Publications (37) View all
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Article: Role for a labor-management partnership in nursing home person-centered care.
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ABSTRACT: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Using a participatory research approach, we conducted case studies of 2 nursing homes participating in a partnership between a labor union and a provider coalition. The study was designed to reveal whether and how the labor-management partnership supported PCC and to identify challenges to overcome in the future. The partnership provided training and follow-up support to member homes to implement PCC. Management and worker participants used the partnership as a learning collaborative to acquire PCC knowledge and to share implementation experience. Key elements of the implementation in each nursing home were translation of the larger labor-management partnership to each member nursing home, management innovations that developed and supported PCC, and conduct of union actors in each nursing home that supported PCC while maintaining traditional union protections. Frontline workers exhibited strong engagement in PCC practices. A partnership between labor and management can foster changes in the organization of frontline work aimed at improving nursing home residents' quality of life and care.The Gerontologist 09/2009; 50(3):340-51. · 2.48 Impact Factor -
Article: Nursing home work practices and nursing assistants' job satisfaction.
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ABSTRACT: To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants' overall job satisfaction, controlling for personal characteristics and local labor market characteristics. Wages, benefits, and job demands, measured by the ratio of nursing assistant hours per resident day, were associated with job satisfaction. Consistent with previous studies, job satisfaction was greater when nursing assistants felt respected and valued by their employers and had good relationships with supervisors. Nursing assistants were more satisfied when they had enough time to complete their work, when their work was challenging, when they were not subject to mandatory overtime, and where food was not delivered to residents on trays. This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.The Gerontologist 07/2009; 49(5):611-22. · 2.48 Impact Factor -
Article: Effect of an expenditure cap on low-income seniors' drug use and spending in a state pharmacy assistance program.
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ABSTRACT: To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders' use of prescription drugs. DATA SOURCES AND SETTING: Claims and enrollment files for the first year ( June 2002 through May 2003) of the Illinois SeniorCare program, a state pharmacy assistance program, and Medicare claims and enrollment files, 2001 through 2003. SeniorCare enrolled non-Medicaid-eligible elders with income less than 200 percent of Federal Poverty Level. Minimal copays increased by 20 percent of prescription cost when enrollee expenditures reached $1,750. Models were estimated for three dependent variables: enrollees' average monthly utilization (number of prescriptions), spending, and the proportion of drugs that were generic rather than brand. Observations included all program enrollees who exceeded the cap and covered two periods, before and after the cap was exceeded. On average, enrollees exceeding the cap reduced the number of drugs they purchased by 14 percent, monthly expenditures decreased by 19 percent, and the proportion generic increased by 4 percent, all significant at p<.01. Impacts were greater for enrollees with greater initial spending, for enrollees without one of five chronic illness diagnoses in the previous calendar year, and for enrollees with lower income. Near-poor elders enrolled in plans with caps or coverage gaps, including Part D plans, may face sharp declines in utilization when they exceed these thresholds.Health Services Research 03/2009; 44(3):1010-28. · 2.16 Impact Factor -
Article: Nursing assistants' job commitment: effect of nursing home organizational factors and impact on resident well-being.
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ABSTRACT: The purpose of this study was to investigate (a) whether certified nursing assistants (CNAs) are more committed to nursing home jobs when they perceive their jobs as enhanced (greater autonomy, use of knowledge, teamwork), and (b) whether CNA job commitment affects resident satisfaction. A qualitative exploration of management philosophy and practice and of CNAs' views of their jobs in 18 Massachusetts nursing homes formed the basis for a survey administered to 255 CNAs in 15 homes. A quality-of-life questionnaire was administered to 105 residents. Logistic regression accounting for clustering estimated the effect of personal characteristics, satisfaction with tangible job rewards, and aspects of job design on CNAs' intent to stay in current jobs. A general linear model estimated the effect of job commitment on residents' satisfaction with their relationship to nursing staff. After we accounted for satisfaction with wages, benefits, and advancement opportunities, good basic supervision was most important in affecting CNAs' intent to stay in their jobs. Job enhancements were not significantly related to intent to stay. Residents were more satisfied with their relationships to nursing staff and their quality of life on units where a higher proportion of CNAs were committed to their jobs. The finding that greater job commitment of CNAs is associated with better quality of relationships and life for residents implies that better jobs lead to better care. Culture change transformation that increases CNA autonomy, knowledge input, and teamwork may not increase workers' commitment to jobs without improvements in basic supervision.The Gerontologist 07/2008; 48 Spec No 1:36-45. · 2.48 Impact Factor -
Article: Manpower Policy and The Supply of Nurses
Industrial Relations A Journal of Economy and Society 04/2008; 12(1):86 - 94. · 1.48 Impact Factor
