Building a Strong

1
Building a Strong
Personal Assistance Services
Workforce
A presentation of the Paraprofessional Healthcare
Institute
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Paraprofessional Healthcare Institute
PHI is a 10-year old non-profit national
organization headquartered in the South Bronx,
NY. Our mission is to create high quality jobs
for direct-care and personal assistance workers
in the long term care continuum and in home and
community based services.
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Institute
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Direct Workforce Experience

• Worker-owned agency in the South Bronx
• Enterprise Development in NY, PA, NH, MI and
  AR
• Independence Care System

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Institute
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Workforce Recruitment and Retention Project

• Purpose Funded by CMS to identify for Systems
  Change Grantees
• Tools
• Resources
• Innovative practices
• in the recruitment and retention of personal
  assistant services workers.

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Institute
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Workforce Recruitment and Retention Project

• Products
• Fact Sheets/ Issue Briefs
• Supervisory Training Curriculum
• Return on Investment Analysis
• Final Report to Systems Change Grantees

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Institute
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Workforce Recruitment and Retention Project
Dissemination Through the National Clearinghouse
on the Direct Care Workforce and searchable
web-based database www.directcareclearinghouse.o
rg
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Institute
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The Demographic Imperative

• States already reporting worker shortages
• Elderly population will double by 2030
• The traditional personal assistance worker
  population is only expected to grow 7
• Currently- the ratio of potential workers to
  consumers is 2 1
• In 2030 - the ratio is expected to be less
  than 1 1

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Institute
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The Widening Care Gap 2000-2030
Source U.S. Census Bureau, National Population
Projections, Summary Files, Total Population by
Age, Sex, Race, and Hispanic Origin,
http//www.census.gov/population/www/projections/n
atsum-T3.html
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Institute
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Terminology

• Direct Support Professionals
• Direct Care Workers
• Personal Care Assistants
• Personal assistance workers
• Home health Aides

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Institute
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The Essentials of a Quality Job
PHI has identified these elements as essential in
creating a good job and a stable workforce

• Wages and Benefits
• Recruitment
• Training
• Supervision
• Support

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Institute
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WagesBenefits
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Wages and Benefits

• In 1999, the median wage of all direct support
  workers was 7.97 per hour
• Personal assistance workers averaged even less
  than other frontline workers

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Institute
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Wages and Benefits
A presentation of the Paraprofessional Healthcare
Institute
Source US Bureau of Labor Statistics, 1999
Occupational Wage estimates by service code
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Recruitment
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Perspectives and Expectations

• High quality
• Difficult to find match
• Systemic barriers in recruitment

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Institute
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Finding an Aide/ Assistant
Conventional screening methods not adequate in
identifying suitable candidates - Education
credentials - Employment records - Criminal
background checks - Medical assessments -
Shift availability
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Institute
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Finding PAS Workers

• Two universal qualities critical in identifying
  suitable candidates
• Intrinsic value in assisting others
• Good (independent) Problem- Solving Skills

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Institute
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Recruitment Takes Time

• Failure to take time in the recruitment process
  results in
• High turnover
• Compromised expectations of service
• Consumer dissatisfaction

Always enough time to do it over, never enough
time to do it right.
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Institute
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but Investment Pays Off

• Develop and maintain linkages with public and
  private community based organizations
• Non-profit social service organizations
• Department of Labor One-Stop Centers
• Public Authorities
• Independent Living Centers
• Faith Based Organizations
• Community Health Centers

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Institute
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Develop Standard Tools

• Structured interview guides
• Suitability rating scales

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Institute
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Interview Tools

• Minimal Work History? Assess further
• Is there anything that you havent listed that
  may be pertinent to this position?
• How do you think your prior work experience
  prepares you to provide personal assistance
  services to someone with a physical disability?
• Have you done any similar volunteer work? What
  attracted your volunteer choice?

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Institute
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Interview Tools

• For attitudinal assessment
• What attracts you to this type of work?
• What are you looking forward to most if you
  are hired?
• What do you think will be the more challenging
  aspects of this work?
• What are your feelings about working with
  people who are different from you?
• What do you think is the most important role
  of a personal services assistant?

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Institute
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Interview Tools

• For problem-solving capacity
• Present real life scenario
• Assess for ideal or preferred response
  based on job description and likely on-the-job
  situations

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Institute
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Barriers Assessment

• A well-intentioned and motivated individual who
  lacks stability in terms of supports, will likely
  become a problem employee
• Child Care
• Housing
• Transportation

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Institute
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TrainingPractices
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Profile of PAS Workers/Learners

• Women between the ages of 24-55
• Poor educational preparation
• Newer immigrants with limited English- language
  skills
• Inconsistent formal work experience
• Single mothers with limited resources

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Institute
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Adult Centered Learning

• Recognize, value and incorporate past
  experiences
• Create safe learning environment

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Institute
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Expand Basic Training Content

• Skills are never purely clinical or technical
• Problem-solving
• Communication
• Interpersonal/ Relational Skills

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Institute
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High Quality Service ProvisionBuilding The
Foundation

• Designed around learners needs
• Problem-Posing
• Accommodates learner differences and styles
• Engaging /Interactive Activities
• Consumer-centered in content

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Institute
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Learner differences

• Visual
• Experiential/ Tactile
• Auditory
• Verbal

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Institute
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Integrate critical-thinking and problem solving
within the context of teaching health content and
clinical/personal care skills.
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Institute
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Strengthen Skills

• Paraprofessional care is about building
  relationships
• Challenge assumptions
• Establish high standards and support to
  learn from failures
• Requires more time and different teaching
  techniques
• Staff and consumer member development

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Institute
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Continuous Learning Improvement (CLI)

• Intensive support during initial probationary
  period build upon initial learning experiences
• Regular post-employment sessions in safe
  environment to
• - Discuss issues faced -Reinforce workplace
  on the job rules and policies
• - Foster peer learning -Teach additional skills

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Institute
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SupportSupervision
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Support and Supervision

• Improve quality of consumer/ worker
  relationship
• Enhance worker retention
• Enhance service quality

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Institute
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Types of support for Direct Care Workers

• Emotional Supports
• Practical Supports

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Institute
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Good Outcomes
What can effective supervision do?
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Institute
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Effective supervision can

• Build communication skills between worker and
  consumer
• Enhance consumer/worker relationship
• Reinforce training and direction
• Orient new employee to the job
• Build employees problem-solving skills
• Help consumers/ agency providers assist
  Personal Assistance Workers manage multiple
  job demands

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Effective supervision can

• Model acceptable behaviors
• Reduce conflict with clients and family
• Prevent dismissals and resignations
• Help employees balance work and family demands
• Assist workers and consumers in managing
  cultural differences

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Institute
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Current DynamicsAgency supervisors and consumer
employers often lack experience and/or training
in supervision.
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Institute
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Frontline supervisors in agencies

• Have intensive scheduling and administrative
  demands
• Come from clerical or direct care jobs
• Do not receive on-the-job training in
  supervision
• Can be critical or demeaning towards direct
  care workers
• Lack skills to guide workers in
  problem- solving on the job

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Institute
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Consumer Employers

• Are rarely trained in supervision
• May be trained in hiring, firing and managing
  fiduciary issues
• Are often self-taught in overseeing their
  employee

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Institute
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How can supervision be different?
A Coaching Model

• Balances support and accountability
• Provides direction and limits without
  criticism
• Establishes acceptable behavior
• Guides employee in problem solving
• Builds on employees intrinsic motivation for
  the job
• Diffuses Stress

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Resources
Existing resources on supervision that PHI has
learned from stakeholders

• Locally developed through the ILC for consumer
  employers (Focuses on management and fiduciary
  responsibilities)
• Wide variability in services and
  sophistication in agencies
• Not well-coordinated or distributed
• Focus on management and fiduciary
  responsibilities

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Institute
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Teaching Supervision
How can we teach consumers and agency supervisors
how to supervise?

• PHI is identifying existing resources through
  stakeholder interviews across the US
• PHI is developing supervisory curriculum for
  teaching diverse audiences

• Within agencies
• In consumer homes
• Through ILCs
• Using web broadcasting

Curriculum will be disseminated to all Systems
Change Grantees
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Practical Supports Assist employees in becoming
successful at work
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Institute
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Why do Direct Care Workers need financial and
tangible supports?

• Insufficient pay
• Fewer resources to manage family stresses

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Institute
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Personal Assistance Workers are

• Among the working poor
• Single heads of households
• Lack of medical insurance
• More likely to rely on public support programs
• Medicaid
• Food Stamps
• Transportation Assistance

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Institute
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Types of practical supports

• Child care
• Transportation assistance
• Affordable housing
• Food Stamps
• Paid health care and other paid benefits
• ESL or GED courses

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Institute
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Employer Role

• In linking the employee to supports in the
  community
• Employer is not a social worker
• Employer can link to resources in the
  community
• Government agencies can play an important role
  in linking workers to private/public supports
  in the community and state

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Institute
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For additional information please contact
Paraprofessional Healthcare Institute 349 East
149th Street, Suite 401 Bronx, NY 10451 Email
info_at_paraprofessional.org Or National
Clearinghouse on the Direct Care Workforce Phone
[phone] Info_at_directcareclearinghouse.org ww
w.directcareclearinghouse.org