1. Session Summary Improving the Jobs of Direct Care Workers in Long Term Care: Findings from the Better Jobs Better Care Demonstration

2. Understand the Limitations of the Design Absence of a control group Baseline not always before intervention Small samples of providers Imperfect measures and survey nonresponse Interventions may change expectations Limited follow up – Change takes time – “Things get worse before they get better”

3. Conclusions Based on analysis so far, we cannot draw conclusions about effects on turnover BJBC did not have its intended effects on direct care worker job outcomes Provider implementation varied greatly, but in general was well below 100% BJBC increased desired management practices modestly

4. Implications Absence of effects likely due to – Limited implementation – Relatively weak interventions – Short duration relative to the challenge Implementing management practice change is difficult, requires resources, and takes a long time More powerful, targeted interventions appear necessary Government, foundation, and research community should assess optimal use of limited evaluation resources

5. Future Research Will alternative methods confirm conclusions? What factors affect implementation? What are the barriers and facilitators? What individual and provider factors affect job outcomes and turnover? Would other interventions have effects? – Wages and benefits – Recruitment interventions – Community-wide interventions