1. Jayne Schaefer, BA Workforce Programs Manager Mather LifeWays Evanston, Illinois Toward Building a Sustainable Long-Term Care Workforce: LEAP

2. Faculty Disclosure Jayne Schaefer has disclosed that she has no relevant financial relationships.

3. Facility Demographics Mather Pavilion Evanston, Illinois A long-term care community of 158 beds 5 Neighborhoods 2 Neighborhoods for Memory Support 3 Neighborhoods for intermediate and Skilled Care Type of Ownership – Non-Profit

4. Learning Objectives By the end of the session, participants will be able to:  Understand the importance of implementing a comprehensive education program for the development of nurse managers and staff nurses  Understand the importance of developing a career mobility ladder for the continued development and advancement of direct-care workers  Measure impact of this program on staff retention rates  Understand the impact of this program on resident care.

5. In the beginning… The nursing staff identified the following needs:  Improve quality of work life  Improve staff retention  Improve care to residents

6. Nurses told us they wanted… Better communication Supportive managers Appreciation for jobs well done Respect from co-workers

7. CNAs told us they wanted…  Provide affection and support to residents and their families  Care for residents in a team environment  Have their knowledge and skills valued by nurses  Sharpen their assessment skills

8. Residents told us they wanted…  To know the staff  To have the staff know them  To develop positive relationships with staff  To be treated as individuals

9. Based on those requests, we developed a program to… educate empower retain nurses and CNAs while nurturing their relationships with residents families each other

10. LEAP  Develops staff leadership skills  Develops teamwork skills  Develops communication skills  Develops a peer-mentoring program  Develops a career ladder for direct-care workers  Puts the resident quality of life and well-being at the center

11. LEAP: A Workforce Initiative Program 1.Resident-centered approach to developing and retaining qualified, effective nursing staff 2.Teaching methods based on adult learning theory 3.Ongoing evaluation mechanisms to track progress 4.Research-based evaluation mechanisms targeting key staff and resident outcomes 5.Training that prepares staff to effect and sustain change

12. LEAP Nurse Training Program Description Training  six training sessions  three hours per session Curriculum Focus  developing the nurse as a leader  empowering the nurse as a role model in providing care  empowering the nurse to become a gerontological clinical expert  developing the nurse as a care team builder

13. LEAP CNA Training Program Description Training  seven training sessions  two and ½ hours per session Curriculum Focus  defining the CNA’s role in person-directed care  developing CNA communication skills  providing the skills for head-to-toe inspection  providing clinical updates  building care teams  developing mentorship skills

14. Implementation  Identification of nursing staff needs – 1999  Pilot of the Workforce Initiative begins – Nov. 2000  100% of nurse managers and staff nurses attend the six training sessions  26 CNAs apply for training – 13 (50%) selected for training  Consistent Assignment Staff Model introduced – 2001  Program philosophy incorporated in hiring process and orientation

15. Measuring the Effectiveness of the LEAP Program  Survey developed to examine  Leadership effectiveness  Job satisfaction  Resident characteristics  Number of health deficiencies  Staff retention data collected and analyzed  Pre-workshop  2-weeks post workshop  6-months post-workshop

16. Measuring the Effectiveness of the LEAP Program  CMS 5-start rating  Annual Turnover Statistics  Annual Resident and Family Survey  Annual Employee Satisfaction Survey  Illinois Department of Public Health Survey

17. Immediate Outcomes Nurses reported:  Increase in positive communication  Improved listening skills  Staff encouragement  Greater receptivity to staff needs and problems  Effective dealing with staff issues

18. Immediate Outcomes CNAs reported :  Perceived leadership behaviors among nursing staff improved  Better relationships with supervisors  Greater emphasis on work recognition  Increased staff communication  Greater opportunities for promotion

19. Immediate Outcomes Association with Resident Characteristics :  Decrease in number of health deficiencies  Fewer residents who were completely bedridden  Fewer residents with abnormal weight changes  Fewer residents with pressure ulcers

20. Sustained Resident Outcomes  Residents and their families  95%-100% satisfaction rating with staff and community  Person-directed care positively impacts loved ones  Improved quality of life

21. Sustained Nurse Outcomes  Nursing Staff  Significant improvement in job satisfaction  Significant improvement in work empowerment  Increased work effectiveness allowing for greater focus on resident needs  Improved communication with CNA staff allowing for better resident care

22. Nurse Turnover Rates

23. Sustained CNA Outcomes  Empowered to work with residents - calls family to report on resident’s care, medication changes, clothing needs  Trained as activities personnel allowing customization of activities to meet resident’s needs  Expected to participate in resident care meetings  Expected to serve on various committees including QA committee  Expected to act as mentors to newly hired staff

24. CNA Turnover Rates

25. Sustained Community Outcomes  Reduced recruitment, hiring, and training costs  No registry staff  Call offs handled internally  Quality of service to resident improved  Heath deficiencies decreased  Resident satisfaction increased  CMS 5-star rating

26. Summary  This program impacts the long-term care workforce in many ways: - encourages collaboration and communication among all staff; - reduces staff turnover; - increases resident satisfaction; and - provides a positive financial impact.  This program changes the way we deliver resident care. In order to sustain LEAP we need: - buy-in from the administration; and - incorporation of the philosophy in the hiring practices, orientation, training, and yearly reviews.

27. Questions?