Turnover among direct-care workers in long-term care (LTC) facilities is high, and has a significant impact on residents, leaders, and owners of LTC facilities. The overall turnover costs are also substantial and constitute a significant financial burden in LTC facilities. This systematic review of the literature examined, retention strategies for direct-care workers in the LTC workforce. The information may be used to develop and provide practice recommendations that will help improve retention rates among direct-care workers in LTC facilities. The project design involved a systematic examination of English-only studies from 2001-2004, retrieved from 3 major databases: CINAHL with Medline simultaneous, ProQuest, and Ovid resources. The review led to the identification of 858 publications out of which 17 articles met the inclusion criteria. The manifested variables were critically analyzed and grouped into 8 categories: job training, management style, acknowledgement of accomplishments, career advancements, benefits, peer mentoring, competitive wages and work load. The findings from this systematic review of the literature suggest that several factors affect turnover rates in the LTC setting, including job training, management style, acknowledgement of accomplishments, career advancements, benefits, peer mentoring, competitive wages and work load. This project aims to provide insight to project developers, administrators, researchers, and policy makers concerning factors that affect retention. The information can be used as a catalyst for positive social change and reduce the turnover crisis among direct-care workers in the long-term care setting.

Yes / This study assessed the effects of a psycho-educational intervention on direct care workers' person-centredness during morning care to residents with dementia. A controlled pretest–posttest study was conducted in four aged-care facilities with 56 direct care workers (female, mean age 44.72 ± 9.02). Two experimental facilities received a psycho-educational intervention comprising person-centred care competences and stress management skills; control facilities received an education-only intervention, without stress support. In total, 112 video-recorded morning care sessions were coded using the Global Behaviour Scale. Both groups reported significantly higher scores on eight of 11 items of the Global Behaviour Scale and on the Global Behaviour Scale total score at posttest (F=10.59; p=0.02). Global Behaviour Scale total score improvements were higher for the experimental group, with values close to significance (F=3.90; p=0.054). The findings suggest that a psycho-educational intervention may increase care workers' person-centredness. Further research is needed to explore the long-term sustainability and extent of its benefits on workers and residents. / Foundation for Science and Technology

Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking.<p> Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina QuAppelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest.<p> Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005.<p> Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed.<p> Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to $2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR.<p> Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals.

This study examined the relationship between subordinates perception of the quality of leader-member exchange (LMX) relationship, dyadic demographic factors and turnover intent in rehabilitation agencies. The sample consisted of 152 direct care employees that work with individuals with disabilities at rehabilitation organizations in the state of Illinois. In particular, the focus was on determining the best fit model that predicts turnover intent among quality of LMX, dyadic age, gender, educational level, ethnicity and duration and their two-way interactions with LMX. Participants were asked to complete the team Leader-Member Exchange scale (LMX-SLX), Turnover Intent Scale (TIS) and a demographic questionnaire. Results of the regression analysis showed that LMX significantly predicted turnover intent, β = -.272, t=-3.298, Sig. F Change = .001. None (dyadic educational level, β = -.146; dyadic ethnicity, β = .068; dyadic gender, β = .100; dyadic duration, β = -.076) of the demographic factors except dyadic age, significantly predicted turnover intent (Sig. F Change = .112). Dyadic age, β = .258, t= 2.502, p= .014 was a significant predictor, although the overall model was not significant. All (dyadic educational level_LMX, β = -.60; dyadic ethnicity_LMX, β = .037; dyadic gender_LMX, β = -.130; dyadic age_LMX, β = .071; dyadic duration_LMX, β = .071), of the interactions significantly predicted turnover intent, although the overall model was not significant. In addition, implications, limitations and delimitation, and recommendations for future research are discussed.

Yes / This study assessed the effects of a person-centred care based psycho-educational intervention on direct care workers' communicative behaviours with people with dementia living in aged care facilities. An experimental study with a pre-posttest control group design was conducted in four aged care facilities. Two experimental facilities received an eight-weekly psycho-educational intervention aiming to develop workers’ knowledge about dementia, person-centred care competences and tools for stress management; control facilities received an education-only, with no support to deal with stress. A total of 332 morning care sessions, involving fifty-six direct care workers (female, mean age 44.72±9.02), were video-recorded before and two weeks after the intervention The frequency and duration of a list of verbal and non-verbal communicative behaviours were analysed. Within the experimental group there was a positive change from pre to post-test on the frequency of all workers’ communicative behaviours. Significant treatment effects in favour of the experimental group were obtained for the frequency of inform (p<0.01, ƞ2partial=0.09) and laugh (p<0.01, ƞ2 partial=0.18). Differences between groups emerged mainly in relation to non-verbal communicative behaviours. The findings suggest that a person-centred care based psycho-educational intervention can positively affect the direct care workers’ communicative behaviours with residents with dementia. Further research is required to determine the extent of the benefits of this approach. / Foundation for Science and Technology

Yes / This study aimed to assess the effects of a psycho-educational intervention, designed to improve direct care workers’ stress, burnout and job satisfaction and person-centered communicative behavior with people with dementia. A pretest-posttest control group design was conducted in four aged-care facilities. Two experimental facilities received a psycho-educational intervention; two control facilities received an education-only. Data were gathered from fifty three care workers at baseline, immediately and six months after the intervention, through self-administrated instruments and video-recorded morning care sessions. The experimental group showed a significant decrease in care workers’ burnout and a significant improvement in several communicative behaviors (e.g., involvement). Stress levels deteriorated at six months and no intervention effects were found for job satisfaction. The findings highlight the importance of providing care workers with both technical competences and tools for stress management as this might be associated with a reduction of their levels of exhaustion and improved communicative behaviors. / Foundation for Science and Technology

There is a worldwide shortage of direct care workers who help older adults in their own homes. The purpose of this multiple case study was to explore strategies that owners of home health care businesses can use to retain adequate direct care workers for their businesses. Five home care agency owners from Wake County, North Carolina, participated. Each owner had successfully implemented strategies to ensure adequate caregivers to sustain the business. Human relations theory was used to address the business problem. Data collection involved interviewing the 5 owners of home care agency businesses in their offices. Through a process of methodological triangulation, observations and documentary evidence supplemented data collected through semistructured interviews. Deductive and inductive coding were used to arrange and identify 3 emergent themes: company reputation, training and career development, and the role of government. The results of this study may contribute to social change because home care agency owners and other business owners can use the findings to improve on their treatment of low income workers which may help eradicate discrimination to ethnic minorities.

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