Future Homecare Work

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					 FORMER FAMILY CAREGIVERS
AND FUTURE HOMECARE WORK
            Kathryn G. Kietzman, MSW
               Ruth Matthias, PhD
               Walter Furman, MA
            A.E. (Ted) Benjamin, PhD



          UCLA School of Public Affairs
               A Better Jobs, Better Care Study
  Funded by the Robert Wood Johnson Foundation and The
   Atlantic Philanthropies, with support from IFAS, AAHSA
      For more information, contact Ted Benjamin <tedbenj@ucla.edu>
                                                                      1
BACKGROUND
   California’s Medicaid IHSS program
    (In-Home Supportive Services) –
       About 300,000 Medi-Cal care recipients monthly
       Eligibility based on income and disability

       Allows hiring of family & friends

       6-10% of former related workers take later jobs in
        health and LTC
       Most related workers “Leave,” but some “Stay”




                                                         2
RESEARCH QUESTIONS

   Why do some related workers remain in
    the caregiving workforce, while others
    do not?

   What is the potential for former related
    workers to return to homecare work?


                                               3
             THE SAMPLE

     “Stayers” (N=180) “Leavers” (N=203)

   ¾ were Family, ¼ were Friends
   Most were women (85%)
   Ages ranged from 21 to 77
   About ½ were married
   61% non-White

                                           4
Stayers and Leavers:
Demographics (Education)
                             Total
                                    Stayers   Leavers    p-
Education Levels            Sample
                                    (N=180)   (N=203)   value
                            (N=383)


Less than High School       23.0%   23.9%     22.2%     .019

High School Graduate        31.1%   35.6%     27.1%

Some college, tech school   35.5%   35.1%     35.9%

College graduate            10.4%    5.6%     14.7%
                                                           5
Prior Employment
          90
          80
          70
          60
Percent




          50                                                       Stayers
          40                                                       Leavers
          30
          20
          10
           0
               Were employed   …in any healthcare   …in homecare


               p=.002                 p=.000             p=.000
                                                                             6
Average hourly wages
$18.00
                                    $16.61
$16.00
                  $13.72
$14.00
         $10.78            $10.80
$12.00
$10.00                                       Stayers
 $8.00                                       Leavers
 $6.00
 $4.00
 $2.00
 $0.00
          Before IWE         After IWE



            p=.015             p=.000                  7
   Stayers and Leavers:
   Index Work Experience
                                 Total                   p-value
                                       Stayers Leavers   (Pearson
                               Sample
                                       (N=180) (N=203)     Chi-
                               (N=383)                    Square)


Was client a close relative?   51.4% 45.0% 57.1%          .018

Did client live with           47.9% 40.6% 54.5%          .007
caregiver?
Client mental status        56.0% 47.8% 63.4%             .002
Emotional problems
Did provider help with ADLs 80.7% 86.7% 75.4%             .005
(dress, eat, bathe, toilet)
Arranging services?            84.6% 90.0% 79.8%          .006
                                                               8
   Stayers and Leavers:
   Index Work Experience
                                  Total
                                        Stayers Leavers
How much choice did             Sample
                                        (N=180) (N=203)
                                                          p-value
worker have?                    (N=383)

Complete                        55.1% 61.7% 49.3%          .007
A lot                           20.7% 22.8% 18.9%
Some/a little                   11.9% 7.2% 15.9%
None                            12.3% 8.3% 15.9%
Reason to work?
(to help others, or to make a   23.8% 31.6% 16.7%          .003
difference vs. non-altruistic
reasons
                                                               9
Would you care again for family?
          60
          50
          40
Percent




                                                                                     Stayer
          30
                                                                                     Leaver
          20

          10
          0
               Definitely   Probably   Uncertain          Probably     Definitely
                  not         not                           yes           yes




                                       Would you care again for strangers?
                                                   60

                                                   50

                                                   40
                                         Percent




                                                                                                                    Stayer
                                                   30
                                                                                                                    Leaver
                                                   20

                                                   10

                                                   0
                                                        Definitely   Probably   Uncertain   Probably   Definitely
                                                          not          not                    yes        yes

                                                                                                                             10
Logistic regression: A predictive model of staying vs. leaving M
(0 = LEAVER; 1=STAYER)
                                                          Odds
                                                                     p
                                                          Ratios
Education (0=HS degree or less; 1=post HS ed)                  .42   **
Worked as a caregiver before? (1= y; 0= n)                    2.44   **
Worker helped arrange services (1=y;0=n)                      3.28   **
Worker helped with ADLs (1=y; 0=no)                         2.578    *
Total IHSS quarters worked (1-31)                             1.07   ***
Employed during IWE (emp=1)                                 22.53 ***
Family support (1=very much; 5=none)                         1.40 *
Reason for caregiving (helping others=0; non-altruistic       .39
                                                                  *
reasons=1)
Career fit lower=more positive                                .81 **
Work Value lower=more positive                               1.25 **
Caregive again for non-family                                1.44
                                                                  **
(1=definitely not; 5=definitely yes)
Percentage predicted correctly          81.80***                     * p < .05
Chi-square-Block                        36.27***                     ** p < .01
                                                                             .001
                                                                     *** p <11
Chi-square-Model                      208.79***
Logistic regression:
A predictive model of staying vs. leaving

0 = LEAVER; 1=STAYER                  ODDS RATIOS

BACKGROUND                                  Model 3

Education
(0=HS degree or less; 1=post HS ed)         .42**


Worked as a caregiver before?
(1= y; 0= n)                            2.44**



                                                      12
Logistic regression:
A predictive model of staying vs. leaving

0 = LEAVER; 1=STAYER                        ODDS RATIOS
INDEX WORK EXPERIENCE (IWE)

Worker helped arrange services (1=y;0=n)       3.28**

Worker helped with ADLs (1=y; 0=no)            2.57*

Total IHSS quarters worked (1-31)              1.07***

Employed during IWE (emp=1)                   22.53***

Family support (1=very much; 5=none)           1.40*
                                                         13
Logistic regression:
A predictive model of staying vs. leaving

0 = LEAVER; 1=STAYER                        ODDS RATIOS
CAREGIVING ATTITUDES                          Model 3

Reason for caregiving (helping others=0;          .39*
non-altruistic reasons=1)
Career fit                                       .81**
lower=more positive
Work Value                                       1.25**
lower=more positive
Caregive again for non-family                    1.44**
(1=definitely not; 5=definitely yes)

                                                          14
Workforce potential?
Of 39,600 related IHSS workers who leave each
year, how many would definitely/probably care
again?
        8,158        7,405           For friend/family
                                     only

                                     For stranger
                             1,346   only

                                     For either F/F or
                                     stranger
6,811                                Uncertain


                                     Definitely or
                                     probably not
                    15,800                           15
             IMPLICATIONS
   Pay increased attention to the career
    paths of related caregivers

   Debrief related caregivers upon
    termination; provide information about
    employment opportunities

   Worker registries should include family
    members

                                             16
           CONCLUSIONS
   Family and friends are a potential
    source of experienced workers in LTC

   Paying family members is one way to
    address workforce shortages

   Need to increase awareness and
    outreach efforts
                                           17
              APPENDICES:
    PRINCIPAL COMPONENTS ANALYSIS
   STRESSFUL WORK (7): too much work to do,
    emotionally hard situations, took too much out of me,
    caused very much stress, was physically hard, often felt
    isolated, too much responsibility. Range=7-35 (α = .827)
   REWARDING WORK (5): helping was rewarding, work
    was interesting, a chance to learn new things, made me
    feel needed, having a lot of different things to do was
    rewarding. Range=5-22 (α = .756)
    CAREER FIT (4): the work fit my job skills, it fit with my
    interests, provided steady employment, I had all the
    training I needed. Range=4-20 (α = .634)
   WORK VALUE (5): helping made a difference in client’s
    life, the work was boring (reversed), gave me a sense of
    accomplishment, lots of flexibility in work schedule, did
    not let me use my skills (reversed). Range=5-20 (α =
    .464)
                                                              18
Stayers and Leavers: Index Work Experience
                        Total
                                Stayers   Leavers
Attitudes   (mean)    Sample
                                (N=180)   (N=203)
                                                    p-value
                      (N=383)
Stressful Work
Range=7-35            21.23     21.42     21.05       NS
lower=more negative
Rewarding Work
Range=5-22            10.06      10.11    10.01       NS
lower=more positive
Career fit
Range=4-20            10.18      9.57     10.73      .000
lower=more positive
Work Value
Range=5-20            10.92     11.05     10.80       NS
lower=more positive                                    19

				
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