The Facts on Long-Term Care Workforce Requirements

Transcription

1 Missouri s LTC Workforce: The Case for Urgency in Addressing Staff Retention Matt Younger, M.S., LNHA Administrator, Section for Long-Term Care Regulation Missouri Dept. of Health and Senior Services 1 Education is not the filling of a pail, but the lighting of a fire. -William Butler Yeats A Starting Thought 2 1

2 In 2010, across the U.S., the following FTEs were needed in Long- Term Care to fill existing vacancies: 8,300 RN positions were vacant. 11,700 LPN positions were vacant. 40,000 CNA positions were vacant. American Health Care Association 2010 Staff Vacancy & Turnover Survey 3 Previous studies: LTC workforce would need to grow by two percent per year from now until 2050 to maintain the current ratio of LTC workers to the population age 85 or older (Friedland, 2004). By 2050, the estimated number of direct care workers will range from million workers, an increase of between 200 percent and 242 percent from The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation 4 2

3 Total established nursing staff positions in nursing facilities will raise to more than 1,343,000 FTEs in Total vacant positions will increase to 142,000 FTEs in American Health Care Association Projected Number of Nursing Staff Positions and Vacancies in Nursing Facilities: Total Long-Term Care Employment: 4.7 million. Long-Term Care as a percentage of U.S. healthcare employment: 29.3 Total U.S. LTC direct-care employees: 2.9 million. Total RNs & LPNs working in LTC: 644,850. AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 6 3

4 Total number of nurse aides & home health aides working in U.S.: 2.2 million. AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 7 Projected U.S. Population Age 65 & Over: 2008: 38.8 Million 2030: 72.0 Million AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 8 4

5 Estimated Population with Diagnosis of Alzheimer s Disease: 2007: 4.9 Million 2030: 7.7 Million AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 9 LTC Population in 2006: Population age 65 & over in Nursing Homes: 1.6 Million Population age 65 & over in Assisted Living Facilities: 1.5 Million Medicare beneficiaries using home health services: 3.0 Million AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 10 5

6 Projected Medicare Enrollment: 2007: 44 Million 2016: 55 Million 2030: 79 Million AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 11 Projected Percentage Increase of LTC Utilization between 2000 & 2020: Nursing home residents: 40% increase Home health visits: 36% increase AHCA & NCAL 2010 U.S. Long-Term Care Workforce At A Glance 12 6

7 The Long-Term Care Workforce: Over 66% of long-term care employees are nurses or nurse aides. Long-term care services are laborintensive, so the quality of care depends largely on the performance of the caregiving personnel. American Health Care Association 2010 Staff Vacancy & Turnover Survey 13 The Long-Term Care Workforce: Long-term care nurses and aides face accident and injury rates exceeding those in the construction and mining industries. 30% of Nurse Aides live at or below the poverty line. Nurse Aides are less likely than the average worker in the U.S. to have health insurance. 75% of Nurse Aides have no employersponsored pension. Institute for the Future of Aging Services:

8 Nursing Home Turnover Nationally: RNs: 41% CNAs: 42.6% Estimated national cost of CNA turnover: $4 billion annually, or $250,000 annually for each facility in the U.S. National Commission on Nursing Workforce for Long-Term Care: April 2005 American Health Care Association 2010 Staff Vacancy & Turnover Survey 15 Staffing Patterns and Quality: Average length of time spent with each LTC resident per day by vocation: CNA: 2.02 hours RN: 0.40 hours RN & LPN: 1.03 hours National Commission on Nursing Workforce for Long-Term Care: April

9 Annual earnings of the national Paraprofessional Workforce in LTC: Home Health Aides: $18,850 Nurse s Aides: $21,480 Retail Cashiers: $17,300 Institute for the Future of Aging Services: % 40% 35% 30% 25% Series1 20% 15% 10% 5% 0% Excellent Good Fair Poor Employees Who Recommend the JOB to Others 2006 Survey: My Innerview 18 9

10 45% 40% 35% 30% 25% Series1 20% 15% 10% 5% 0% Excellent Good Fair Poor Employees Who Recommend the CARE to Others 2006 Survey: My Innerview 19 Recommendations for RN education: The National Advisory Council on Nurse Education and Practice (NACNEP): By 2010, two-thirds of the RN workforce should have baccalaureate or higher degree in nursing. If this could be achieved, it would have a large impact on the shortage of nursing faculty as well as the shortage of registered nurses. National Advisory Council on Nursing Education and Practice: October,

11 A 2011 national survey of RNs Highest educational level: 12% diploma 35% associate degree 40% baccalaureate 12.5% is master s or doctoral education AMN Healthcare 2011 Survey of Registered Nurses 21 Nearly 20,000 fewer students took the national registered nurse licensing exam in 2003 than did in 1995 a reduction of 20% American Association of Colleges of Nursing:

12 Missouri RN shortage forecast: 2010 Forecast: 12,900 too few RNs Forecast: 18,900 too few RNs Forecast: 25,400 too few RNs. HRSA: Despite Looming Shortages: U.S. Nursing schools turned away nearly 43,000 qualified applicants to baccalaureate and graduate nursing programs in Those schools cited an insufficient number of faculty as the primary reason for rejection of qualified candidates. Lack of clinical training space, classroom space, clinical preceptors & budget constraints were some secondary reasons. American Association of Colleges of Nursing:

13 We have lives and careers that enable us to affect the lives of others for the better. Let s not waste an opportunity. Sometimes the period before a system breaks is the only time to solve the problem before the system breaks. Some Parting Thoughts 25 We feel worse about bad events that happen because of our action than we feel about events caused by our inaction but we re only fooling ourselves. The real risk in this case is the risk we all take by doing nothing. A Final Parting Thought 26 13

14 Advancing Excellence in America s Nursing Homes Making Nursing Homes Better Places to Live, Work and Visit! Missouri 1/5/12 Objectives: Campaign Website How to Access and Use the Tools & Resources Instruction on Staff Turnover Tool Staff Turnover Goal Data Entry 1

15 Want More Info on the Campaign? Contact Carol Scott Campaign Website: 2

16 Staff Turnover AE Goal Goal 1 - Staff Turnover: Nursing homes will take steps to minimize staff turnover in order to maintain a stable workforce to care for residents. Goal 1: Staff Turnover Resources 6 3

17 Accessing the Resources 7 Select Goal 1: Staff Turnover 4

18 Resources: Staff Stability Implementation Guide A Great Place to Get Started 5

19 Fact Sheet For Consumers Fact Sheet For Staff Page 1 6

20 Fact Sheet For Staff page 2 Staff Stability Toolkit Staff Stability Toolkit: Click Here Many Great Resources 7

21 Staff Turnover Tool Demonstration Simple as Download the Excel Tool. 2. View Webex training tool for tutorial on tool use. 3. Enter data from tool Monthly into Web site. Be sure to SAVE the Excel Spreadsheet to your computer BEFORE you enter any data! 8

22 National Nursing Home Turnover Data CNA 65.6% RN 41.0% LPN 49.9% AHCA s Staff Vacancy and Turnover Report 2007 To Help With Your Facility Benchmarking The Staff Turnover Calculator Tool Only nationally available standardized way to collect turnover data Developed for QIO s 8 th scope of work and modified to make it better over past 6 years Used to collect and analyze monthly data Prepares the data for entry into the AE Website 9

23 Accessing the Staff Turnover Tool Click Here to Download the Staff Turnover Tool Click Here to learn to use the tool step by step Staff Turnover Calculator Welcome Page 20 10

24 Instructions TAB 21 Common Qs & As Tab 22 11

25 CNA Calculation Tab Two Data Points are Entered Monthly in the Yellow Boxes 23 CNA Trending TAB 24 12

26 Data Entry on AE Website Enter staff turnover data on AE website monthly Use data from the tool to enter the data 6 data points are entered per month (2 for each: C.N.A., RN, LPN) Your data are confidential others cannot see it Print off and use the provided trend graphs for PI meetings Data Entry on AE Website Log in and find the Enter My Data button Enter Staff Turnover Data for C.N.A. s, RN s and LPN s Monthly on Advancing Excellence website Be sure to click the submit data button for each category Your data is confidential others cannot see it No HIPAA Issues Aggregate Data Only 26 13

27 Log In with your user name and password To enter demo data for the organizational goals, click on the Enter My Data Link on the left menu. If you don t have your username/password, you can contact Deborah Finley to reset it at dfinley@primaris.org To enter Staff Turnover data monthly for the goal, click on the Enter My Data Link on the left menu. 14

28 Click on Submit Data to Enter Data for Staff Turnover Goal 1: Staff Turnover Data Entry Click down box to year, Enter C.N.A. Data for the month and make sure to press the submit button and you will receive a red message confirming your submission Repeat for RN and LPN 15

29 Questions?? Thank You! Tammy Rolfe (207)

30 Advancing Excellence in America s Nursing Homes Making Nursing Homes Better Places to Live, Work and Visit! Campaign Overview 1

31 Campaign Website: Campaign Overview Largest national coalition (30 organizations) of nursing home stakeholders working together to help nursing homes improve care Voluntary for nursing homes (50% registered!) Based on measurement of meaningful goals Initially a two-year campaign started in 2006 Slated to continue with new goals spring 2012 The data show that it works! 2

32 Purpose of the Advancing Excellence in America s Nursing Homes Campaign Helps make nursing homes better places to live, to work, and to visit. What the Campaign Does.. Provides free, practical and evidence-based QA/PI resources to support quality improvement efforts in America s nursing homes. Commits support to those on the frontlines of nursing home care and encourages engagement of frontline staff. Promotes open communication and transparency among families, residents, and nursing home staff. 3

33 How It Works Nursing Homes register Pick at least 3 Goals 1 Clinical, 1 Organization and 3 rd of your choice (may pick all 8 goals) Set targets Use the resources and tools Track and Trend your data Share the results Enter Data for selected organizational goals at prescribed intervals (monthly/quarterly) Consumers and Direct Care staff can register as well Advancing Excellence Phase 2 Goals 1. Staff Turnover 3. Physical Restraints 5. Pain 7. Resident Satisfaction 2.Consistent Assignment 4. Pressure Ulcers 6. Advance Care Planning 8. Staff Satisfaction 8 4

34 New Goals for 2012 An AE Campaign task force is working on a slate of new and updated goals Person Centered Care Focused Tools and Resources should be in place on website by late spring Resources 1 0 5

35 MOLANE Team: Session One Alexis Roam, MSN, RN Publication MO NH January 2012 This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy Teams, Teams, and more Teams Management team Consistent assignment team Care plan team Quality improvement teams And the list goes on 1

36 Teams Ask yourself if you have a team or groups of people working? If you have teams, are they: Working toward a common goal and focused on results? Challenging each other and holding each other accountable? Committed to their purpose and contribution to the team s work. Getting Started Become a knowledgeable team leader Read books and articles & speak to others who lead successful teams Include a diverse group of people Give voice to those involved Set the tone Atmosphere where people can be honest and challenge ideas Be clear about what you want to accomplish- what is your vision and how do people fit in that vision 2

37 General suggestions for team members No more than 10 people Representatives from each shift Include informal leaders Those leaders you wish weren t??? How do I get them to join? Ask for volunteers-leave some spots open for those you know you want to include Give people time and resources to participate Communicate why you have asked them to join the team and other details of what will be happening on the team Discover why there is resistance 3

38 Communicating throughout the Change Listen, ask questions, discuss people s ideas Communicate in the same message in several ways on several occasions Listen to people s complaints or fears and discuss how they fit into the solution aroam@primaris.org