Nursing Shortage Has Solutions

Over the weekend the University of Louisville and Owensboro Medical health System in Kentucky announced a collaborative effort to train an additional 40 nurses a year, utilizing distance education.

Last week, we got a phone call in our office from a guy who wants to become a nurse - badly. He says he was one of over 600 people applying to a local nursing school that had 24 openings. And the nursing shortage is near crisis level.

There's simply no rational reason for such a dramatic restriction in the admission to nursing programs, especially today with elearning options.

In the online nursing assistant program we launched July 1, we've had over 150 applicants with minimal publicity. Many of these individuals are anxious to take the first step in their nursing career with this program - and many of them need the flexibility and accessibility that elearning offers.

It's time to blow the doors off the classroom and begin training enough individuals to become nurses that we make a significant difference in the shortage of trained professionals - from the nursing assistant and caregiver level all the way through to the graduate nurse level.

We have the skills. We have the technology. We simply need the focus and the dedication of resources and we can solve this problem today and for the future needs in our country.

Sleeping Well at Night

I was touched by the entry written yesterday by a family member who had just moved his loved one into a care center.

He talked of the pain of leaving his wife, but the joy when he came to visit a few days later to see his wife happy - dancing, even.

His closing comment was the most poignant:

This good news has lifted a huge burden from me. I now sleep through the night for the first time in eight years.

This is a comment I've heard countless times over the years. Families agonize about finding care for a loved one. They feel deep angst about moving a mom, dad or spouse out of the family home. Of course there's a little guilt. Of course there's grieving what once was, and is now lost.

After it's all said and done, however, the dominant feeling is relief.

It's all about balance. What works for one family is not the same as what will work for another. In this era, we need to be open, accepting and supportive of the solution that each individual family chooses. Not everyone should move into a care community. Not everyone should stay in his or her own home.

The true beauty of living in the age we do is that we have the choice. It's no longer home or nursing home - many options exist in between.

Here's to finding what works for you, and what lets you sleep well at night.

Medicaid is NOT the solution

Today's promising headline read, "Solutions for elder-care issues." in the LoHud.com, the Journal News of the Lower Hudson's news site.

Among the solutions? Transfer all mom and dad's assets to your own bank account, so that Medicaid will pick up the cost of their care. Takes all the stress off the sandwich generation kids, and - hey, the government can pick up the tab!

Here's my response:

It's a solution for one individual family to transfer assets and make mom or dad eligible for Medicaid - but it's a societal nightmare. Imagine the implications if all 18.2 million individuals over 85 paid no portion of their own care, but left it all up to the government in the form of subsidies and Medicaid. No longer would the individual family benefit - we'd all be paying the cost through tax rates through the roof.

I believe it is time to look for more creative solutions that benefit not just the heirs but the greater society as well. Perhaps if we start by recognizing those who provide care in this country and honoring, training and valuing these individuals, more people will be willing to take on this work. We need honest discussions about best ways - and places - to provide care to individuals, whether they need just a little support or are fully dependent.

Being a tightly squeezed member of the sandwich generation myself, I know that this is not a battle for me alone. We're facing these issues with both sets of parents, at the same time we're having discussions among ourselves, our siblings and children about how we want to handle our own aging needs when they arise. While we don't have unlimited assets, we all have some ability to plan, to pay and to creatively address these challenges - not to leave the solutions to "the government."

As we boomers age, we may rediscover the commune - now for mutual caring purposes. We may find that we can afford the services we need (and want) best by joining together with others. We may find other creative options that work for many, and are affordable in cost.

We WILL need individuals from the younger generation who find personal meaning and societal value in providing care. We WILL need to invest in their training as well, if we want quality care for our parents today, and ourselves tomorrow.

For my part, I've dedicated my time and resources to developing training programs, accessible via the internet, to train not only the minds but also the hearts of the next generation of caregivers. It's a professional focus, but it's also very, very personal.

Join me for creative solutions to this challenge,

Sharon K. Brothers, MSW
aQuire Training Solutions
Sharon@aquiretraining.com

Caregiver Shortage to Affect Everyone

Here’s the headline that hit my inbox today: “One Million New Direct-Care Workers Needed by 2016.”

This fact was taken from a recent report by PHI, an advocacy group for direct care workers, that also noted that home care and home health aides are among the fastest growing occupations projected for the coming decade.
That number is an incredibly large number, especially when it is accompanied by the miniscule growth in the pool from which these workers are typically drawn – women ages 25-54.

This level of shortage will likely affect nearly every community – and many, many families.

What can we do? Here are some ideas that we all can participate in implementing:

1. Start a small movement in your work, home, and community to improve the respect caregivers experience. If you work with caregivers, go out of your way to thank them. Tell others what a great job they do for all of us. If the job begins to have more social rewards, perhaps it will begin to attract more individuals, male and female.

2. Support caregiver training. If you employ caregivers (whether on a family level or a corporate level), invest in their training. This not only helps the individual caregiver build skills and knowledge, it also supports training efforts that are available in the community. Free training opportunities are out there (here’s a sample that came into my inbox today); many caregivers, however, need support in the form of payment for their time or other compensation to be able to take advantage of these opportunities. Find a way to help this process. Our company is supporting caregiving training by posting “How-To” videos on the internet on a website called Howcast. Check out a few samples: Blood Pressure, Wash Hands, and more. We're also actively involved in developing and providing more online training for CNAs and caregivers, increasing the access which will, in turn, increase the supply of qualified caregivers.

3. Support bills, regulations and initiatives to improve the pay and benefits of caregivers in your state.

Small steps, but the payoff will be huge – and personal – some day.

Wings on the Web

It's a fun experience seeing how far this electronic age reaches. It is truly a new age of information technology, as individuals all over the world can communicate - or listen in - to our electronic conversations.

Yesterday, one of our key staff members picked up the phone at our office, answering with her name, as we always do. The caller said, "Is this THE Wendy Finch?"

Wendy says, "Wow, did I feel like a rock star right at that moment!"

The caller went on to say that she reads Wendy's e-newsletter called Friday Funnies every week (subscribe) and feels like she knows Wendy. Wendy frequently shares stories that end up being the "joke was on me" type of stories, and readers love her.

I had a similar experience a few years ago, walking into a senior living community in northern California. The community representative handed me a packet of information. Included in that packet was an essay, printed on bright pink paper, that I had written some months ago. This community was distributing my essay to every visitor. It was exciting and humbling at the same time.

The essay is one that I think back on often, because I believe so strongly in this concept. I'll reprint it below, but, in essence, the message is this: we need to stop thinking of moving into a care community - or even a senior living community - as a step down. It's not "losing our home" - it's just changing our home address. It can be a positive, meaningful experience for so many people. It would certainly help if our society didn't label it so negatively.

Finally, this week I was invited to participate as a featured blogger for a site called Wellsphere. Once again, the power of the internet is demonstrated, as well as the power of community. As a community of resources, we can join together to make a profound difference in the lives of people all over the world.

It is truly a new age for communication, for support, and for community.

Here's a reprint of my essay titled Changing Home:

A few weeks ago I shared with you our family's story of helping BOTH sets of parents choose to move into a retirement community.

We spent weeks scheduling the first retirement community visit - weeks during which the negotiation went like this, "Mom, Dad, I know YOU aren't ready for a retirement center, but you know how much it would help the other set of parents."

And the reply invariably went like this, "You're right, we're not ready yet, but the other set of parents sure is!"

Finally, we got to the retirement center and spend hours - literally - getting through both sets of parents' anxieties and resistances.

When we left, all four parents were talking about how nice this would be - "4 or 5 years in the future" (that's a 92- year-old speaking)!

Now, two months later, MY parents have their name on two waiting lists, and are actively cleaning out their very formidable collection of stuff; my husband's parents are still talking about the "where" and the "when."

My mother-in-law keeps bringing up this refrain, "I never thought I'd have to give up my home."

And I've been thinking, we've been missing the mark here, both in our conversations with the folks, and in the marketing within our profession.

We're not asking people to "give up their home" - we're simply asking them to change their address.

Because ANYWHERE can be home - whether you own, rent, or stay free.

HOME is that place where you feel comfortable being just "you."

Where, if you're lucky (Mom, Dad, are you listening?) you're surrounded by people who make you laugh, who give you something to talk about, and who share meals, good times and bad times with you - and who are there to help you when you need help.

Because a house is just a house...but a home is absolutely wherever your heart happens to land.

Just a footnote: my parents were in a severe auto accident a little over a year ago, leaving my father dead at the scene. My mother, injured severely and, of course, devastated with her loss, never returned to their home. She went straight from the path from hospital-rehab-assisted living into her new home in the retirement community she and my father had already selected. She absolutely loves it there. The only shadow is a frequent feeling we both have that my dad would have loved living there, too - only he missed the opportunity.

My in-laws are still not budging from their house...stay tuned!

aQuire Training Prepares to Launch Online CNA course

After a lot of hard work on the part of all the aQuire Training Solutions' team, along with many of the folks at the Oregon Health Care Association, we are finally preparing to launch the first ever online nursing assistant course in the state of Oregon.

Might not sound like a big deal to you, but it IS a big deal to people in this state. Last year the state legislature passed a new law increasing the ratio of CNAs to residents in nursing facilities here; that ratio increases yet again two more times. The bottom line for residents is better care. For facility managers, however, it could present a nightmare scenario when they can't find enough CNAs to fill the jobs they must fund to meet the new staffing ratio.

At the same time, the number of individuals being certified as nursing assistants in the state has been in a steady decline.

At the intersection of increased demand and reduced supply is a crisis.

With this course, we not only utilized every tool at our disposal to create a course that showcases what online learning can be, but we also, in our partnership with OHCA and over 40 member facilities (where students will complete the lab and clinical aspects of training), are breaking some exciting new ground in creating the ideal blended learning environment.

We've got people clamoring to begin the course as quickly as possible - people who simply couldn't access training without the online portion of this course.

It's pretty exciting for us. We'll keep you posted on the results in the weeks and months to come.

Read the whole press release.

Use Your Brain and Your Heart

Our IT Director wandered into my office the other day and made the general announcement that I send – and receive – the most emails of anyone in the company. While I was feeling a bit smug, my husband reminded everyone that only a few years ago (time goes by fast – it was at least 8 years ago) I refused to use email, telling all my friends and colleagues that if they wanted to talk to me, pick up the @#$%$& phone!

But I digress from the topic I intended to write about, and that’s an April Fool’s email I picked up today - ahhh, that’s how I got to the bit about too many emails – some don’t get read until a week or more has gone by.

It was a post from my very favorite e-learning blogger, Tom Kuhlmann at the Rapid E-Learning Blog. Here’s the link – it’s worth 5 minutes of your time: April Fool’s E-Learning Example.

While it’s a spoof on e-learning tips, one message stuck with me, because I believe this one message alone would change the face of training, especially for senior care staff in assisted living communities, nursing homes and home care settings:

“Use your brains and your heart to make your training smart.” (It’s actually part of a rap that’s on the demo.)

Although in my company we often refer to the flash-card approach to e-learning; that is, the repetition of key concepts through stories, games, quizzes and illustrations, we aren’t really teaching multiplication tables.

We’re teaching people to be compassionate, caring, observant individuals – to notice something that is unusual before it becomes a crisis.

We’re teaching people to be on the lookout for ways to brighten the days of the seniors they work with; to add smiles, hugs, laughter and playfulness to the daily dose of doctor-prescribed medication.

We’re teaching staff to understanding how to create an environment of caring and to avoid anything that might harm a resident, no matter how unintentional.

We’ve got to teach the heart and the mind to truly train people to be the kind of caregivers that we want caring for our mothers – our fathers – someday, ourselves.

The Ethics of Truth

The past couple of weeks have been ones in which truth-telling has taken a bath. One of my personal “good guys,” Eliot Spitzer, was found – well, you know where.

And while my local newspaper endorsed Barak Obama in large black editorial typeface, my periodical of choice, Time Magazine, ran its own editorial about why newspapers should never write an endorsement of a candidate (makes them look less objective, was the reasoning).

Then in this week’s Time, a columnist shared his day’s tasks: run, eat, drop off kids, vote for Barak.

It makes me think about an issue of ethics that I’ve believed in for some time: transparency.

I remember precious little else from my undergraduate education, but this one bit of extemporaneous advice from a professor stuck with me and rang true: as people setting ourselves up to help and guide other people, the most honest thing we should do is post, for everyone to see, our own personal guiding beliefs. Then, people who chose to accept our help would know what they were getting into.

It rang true to me then, and it rings true to me today. What guides me, as a person, will deeply affect the advice and assistance I give you.

As an educator, dedicating this phase of my career to training the next generation of senior care providers, my personal beliefs profoundly affect how I craft the learning experience.

My staff has been immersed in the creation of the first online course to train Certified Nursing Assistants in the state of Oregon, a project jointly sponsored by my company, aQuire Training Solutions, and the Oregon Health Care Association.

Part of what every nursing assistant must know to pass the state exam is a set of procedures for providing specific care tasks to individuals; things like transferring from bed to wheelchair, and assisting with a shower.

The state posts these procedures, step by 101-step, on their website. Instructors must teach the steps exactly as the state sets out.

As we were creating learning activities to help students learn these steps easier I felt myself getting more and more agitated – couldn’t figure out why, until I realized – and shouted, “These steps sound like we’re moving pieces of furniture!”

We’re teaching students the steps, but we’re adding in, for every step, a sample quote of what the student might say to the individual as the step is being taken.

We’re not caring for pieces of furniture. We’re caring for individuals – with losses, with needs, with real human lives.

My own beliefs show through in every aspect of this course. I think that the course will be better for it – but that’s for you to judge. My beliefs are pretty much out there for everyone to see…

Watch the movie…you’ll get it!

E-Learning One Solution to Nursing Shortage

T & D blog linked to my most recent press release about the adaptability of e-learning to the health care field - an adaptation that seems to me to be long past due. Here's my original comment:

When Parade Magazine highlights the nursing shortage, you know the issue has reached popular concern.

Parade Magazine is the supplement that comes in more than 400 Sunday newspapers and contains celebrity news and interviews as well as popular features.

Recently Parade ran an article titled “What’s Behind the Nurse Shortage?” In the one paragraph article Parade quotes Cheryl Peterson of the American Nurses Association citing the trend toward hiring foreign nurses as a poor solution to the problem.

But why is there a nursing shortage in the first place? Nurses make good pay, have their choice of many types of work environments including hours and shifts, and often receive large pay differentials for working the less desirable hours like evenings, nights and weekends. It seems like a good profession, with a fairly quick timeline between starting nursing school and entering a well-paying, high-prestige medical profession.

Here’s the problem, as identified in Parade: not enough schools, instructors, classrooms and training openings. Applicants are being turned away by the thousands (over 42,000 just last year, according to Parade); meanwhile foreign nationals are being hired to fill critical positions in hospitals, nursing homes and home health agencies, often with less than optimal results.

aQuire Training Solutions (www.aQuireTraining.com ) has begun developing new programs to address this problem, beginning at the most basic level, the Certified Nursing Assistant.

“So much of education is currently defined by hours in a classroom rather than by knowledge and skills developed,” comments Sharon K. Brothers, MSW, President and CEO of aQuire Training Solutions. “As the shortage of nursing staff increases across the country we will need to be much clearer about the real goals of training, and how to be more efficient – and effective – in training more individuals to be skilled nursing professionals,” says Brothers.

Brothers and her staff at aQuire Training Solutions have begun offering online courses to Certified Nursing Assistants and other caregiver staff and are working hard on developing new courses designed to train more nursing professionals.

“We can train an unlimited number of individuals with the reach of the Internet and the technology for training and testing currently available,” asserts Brothers. “There is absolutely no reason that individuals who have a heart for nursing should be turned down because of a lack of classroom space or instructors.”

Brothers believes that learner-led e-learning can be just as effective as classes taught in the traditional setting. E-learning courses are available over the Internet, and don’t need a classroom, set schedule or physical instructors.

“E-learning today involves the student in a participatory, learner-directed style,” says Brothers. “With e-learning, not only is the student unable to sit passively in the back of a classroom, but the student is also controlling his or her learning completely: the pace of learning, the environment, and the flow of the content.”

New approaches to e-learning include the use of games, real-life scenarios and content designed to grab the emotions of the learner.

“Quickly engaging the emotions of the student is especially important in training people in the field of nursing,” says Brothers. “The best nursing assistants and nurses are those who have made the ‘ah-ha’ leap between nursing knowledge and skills, and the feeling that their work makes a real difference in the lives of the people they care for.”

Brothers predicts that e-learning will rapidly grow as a viable alternative to traditional classroom training, especially for nursing professionals who are becoming increasingly in demand in the U.S.’s aging society.

About aQuire Training Solutions is an e-learning solution to the challenges of providing meaningful training – both initial and ongoing – to senior care providers, particularly those with hands on, direct care responsibilities. aQuire Training staff are senior care and education professionals who have developed online training that incorporates games, scenarios and emotional learning to help build a workforce prepared to meet today’s senior care needs and poised for tomorrow’s avalanche of needs. aQuire Training currently offers a variety of courses including compliance courses, skills training for caring for individuals with memory loss and dementia, and general direct care courses. aQuire Training also develops custom courses to meet the needs of senior care professions or provider companies. aQuire Training staff can be reached toll free at 877-843-8374. Sharon K. Brothers can be reached via email at Sharon@aQuireTraining.com.

It’s About Your Team

We have a motto at our company, aQuire Training Solutions. We say, repeatedly, that “In senior care, your most valuable asset is not your building, it’s your team.”

We say this based not only on our passionate belief that people make the difference in care, but also on our experience as owners and operators that you can have the most beautiful building in the world but if it is not staffed with people who love their work – and love their residents – it will not be a successful business venture, let alone a valuable contributing force for excellence in senior care.

Not too surprising then, that a company called My InnerView’s recent survey of employees in senior care found that what matters most to senior care employees is having management who cares and listens to them.

This 2006 survey found that, among the 100,000 employees of about 2,000 nursing homes, 45% felt their satisfaction level was “Good” with only 16% feeling it was "Excellent". This appears to be a win, since over 60% of employees apparently are reasonably happy.

If, however, you follow the Disney approach to customer satisfaction, you’re running a pretty dismal show. Disney, according to Fred Lee (If Disney Ran Your Hospital), considers anything less than "Excellent" to be missing the mark.

We’re about to embark on a time in history when our needs for caregivers vastly outnumber our supply of trained and capable individuals. Perhaps this is a time when we, as a profession and as a society, need to be investing far more in building the teams than in building the buildings.

Just a thought.

An Offer to Atria and Assisted Living Communities

Atria is still making news as the target for unionizing efforts by SEIU, who is now focusing on yet another Atria community, this one located Riverdale, NY. SEIU, presenting itself as “Senior-care advocates from the Campaign to Improve Assisted Living”, has been zeroing in on the national company’s 121 facilities in 27 states as a prime target for unionizing caregivers throughout the US.

SEIU has issued press releases on Atria beginning some months ago, with the most recent ones coming in a one-two punch August 19 and 21st. In each press release the union focuses on a community with infractions, and their “advocacy” work on behalf of residents. Here’s a paragraph from the press release dated August 19, 2007:

Advocates will deliver an over-sized "Get- Well" card to residents, and ask to meet with facility administrators to discuss the recent viral outbreak that drove residents to their rooms and closed down the communal dining room.

No mention, of course, that over the past few years viral outbreaks like this have occurred in many communal living/dining environments. Some, including one in the state of Washington, resulted in multiple hospitalizations of residents as well as hospitalization of staff and even some emergency workers responding to the situation (these are nasty bugs indeed). Clearly Atria is not alone in experiencing this admittedly dangerous, distressing situation.

And while I’m all for advocacy, I’m truly for advocacy that supports all the needs of the consumer – in this case the senior and his or her family – both in improving care and in increasing accessibility. Explain to me how putting an organized labor union layer between owners, management and caregiver is going to truly achieve either one. As unions siphon off their dues, someone will pay that cost. And the possibility of a labor strike as a tool to increase wages certainly won’t benefit the residents.

So to John Moore, CEO of Atria Senior Living Group and all the other assisted living communities who are interested in genuinely improving care and services, I have an offer for you. We’ll provide to you – at no charge (other than set-up fee) for up to 6 months – our online staff training system, aQuire Training Solutions, to help you demonstrate your commitment to increasing staff training.

Even the SEIU knows that a better trained workforce is a workforce that will provide better quality care. Here’s their press releases’ closing line:

The Campaign to Improve Assisted Living is calling for Atria to make a real investment in front-line care by staffing-up, increasing worker training, and lowering worker turnover.

Atria – we’ll help you achieve this without unionization. Any other assisted living company – the offer stands for you, too. Contact me and I’ll personally sign you up.