YES on Initiative 1029: I-1029 Fact Checker on Quality Care

I-1029 Factchecker

I-1029 Facts: Better Training Will Improve Worker Supply, Improve Quality

Opponents claim that there is no evidence that better training will improve quality care. They also assert that higher training standards will reduce the supply of workers. No evidence is presented to support this claim, and a variety of studies actually suggest just the opposite.

Workforce Supply:

One review of national literature on the impact of training on recruitment and retention found that, in general, higher levels of training for direct-care workers helped employers both find and keep employees, especially in home care agencies (see Workforce Strategies #3, Paraprofessional Healthcare Institute, January 2005)
When nurse aides reported that training prepared them well for their jobs, intent to leave and actual workforce turnover were lower (see "Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover, The Gerontologist 47, 2007)
In Pennsylvania's home health agencies, more staff training was found to be associated with lower reported recruitment and retention problems (see Pennsylvania's Frontline Workers in Long Term Care, report to Philadelphia Geriatric Center, 2001)

Quality Care

In the recent report "Retooling for an Aging America," the Institute of Medicine wrote: "Direct-care workers are the primary providers of paid hands-on care and emotional support for older adults, yet the requirements for their training and testing are minimal. Furthermore, even though patient care has become much more complex... very little is done to ensure the competence of personal care aides. The committee concluded that current federal training minimums are inadequate to prepare direct care workers and that the content of the training lacks sufficient geriatric-specific content."

A 2000 Institute of Medicine report found "some agreement among experts... that there is a relationship between the level and type of training and the quality of care that nursing assistants provide." The report also noted that "improved training and job quality decreases turnover, which impacts both quality of care and quality of life for residents."

In one study comparing quality of care in nursing homes before and after establishing national CNA training standards in 1987, quality of care improved after the law's training mandate went into effect (see Bernard Gross: Quality of Care Defined, PA Department of Education, 1995)

A 2001 survey of nursing facility administrators, nursing directors, nursing assistants, social workers, family members, and surveyors found that "training, orientation, or education" was tied for first place as a means of improving quality of care. (see "Redefining Quality and Excellence in the Nursing Home Culture," Journal of Gerontological Nursing)