korean, or Asian Indian 3. What is your age?________ 4. What degrees/certifications do you currently hold? (Mark all that apply) H.S. B.A. B.S. B.S.W. B.S.N. R.N. C.N.A.

N.P.-C. A.N.P. M.A. M.S. __ M.S.N. M.S.W. M.Ed.

M.P.H. M.D. M.Div. Ph.D. Ed.D. D.P.H. D.S.W.

D.N.Sc/N.D. D.Pharm. D. Min. D.D.S. Psy. D. Other _______ (specify)

5. To what extent do you anticipate an emphasis on long term care across the course of your career? 6. When looking for your next position, how will the opportunity to work in the area of long term care influence your decision?

Not at All Extremely 1 2 3 4 5 Not at All Extremely 1 2 3 4 5

7. The questions below ask about your line of work or career field in which you are currently employed. You may consider line of work/career field as having the same meaning as occupation, profession, or vocation. When completing this survey, ask yourself: How satisfied am I with this aspect of my job? Please answer using the scale below and circle the number that corresponds with your response for each item: VS = I am very satisfied with this aspect of my job. S = I am satisfied with this aspect of my job. N = I can’t decide whether I am satisfied or not with this aspect of my job. DS = I am dissatisfied with this aspect of my job. VDS = I am very dissatisfied with this aspect of my job. On my present job, this is how I feel about: VDS DS N S VS

1.

Being able to keep busy all the time

1

2

3

4

5

2. The chance to work alone on the job

1 2 3 4 5

3. The chance to do different things from time to time

1 2 3 4 5

4. The chance to be “somebody” in the community

1 2 3 4 5

5. The way my boss handles his men (women)

1 2 3 4 5

6. The competence of my supervisor in making decisions

1 2 3 4 5

7. Being able to do things that don’t go against my conscience

1 2 3 4 5

8. The way my job provides for steady employment

1 2 3 4 5

9. The chance to do things for other people

1 2 3 4 5

10. The chance to tell people what to do

1 2 3 4 5

11. The chance to do something that makes use of my Abilities

1 2 3 4 5

12. The way company policies are put into practice

1 2 3 4 5

13. My pay and the amount of work I do

1 2 3 4 5

14. The chances for advancement on this job

1 2 3 4 5

15. The freedom to use my own judgment

1 2 3 4 5

16. The chance to try my own methods of doing the job

1 2 3 4 5

17. The working conditions

1 2 3 4 5

18. The way my co-workers get along with each other

1 2 3 4 5

19. The praise I get for doing a good job

1 2 3 4 5

20. The feeling of accomplishment I get from the job

1 2 3 4 5

5

Please answer the following questions as honestly as you can. Circle the number to the right of each statement that best corresponds to your level of agreement. Strongly Strongly Disagree Agree

1.

My line of work is an important part of who I am

1

2

3

4

5

2.

This line of work has a great deal of meaning to me

1

2

3

4

5

3.

I do not feel “emotionally attached” to this line of work

1

2

3

4

5

4.

I strongly identify with my chosen line of work

1

2

3

4

5

5.

I do not have a strategy for achieving my goals in this line of work

1

2

3

4

5

6.

I have created a plan for my development in this line of work

1

2

3

4

5

7.

I do not identify specific goals for my development in this line of work

1

2

3

4

5

8.

I do not often think about personal development in this line of work

1

2

3

4

5

9.

The costs associated with my line of work sometimes seem too great

1

2

3

4

5

10.

Given the problems I encounter in this line of work, I sometimes wonder if I get enough out of it

1

2

3

4

5

11.

Given the problems in this line of work, I sometimes wonder if the personal burden is worth it

1

2

3

4

5

12.

The discomforts associated with my line of work sometimes seem to great

1 2 3 4 5

9. To what extent did the training improve the likelihood that you will stay at your current job? 1 2 3 4 5 Not at A Great All Deal Thank you for your participation in this important and timely project. If you have any questions or comments, please contact the VGEC Evaluator, Constance Coogle, (804) 828-1525 (ccoogle@hsc.vcu.edu)

6

Part I. Training of Direct Service Providers (continued) Evaluation measures documented the achievement of curriculum objectives, the satisfaction of trainer expectations, and the likely impact of DSP training. Training was evaluated using four post-training questionnaires corresponding to each of the modules presented. After the end of each of the four training days, participants were encouraged to evaluate the training provided to them with respect to the extent that each of the specific objectives had been met. A composite variable was derived by averaging individual ratings across the stated objectives. In addition, trainees were asked to rate more general criteria that included the presentation and organization of materials, the presenter’s knowledge of the material, the use of teaching tools, and the degree to which the training site was conducive to learning. Again, a composite variable was computed to represent the extent that participants’ expectations had been met with respect to the general criteria. A third composite variable, representing the likely impact of the training, combined ratings on four items related to the extent that training increased participants’ knowledge about geriatrics, helped them use problem-solving techniques, changed the way that they would perform their jobs, and altered perceptions about their clients’ quality of life.

7

Enhanced Care Assistant Training II Module 1: SEEING THE PERSON, NOT THE ILLNESS

VERY IMPORTANT: Please enter the last 6 digits of your social security number ___________ For the following sections, II and III, circle the appropriate number with 1 representing "LOW" and 5 representing "HIGH." I. PROGRAM EVALUATION A) To what extent were the following objectives met: LOW HIGH 1) To describe why this opportunity is important to you 1 2 3 4 5 2) To describe the difference between cognitive impairment and diminished capacity 1 2 3 4 5 3) To list at least 2 causes of dementia 1 2 3 4 5 4) To list at least 3 principles of person centered care 1 2 3 4 5 5) To discuss at least 3 principles of communicating appropriately with people who have cognitive impairment 1 2 3 4 5 B) In general, to what extent have your expectations been met: LOW HIGH 1) Presentation and organization of material 1 2 3 4 5 2) Use of teaching tools (handouts, slides, etc.) 1 2 3 4 5 3) Presenter’s knowledge of material 1 2 3 4 5 4) Training site conducive to learning 1 2 3 4 5 5) Registration process 1 2 3 4 5 6) Parking 1 2 3 4 5 7) Conference room 1 2 3 4 5 8) Conference handouts 1 2 3 4 5 9) Lunch and breaks 1 2 3 4 5

II. TRAINING IMPACT A. How much did the session increase your knowledge of geriatrics? LOW 1 2 3 4 5 HIGH B. How much did the session help you use problem-solving techniques? LOW 1 2 3 4 5 HIGH C. How much will this session change the way you do your work? LOW 1 2 3 4 5 HIGH D. How much did this session change the way you view your patients'/clients' quality of life? LOW 1 2 3 4 5 HIGH III. ANCILLARY QUESTIONS Please answer the following questions using the five point scales given below. A. Are you planning on continuing your work with the geriatric population? Not at all 1 2 3 4 5 Extensively B. When looking for your next job, will you want to provide geriatric care? Not at all 1 2 3 4 5 Extensively C. How much has this session increased the chances that you will take more training classes in geriatrics? Not at all 1 2 3 4 5 Extensively

8

Enhanced Care Assistant Training II Module 2: Between a Rock and a Hard Place: Legal and Ethical Challenges Faced by PCAs

VERY IMPORTANT: Please enter the last 6 digits of your social security number ___________For the following sections, II and III, circle the appropriate number with 1 representing "LOW" and 5 representing "HIGH." I. PROGRAM EVALUATION A) To what extent were the following objectives met: LOW HIGH 1) To list 2 specific communication strategies for successfully

managing challenging situations 1 2 3 4 5 2) To explain the importance of professional behavior 1 2 3 4 5 3) To describe 3 ways to work effectively with families 1 2 3 4 5 4) To describe 3 ways to work effectively with supervisors 1 2 3 4 5 5) To describe 3 methods to prevent or resolve specific legal and ethical problems encountered in the home care setting 1 2 3 4 5 6) To describe at least 3 types of elder abuse that may be

encountered in the home setting 1 2 3 4 5 7) To state the telephone number to call if elder abuse is suspected 1 2 3 4 5 8) To identify 2 strategies to minimize the effect of violence

on clients and caregivers within the home care community 1 2 3 4 5 B) In general, to what extent have your expectations been met: LOW HIGH 1) Presentation and organization of material 1 2 3 4 5 2) Use of teaching tools (handouts, slides, etc.) 1 2 3 4 5 3) Presenter’s knowledge of material 1 2 3 4 5 4) Training site conducive to learning 1 2 3 4 5 5) Registration process 1 2 3 4 5 6) Parking 1 2 3 4 5 7) Conference room 1 2 3 4 5 8) Conference handouts 1 2 3 4 5 9) Lunch and breaks 1 2 3 4 5 II. TRAINING IMPACT A. How much did the session increase your knowledge of geriatrics? LOW 1 2 3 4 5 HIGH B. How much did the session help you use problem-solving techniques? LOW 1 2 3 4 5 HIGH C. How much will this session change the way you do your work? LOW 1 2 3 4 5 HIGH D. How much did this session change the way you view your patients'/clients' quality of life? LOW 1 2 3 4 5 HIGH III. ANCILLARY QUESTIONS Please answer the following questions using the five point scales given below. A. Are you planning on continuing your work with the geriatric population? Not at all 1 2 3 4 5 Extensively B. When looking for your next job, will you want to provide geriatric care? Not at all 1 2 3 4 5 Extensively C. How much has this session increased the chances that you will take more training classes in geriatrics? Not at all 1 2 3 4 5 Extensively

9

Enhanced Care Assistant Training II Module 3: It’s Like Losing a Piece of My Heart:

Dealing with Loss, Death, and Mourning VERY IMPORTANT: Please enter the last 6 digits of your social security number ___________

For the following sections, II and III, circle the appropriate number with 1 representing "LOW" and 5 representing "HIGH." I. PROGRAM EVALUATION A) To what extent were the following objectives met: LOW HIGH 1) Describe losses felt by older and/or disabled individuals 1 2 3 4 5 2) List signs that the client may be grieving a loss 1 2 3 4 5 3) List ways in which they can lessen the losses experienced by older and/or disabled individuals 1 2 3 4 5 4) Describe the dying trajectory 1 2 3 4 5 5) List 3 physical signs of death 1 2 3 4 5 6) List 3 psychosocial indicators of death 1 2 3 4 7) Describe ways in which formal caregivers can help selves and others cope with death 1 2 3 4 5 B) In general, to what extent have your expectations been met: LOW HIGH 1) Presentation and organization of material 1 2 3 4 5 2) Use of teaching tools (handouts, slides, etc.) 1 2 3 4 5 3) Presenter’s knowledge of material 1 2 3 4 5 4) Training site conducive to learning 1 2 3 4 5 5) Registration process 1 2 3 4 5 6) Parking 1 2 3 4 5 7) Conference room 1 2 3 4 5 8) Conference handouts 1 2 3 4 5 9) Lunch and breaks 1 2 3 4 5 II. TRAINING IMPACT A. How much did the session increase your knowledge of geriatrics? LOW 1 2 3 4 5 HIGH B. How much did the session help you use problem-solving techniques? LOW 1 2 3 4 5 HIGH C. How much will this session change the way you do your work? LOW 1 2 3 4 5 HIGH D. How much did this session change the way you view your patients'/clients' quality of life? LOW 1 2 3 4 5 HIGH III. ANCILLARY QUESTIONS Please answer the following questions using the five point scales given below. A. Are you planning on continuing your work with the geriatric population? Not at all 1 2 3 4 5 Extensively B. When looking for your next job, will you want to provide geriatric care? Not at all 1 2 3 4 5 Extensively C. How much has this session increased the chances that you will take more training classes in geriatrics? Not at all 1 2 3 4 5 Extensively

10

Enhanced Care Assistant Training II Module 4: Avoiding Burnout: Caring for Others by Caring for Ourselves

VERY IMPORTANT: Please enter the last 6 digits of your social security number ___________ For the following sections, II and III, circle the appropriate number with 1 representing "LOW" and 5 representing "HIGH." I. PROGRAM EVALUATION A) To what extent were the following objectives met: LOW HIGH 1) List strategies for caring for the physical self 1 2 3 4 5 2) List strategies for caring for the psychological self 1 2 3 4 5 3) List strategies for caring for the social self 1 2 3 4 5 4) Describe ways to recognize stress 1 2 3 4 5 5) Describe ways to modify reactions to stress 1 2 3 4 5 6) Discuss specific care situations that may place additional stress on nursing assistants or personal care assistants 1 2 3 4 5 B) In general, to what extent have your expectations been met: LOW HIGH 1) Presentation and organization of material 1 2 3 4 5 2) Use of teaching tools (handouts, slides, etc.) 1 2 3 4 5 3) Presenter’s knowledge of material 1 2 3 4 5 4) Training site conducive to learning 1 2 3 4 5 5) Registration process 1 2 3 4 5 6) Parking 1 2 3 4 5 7) Conference room 1 2 3 4 5 8) Conference handouts 1 2 3 4 5 9) Lunch and breaks 1 2 3 4 5 II. TRAINING IMPACT A. How much did the session increase your knowledge of geriatrics? LOW 1 2 3 4 5 HIGH B. How much did the session help you use problem-solving techniques? LOW 1 2 3 4 5 HIGH C. How much will this session change the way you do your work? LOW 1 2 3 4 5 HIGH D. How much did this session change the way you view your patients'/clients' quality of life? LOW 1 2 3 4 5 HIGH III. ANCILLARY QUESTIONS Please answer the following questions using the five point scales given below. A. Are you planning on continuing your work with the geriatric population? Not at all 1 2 3 4 5 Extensively B. When looking for your next job, will you want to provide geriatric care? Not at all 1 2 3 4 5 Extensively C. How much has this session increased the chances that you will take more training classes in geriatrics? Not at all 1 2 3 4 5 Extensively

11

Part II. Supervisor Training The VGEC also conducted supervisory training for those working with direct service

workers to build a culture of respect and value. This training was designed to engender and enhance the extent to which supervisors recognize, respect, and reward their personal care workers who strive to provide better quality care. There is a focus on the team approach to care and appropriately delegating responsibility. Supervisors are encouraged to promote the professional development of their employees and to regard them as partners in the provision of quality care. The evaluation protocol was designed to collect pre-training and post-training data on several constructs that could be influenced by the educational intervention. We collected data about how the supervisors relate to their home care employees and well as information about the consequences of the training as it might be applied on the job. Baseline data was collected when supervisors attended the training session.

12

Supervising or Snoopervising? Virginia Geriatric Education Center

ID Number (FIRST letter of your last name and LAST 4 digits of your SSN): _________ Name of Agency or Facility: _____________________________ Date _____________ What is your racial background? ___ 1) White/Caucasian ___ 2) Black/African American ___ 3) Asian ___ 4) American Indian or Alaskan Native ___ 5) Hispanic or Latino ___ 6) Native Hawaiian or Other Pacific Islander ___ 7) Under-represented Asian Subgroup* ___ 8) Jamaican * Refers to any Asian other than Chinese, ____ 9) Haitian/Caribbean African Filipino, Japanese, Korean or Asian Indian ___ 10) Other ___________________________ (please specify) Were you born in the United States? Yes No What is the highest level of education you have completed? (check one) ___ Doctoral Degree ___ Associate Degree ___ Masters Degree ___ High School ___ Bachelors Degree ___ Other _________________________ (please specify) In what city, county AND state do you work? County: _________________ City: _____________________ State: _______ What is your gender AND age? ___ Female ___ Male Age: _____ From the list below, please check the ONE category that best describes your occupational area: ___ 1) Undergraduate Nurse ___ 7) Advanced Practice Nurse ___ 13) Chiropractic ___ 2) Public Health ___ 8) Health Administration ___ 14) Preventive Medicine ___ 3) Pharmacy ___ 9) Counseling/Psychology ___ 15) Social Work ___ 4) Clinical Laboratory ___ 10) Food/Nutrition ___ 16) Health Information ___ 5) Rehabilitation ___ 11) Technologist/Technician ___ 17) Dental ___ 6) CNA/PCA ___ 12) Health Education ___ 18) Pastoral Care

___ 19) Other_____________ (please specify) What is your current job title? ______________________________________________________________________

13

*As a supervisor….. 1. I treat my employees as equal members of the healthcare team. 2. I listen carefully to the observations and opinions of my

employees 3. I give my employees credit for their contributions to resident

care. 4. I respect my employee’s ability to observe and report clinical

symptoms. 5. I ignore my employee’s input when developing resident care

plans. 6. I let my employees know how helpful their observations are for

resident care. 7. I trust my employees to give clients the care they need. 8. I help my employees with their job tasks when help is needed. 9. I discipline or remove employees who do not do their job well or

perform their share of the work.

Hardly Some of Most of Ever the Time the Time 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2

Perceived racial bias, as a stressor, can affect productivity in the workplace. The VGEC is interested in determining the extent to which this may be an issue for home care. Please be frank in your responses to the following items: Very Never Sometimes Often

1. I have dealt with racism from clients or their families. 1 2 3 4 5

2. My employees have dealt with racism from clients or 1 2 3 4 5 their families .

3. I feel able to support employees who must deal with racism 1 2 3 4 5

from clients or their families. 4. I feel that racism from clients or their families impacts 1 2 3 4 5

the quality of care my employees can provide to the clients. * * I feel that being ethnically/racially different from my employees: Strongly Strongly Disagree Agree

5. makes them less likely to think I do a good job. 1 2 3 4 5 6. makes them more likely to find fault with my actions. 1 2 3 4 5 .

7. Do you think training for supervisors on how to support employees Yes No who have encountered racism in the workplace would be useful?

8. Do you think training for employees on how to cope with racism Yes No

in the workplace would be useful?

* * *Using the scale below, please circle the response that best indicates to what extent, that is, how much each of the following statements is true for you in your practice or position. There are no right answers. For the purposes of this survey, vision is defined as a statement which clarifies the current situation and induces commitment to the future 1=Not at all True (NT) 2=Slightly True (ST) 3=Moderately True (MT) 4=Very True (VT) 5=Extremely True (ET) 1. I communicates clear, consistent expectations to my employees. 2. I have a strong vision for the home care agency. 3. I have no idea what my employees really do in their jobs. 4. I explain to my employees where we are going as an agency in a

way that makes them want to go along. 5. I create the feeling that good things are happening. 6. I am too controlling. 7. I treat my employees with respect and dignity. 8. I make my employees believe that they can make a difference. 9. My employees sometimes feel as though they don’t have any

alternatives. 10. I stimulate and challenge my employees to contribute. 11. I use the recommendations my employees give me. 12. My employees feel free to give me feedback about the direction of

the agency. 13. All of the communication is one-way from me down to the

employees. 14. I share important information with my employees that they need to

do their jobs. 15. There is a lot of give and take between my employees and me. 16. I resent feedback that my employees share me. 17. I delegate appropriate assignments to my employees along with the

authority to implement them. 18. I am a role model for my employees.

19. I rarely provide feedback on how my employees are doing.

NT ST MT VT ET 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

14

15

* Adapted from Craft Morgan, J., Haviland, S., & Konrad, T. R. (2005). Direct care workers in long-term care: Exploring the relationship between job quality and perceived quality of care. Presented at the annual meeting of the Southern Gerontological Society. Orlando, FL. ** Adapted from Ramirez, M., Teresi, J. A., Holmes, D., & Fairchild, S. (1998). Ethnic and racial conflict in relation to staff burnout, demoralization, and job satisfaction in SCUs and Non-SCUs. Journal of Mental Health and Aging, 4(4), 459-479.

* * * Adapted from Klakovich, M. (2003). The reciprocal empowerment scale. In L. D. Harris-Kojetin, K. M. Kiefer, D. Brannon, T. Bary, J. Vasey, & M. Lepore, Measuring long-term care work: A guide to selected instruments to examine direct care worker experiences and outcomes (pp. 4-45-4-47). Washington, DC: Institute for the Future of Aging Services

Part III. Team Training The team training for both the direct service providers and the supervisors was

designed to improve the working relationships and increase the demonstrations of mutual respect between direct care providers and supervisors by emphasizing the concepts of team work, communication, enhancing partnerships, and problems solving within a group. The team training sessions provided an opportunity to collect follow-up data from both groups of participants. For DSPs, the follow-up questionnaire collected retention data, as well as information about the extent to which the training content had been of assistance and whether their work situations had changed as a consequence of the training. Supervisors were asked to provide information about changes in employee relationships that might be attributable to the training. Additional questions asked supervisors about how many of their employees participated in various kinds of formal training or continuing education programs and whether this was linked to employee performance appraisal.

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Enhanced Care Assistants Training II Follow-Up Questionnaire for DSPs Participant Identification Number (LAST six digits of your social security number) Site where training was received_______________________________________________________ 1. Are you currently employed at the same agency or facility as you were when you most recently participated in the Enhanced Care Assistants Training? (Circle one) Yes No 2. To what extent did the training improve the likelihood that you will stay at your current job?

1 2 3 4 5 Not at all A great deal 3. In the past 6 months, have you considered leaving your current job? Yes No 4. Would you recommend your job to someone else? Why or why not? 5. As a consequence of the training, to what extent are you now better able: 5.1. To cope with on-the-job stress? 5.2. To reduce the amount of stress you feel

regarding your job? 5.3. To rely on others to help with your stress? 5.4. To recognize the rewards of your job? 5.5. To do your job? 5.6. To handle difficult behaviors in clients? 5.7. To understand your clients’ quality of life? 5.8. To use problem-solving techniques? 5.9. To address the factors that impact your

client’s sexuality? 5.10. To care for your physical, psychological,

and social self? 5.11. To use appropriate communication skills? 5.12. To show respect for the /clients? 5.13 To recognize neglect in the home? 5.14. To understand/handle the dying and

grieving processes? 5.15. To provide for the client’s spiritual needs?

Not at all A great deal 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

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* 6. As a consequence of the training you received, has your work situation changed in any of the following areas. (Circle the number which corresponds with your answer):

Much Worse

Slightly Worse

No Change

Slightly Better

Much Better

6.1 Opportunity for advancement 1 2 3 4 5 6.2 Communication/cooperation with

supervisor

1

2

3

4

5 6.3 Communication/cooperation with

family members

1

2

3

4

5 6.4 Resolution of complaints and grievances 1 2 3 4 5 6.5 Amount of feedback from

clients/families about how I do my job.

1

2

3

4

5

6.6 My supervisor treating me with respect. 1 2 3 4 5 6.7 Having work assignments that best

use my abilities.

1

2

3

4

5 6.8 Functioning as part of a team to care

for clients.

1

2

3

4

5 6.9 Making a difference in how clients

are cared for.

1

2

3

4

5 6.10 Opportunities to contribute my ideas

to client care plans.

1

2

3

4

5 6.11 Level of job satisfaction. 1 2 3 4 5 7. Below are a list of reasons why people sometimes leave their jobs or change occupations. Which of the following would be likely reasons, if you were to leave your current job or line of work? In the column on the left, please mark the likely reasons with an “X.” Then, in the margin beside the item numbers, rank your top three reasons (with “1” being your most likely reason). You may add reasons in the “Other” option at the bottom of the list. Check all that Apply 7.1) ____Continuing my education 7.2) ____Did not like the shift I worked 7.3) Decided to move from the area 7.4) Generally, did not like the work 7.5) Moved from area for spouse’s job 7.6) Did not like the working conditions 7.7) Retirement 7.8) Did not like the overtime required 7.9) Other family circumstances 7.10) Did not like the schedule 7.11) Got a different job with similar pay 7.12)_ Other scheduling issue (explain below) 7.13)__ Got a job with better pay 7.14)_ Supervision received 7.15)_ Poor or no fringe benefits 7.16)_ Agency becoming smaller 7.17)_ Health Reasons 7.18)__ Discharge for poor performance 7.19) Other________________________

(please specify)

18

19

* Adapted from McKee, G., Clabby, R., & Heinlein, K. (2001). State of Wyoming, Department of Health report to the joint appropriations committee on study of nonprofit direct care staff recruitment, retention, and wages. Retrieved November 11, 2002, from http://ddd.state.wy.us/Documents/wagedoc.htm

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ECAT II Supervisor Follow-Up Virginia Geriatric Education Center

ID Number (FIRST letter of your last name and LAST 4 digits of your SSN): _________ Name of Agency or Facility: _____________________________ Date _____________ As a supervisor….. 10. I treat my employees as equal members of the healthcare team. 11. I listen carefully to the observations and opinions of my

employees 12. I give my employees credit for their contributions to resident

care. 13. I respect my employee’s ability to observe and report clinical

symptoms. 14. I ignore my employee’s input when developing resident care

plans. 15. I let my employees know how helpful their observations are for

resident care. 16. I trust my employees to give clients the care they need. 17. I help my employees with their job tasks when help is needed. 18. I discipline or remove employees who do not do their job well or

perform their share of the work.

Hardly Some of Most of Ever the Time the Time 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2

10. Is participation in formal training or continuing education

programs linked to performance appraisal of direct care workers? Yes No * 11 . Excluding this ECAT training program, during the past year, approximately what percentage of

direct care workers have participated in any of the following:

a. Formal in-service programs beyond those required for certification

None 1-25% 26-50% 51-75% 76-100%

b. Self-directed educational video or computer-based training program

None 1-25% 26-50% 51-75% 76-100%

c. A job-related conference or workshop None 1-25% 26-50% 51-75% 76-100%

d. Career-ladder training (e.g., Certified nurse aide training)

None 1-25% 26-50% 51-75% 76-100%

e. Other staff development training None 1-25% 26-50% 51-75% 76-100%

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Using the scale below, please circle the response that best indicates to what extent, that is, how much each of the following statements is true for you in your practice or position. There are no right answers. For the purposes of this survey, vision is defined as a statement which clarifies the current situation and induces commitment to the future. 1=Not at all True (NT) 2=Slightly True (ST) 3=Moderately True (MT) 4=Very True (VT) 5=Extremely True (ET) 1. I communicates clear, consistent expectations to my employees. 2. I have a strong vision for the home care agency. 3. I have no idea what my employees really do in their jobs. 4. I explain to my employees where we are going as an agency in a

way that makes them want to go along. 5. I create the feeling that good things are happening. 6. I am too controlling. 7. I treat my employees with respect and dignity. 8. I make my employees believe that they can make a difference. 9. My employees sometimes feel as though they don’t have any

alternatives. 10. I stimulate and challenge my employees to contribute. 11. I use the recommendations my employees give me. 12. My employees feel free to give me feedback about the direction of

the agency. 13. All of the communication is one-way from me down to the

employees. 14. I share important information with my employees that they need to

do their jobs. 15. There is a lot of give and take between my employees and me. 16. I resent feedback that my employees share me. 17. I delegate appropriate assignments to my employees along with the

authority to implement them. 18. I am a role model for my employees. 19. I rarely provide feedback on how my employees are doing.

NT ST MT VT ET 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

22

Perceived racial bias, as a stressor, can affect productivity in the workplace. The VGEC is interested in determining the extent to which this may be an issue for home care. Please be frank in your responses to the following items: Very Never Sometimes Often

5. I have dealt with racism from clients or their families. 1 2 3 4 5

6. My employees have dealt with racism from clients or 1 2 3 4 5 their families .

7. I feel able to support employees who must deal with racism 1 2 3 4 5

from clients or their families. 8. I feel that racism from clients or their families impacts 1 2 3 4 5

the quality of care my employees can provide to the clients. I feel that being ethnically/racially different from my employees: Strongly Strongly Disagree Agree

5. makes them less likely to think I do a good job. 1 2 3 4 5 6. makes them more likely to find fault with my actions. 1 2 3 4 5 .

7. Do you think training for supervisors on how to support employees Yes No who have encountered racism in the workplace would be useful?

8. Do you think training for employees on how to cope with racism Yes No

in the workplace would be useful?

* Adapted from Brannon, D., Barry, T., Angelelli, J., & Weech-Maldonado, R. (2005). 2004 Pennsylvania Long-Term Care Workforce Surveys: A Report to the Pennsylvania Intra-Governmental Council on Long-Term Care (Appendix A: Clinical Manager Survey). Retrieved January 10, 2006 from http://www.aging.state.pa.us/aging/lib/aging/Appendix_A_PCA_Provider_Survey.pdf

23

Part IV. Additional Follow-Up In addition to the effort to collect retention and follow-up data at the team training sessions, the Partnership for People with Disabilities at Virginia Commonwealth University was contracted to conduct an additional follow-up through a mailed questionnaire sent approximately 6 months after the DSPs attended training. A return rate of 62% was achieved by providing an incentive (discount store payment card). The survey was intended to primarily provide information about job retention and whether the training had an impact in that respect. In addition it again gathered information about the participants’ satisfaction with the training, and collected additional data related to job satisfaction and health insurance enrollment.

Direct Service Worker Survey

PLEASE TELL US YOUR… 1) Age: ________ years old

2) Sex:

Male Female

3) Race (Check all that apply.)

Black, not of Hispanic origin Hispanic White, not of Hispanic origin American Indian or Alaskan Native Asian or Pacific Islander Other (specify)___________________

4) Highest level of education:

Some high school How many years of high school did you complete? ____ years High school graduate Some college How many years of college did you complete? ____ years College graduate Other (specify) _____________________

5) How many years have you worked as a direct service worker? (Note: these are jobs in

which you take care of an elderly person or a person with disabilities.) ______ years [Write 0 if you have never worked as a direct service worker.]

6) What ECAT training (Enhanced Care Assistant Training) did you take? (Check all that apply.)

1-Seeing the Person, Not the Illness 2-Between a Rock and a Hard Place: Legal and Ethical Challenges Faced by PCAs 3- It’s OK to Become Attached to your Clients: Dealing with Loss, Death, and Mourning 4- Avoiding Burnout: Caring for Others by Caring for Ourselves I don’t remember

7) When was the last ECAT training (Enhanced Care Assistant Training) session you took?

March 25, 2006 April 8, 2006 April 22, 2006 May 6, 2006

September 9, 2006 September 23, 2006 October 7, 2006 October 21, 2006

8) Where did you take the last ECAT (Enhanced Care Assistant Training) training?

Abingdon Charlottesville Eastern Shore (Melfa, VA) Hampton Martinsville Norfolk

24 Richlands

Richmond Roanoke Springfield Virginia Beach

25

9) In general, how would you rate the ECAT trainings (Enhanced Care Assistant Training) you have taken?

Excellent Good Fair Poor Don’t remember the training

10) What did you most enjoy about the ECAT training (Enhanced Care Assistant Training)?

11) What would you like to share with us about the ECAT training (Enhanced Care Assistant Training) so we can make the training better?

12) Please tell us how much you agree or disagree with the following statements. Strongly

Agree Agree Disagree Strongly Disagree

I am happy with my job………………………………………………….

Home-based care is a rewarding job…………………………………..

I love helping people……………………………………………………..

I will probably be a direct service worker for many years……………

I would quit my job if I could……………………………………………

I often don’t know how to deal with some clients’ problems………..

I would stay in my job longer if I had health insurance………………

There is no reason for me to stay in my current job………………….

The ECAT training helped me see how my job can be enjoyable….

The ECAT training taught me a lot……………………………………..

I want to attend other ECAT trainings………………………………….

The ECAT training made me want to stay with my job………………

The ECAT training helped me to like my job more……………………

The ECAT training was boring………………………………………….

I really didn’t get anything out of the ECAT training………………….

13) Are you currently working as a direct service worker? Yes No Please go to question 15

14) Are you working at the same agency where you worked when you

went to ECAT training (Enhanced Care Assistant Training)? Yes Please skip to question 16 No

Where are you currently working? Self-employed direct services worker Another home-based care agency Assisted living facility Nursing home Other Please specify: _______________________________ Not employed

15) What are the reason(s) you quit? (Check all that apply.)

Low pay I got another job with similar pay I got another job with better pay Retired

No health insurance Poor fringe benefits No vacation or sick leave

Clients required too much care Clients were difficult Clients’ needs were too big Clients’ family members were

demanding

Too many patients Could not provide care in the way I wanted

Did not enjoy the work Found a better job Did not like the working

conditions

The work is stressful Not enough training Difficult supervisor Little support for doing a good job

Skip to Question 17

My health problems Needed to care for sick relative Family needed me at home Needed to care for my children I wanted to continue my education

Transportation problems Too far from home Moved Family issues

Agency downsized Fired Laid off

Bad work schedule Did not like the overtime required Not enough hours Too many hours

Nobody to fill in when I couldn’t work Did not like the schedule Please

explain ___________________________________

Other Please explain ___________________________________

26

27

16) For those who still work at the same agency: Have you considered quitting?

Yes, I often think about quitting Yes, I sometimes think about quitting No

16a.) To what extent did the training improve the likelihood that you will stay at your current job?

1 2 3 4 5 Not at all A great deal

16b.) What might be some reason(s) you would quit? (Check all that apply.)

Low pay No health insurance Poor fringe benefits No vacation or sick leave

Clients require too much care Clients are difficult Clients’ needs are too big Clients’ family members are demanding

Too many patients Cannot provide care in the way I want Do not enjoy the work To find a better job Do not like the working conditions

The work is stressful Not enough training Difficult supervisor Little support for doing a good job

Bad work schedule Do not like the overtime required Not enough hours Too many hours

Nobody to fill in when I can’t work

Did not like the schedule Please explain _______________________

Other Please explain _______________________

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17) Do you have health insurance for yourself? Yes Please answer questions 17a and 17b. No Please go to question 18.

17a. What type of health insurance do you have for yourself?

Medicaid Health insurance offered by my employer Health insurance offered by my spouse’s employer Other: (please specify) __________________________________________

17b. Who pays the health insurance premiums for your health insurance?

I pay all the premiums (or my spouse pays) I (or my spouse) pay part of the premiums; my employer pays the other part My employer pays all the premiums I’m not sure

18) Do you have children under the age of 23 who live with you (or are away at college)?

Yes Do your children have health insurance? Yes No No

19) When looking for a job, how important is it to you that the employer offers health insurance?

Very important Somewhat important A little important Not important

20) Would you recommend your job to someone else? Why or why not?

21) What are some reasons that you would quit your job as a direct service worker?

22) What are some reasons that you would want to stay in your job as a direct service worker?

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Part V. Family Training

An additional focus of this training initiative has been the training of the families themselves. The goal is to have all the partners in care: the direct care workers, their supervisors and the families understand the complexities of the caring process. If all groups understand these complexities, there should be less frustration, stress, and miscommunication. Because the family training did not include an opportunity to follow-up, the opportunity to measure outcomes was precluded. As a consequence, the evaluation was designed to simply collect information about the nature of relationships between families and paid caregivers. We asked about staff behaviors, interpersonal conflict, and staff empathy. A forced choice question asked family members to tell us whether they valued emotionally sensitive care over technically competent performance. Other items were rather straight forward, documenting the achievement of curriculum objectives and satisfaction with the training. One question attempted to collect data related to the impact of the training, however. Family caregivers were asked to tell us the extent to which they felt prepared to tackle communication difficulties that might arise in their relationships with paid caregivers before and after the training.

30

ECAT II: Family Training Date:_________________ Thank you for participating in the training, Between a Rock and a Hard Place: Navigating the Challenges of Family Caregiving. Please take a few minutes to complete this training evaluation form. Your comments will help to improve the program by providing valuable feedback. A. Demographic data

1. What is your gender? Male Female 2. What is your race? White Black Other

3. What is your age? a. 20 – 40 Years b. 41 – 50 Years c. 51 – 60 Years d. 61 – 70 Years e. Over 70 Years 4. What is your level of education? a. Less than High School b. High School Graduate c. Post High School Education d. College Graduate 5. What is your relationship to the person who receives home care services?

Spouse Child/child-in-law Other relationship_____________________________ (please specify) B. To what extent did the training provide you with new knowledge in the following areas? Not at all Extensively 1) Negotiating the boundaries with paid caregivers 1 2 3 4 5 2) Communicating effectively with paid caregivers 1 2 3 4 5 3) Skills to care for family members with cognitive impairments 1 2 3 4 5

4) Skills to care for yourself and prevent burnout 1 2 3 4 5

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5) Prior to the training, how prepared did you feel to tackle communication difficulties that might arise in your relationship with paid caregivers?

1 Very well prepared 4 A little prepared 2 Well prepared 5 Not at all prepared 3 Somewhat prepared 6) After participating in this training, how prepared did you feel to tackle communication difficulties

that might arise in your relationship with paid caregivers? 1 Very well prepared 4 A little prepared 2 Well prepared 5 Not at all prepared 3 Somewhat prepared C. Program Evaluation In general, to what extent have your expectations been met: LOW HIGH 1) Organization of presented material 1 2 3 4 5 2) Delivery of presentations 1 2 3 4 5 3) Presenters' knowledge of material 1 2 3 4 5 4) Effectiveness of teaching methods 1 2 3 4 5 5) Training site conducive to learning 1 2 3 4 5 What is your overall evaluation of this training program? 1 Excellent 2 Good 3 Average 4 Inadequate 5 Very poor Would you recommend this training program to others? 1 Yes 2 No

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C. Please help us learn a little more about the relationships between family caregivers and home care service providers (i.e., paid caregivers, personal care attendants).

1. Which of the following is most important to you when it comes to the services provided by paid

caregivers? (Circle only ONE) a. Emotionally sensitive care b. Technically competent performance 2. How often does your paid caregiver provide you with news, encouragement, or suggestions about

your family member’s condition or well being?* a. Never b. Rarely c. Sometimes d. Almost Always 3. How frequently do you find yourself in an argument or conflict with the paid caregiver over issues related to the personal care provided (e.g., the family member’s appearance, attentiveness to the family member’s needs, toileting, meals/food prepared, laundry/clothing, or the agency rules)?**

a. Never b. Once a Month c. A Few Times a Month d. A Few Times a Week e. Every Day 4. How often do you find the paid care provider to be understanding, easy to talk to, or helpful?***

a. Never b. Rarely c. Sometimes d. Almost Always Thank you. Please feel free to add additional comments. 1) Is there one part of the training that pleased you the most? Why? 2) Is there one part of the training that bothered you’re the most? Why? 3) Is there one part of the training that surprised you the most? Why? 4) Is there anything else about the training that you would like to mention?

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34

* Staff Behaviors Scale adapted from Pillemer, K., Hegeman, C., Albright, B., Henderson, C. (1998) Building bridges between families and nursing home staff: the Partners in Caregiving program. The Gerontologist, 38, 499-501. ** Interpersonal Conflict Scale adapted from Pillemer, K. & Moore, D. W. (1989). Abuse of patients in nursing homes: Findings from a survey of staff. The Gerontologist, 29, 314–320. *** Staff Empathy Scale adapted from Pillemer, K., Hegeman, C., Albright, B., Henderson, C. (1998) Building bridges between families and nursing home staff: the Partners in Caregiving program. The Gerontologist, 38, 499-501.

CD for Training D

ocuments

CD for Training DocumentsDr. Rita JablonskiDr. Anthony Delellis

Research MaterialsDr. Constance CoogleDr. Iris ParhamMs. Parthy Dinora

DVD for Didactic Video Presentations

Mr. Jason Rachel, Executive ProducerDr. Rita JablonskiDr. Anthony Delellis

CD with Photo GalleryMs. Lynda Ramsey

Recruitment Brochures

Affiliation Listing of Editors and A

uthors

AUTHOR AFFILIATIONS: Dr. Iris A. Parham, President and CEO of AGES, Inc., Access to Geriatrics Education and Services, and Professor Emerita of Gerontology, Psychology and Medicine, Virginia Commonwealth University. Dr. Constance Coogle, Associate Director for Research, Virginia Center on Aging, Virginia Commonwealth University and Associate Professor, Department of Gerontology. Dr. Rita A. Jablonski, Pennsylvania State University. Jason Rachel, M.S., Virginia Department of Medical Assistance Services. Dr. Anthony J. DeLellis, Associate Professor and Assistant Dean for Administration, School of Nursing, Virginia Commonwealth University. Teja Stokes, Virginia Department of Medical Assistance Services.