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Results of the ProCare Phase II Study

Features of long term care facilities associated with safety, health, and satisfaction for employees and residents.

Using a statistical method called, “cluster analysis” we examined organizational features of 203 long term care facilities to identify two clusters of centers. The centers in one cluster were very similar to one another and different from the centers in the second cluster. Centers in the first cluster had favorable organizational characteristics such as more nursing staff per resident, fewer employee sick hours, lower workers’ compensation (WC) claim rates and higher Safe Resident Handling Program (SRHP) return on investment (ROI), higher retention of CNA’s, lower rates of adverse resident incidents, higher employee and resident satisfaction, and higher CMS survey ratings. The second cluster of centers had less favorable outcomes for all of these characteristics.

The results suggest that when the work environment is safer and more satisfactory, employees may choose to stay in the job longer, making it easier for centers to maintain higher staff-to-resident ratios. Higher proportions of experienced clinical staff can deliver better quality care, in turn, helping residents experience the center as a better place to live. The results of this study also provide some hypotheses for future analyses, for example, whether CNA retention predicts lower rates of adverse resident outcomes.

In a separate analysis, we observed that higher average employee satisfaction was associated with higher average resident satisfaction. Additionally, we found that higher worker satisfaction was associated with a lower combined rate of adverse resident outcomes (resident falls, pressure ulcers, and unexplained weight loss).

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Health and cost benefits of Safe Resident Handling Program sustained

In the first 5 years following implementation of a SRHP, rates of WC claims declined and overall ROI was high. Continued follow-up in ProCare II showed that the company maintained lower levels of injury rates, and net savings increased by 20%. We estimate that the company realized a total net savings of $2.56 million. WC claim rates were higher on average in centers that were unionized, had lower levels of wellness program activity, and had higher LPN turnover pre-SRHP. Higher net savings were observed in centers where employees gave higher ratings for adequacy of equipment, quality of new worker orientation, quality of resident-related training, and quality of in-service training.

The SRHP appeared to significantly reduce the rate of recurrence among resident handling (RH)-related injuries (and RH-related back injuries) in the six years post-SRHP. About 30,000 lost work days (and associated costs) were avoided due to reductions in RH-related recurrence, about a third of which specifically affected the back.

Claims for back problems were more likely to be filed by employees with more severe pain and higher physical demands at work. However, higher psychosocial job strain, social support at work, and education level decreased the odds of claim-filing.

Higher frequency of resident handling equipment use was related to higher perceived management commitment to the SRHP, higher prior expectations of program benefits, older age, and higher health self-efficacy. These findings point to the importance of facility leadership in promoting a positive, supportive safety climate in long term care facilities.

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Evaluation of Participatory Health and Wellness Teams

In ProCare I, an intervention study tested whether implementing a participatory health and wellness program for employees would result in added benefits beyond those achieved by the SRHP. Employee health and wellness (HW) teams designed, proposed, and implemented activities that would address key health/well-being concerns raised by front-line caregivers (see ProCare I results page). In ProCare II, we extended the HW team evaluation for two additional years. Early in ProCare II, more staff members in the sites with participatory teams (versus control sites) said they were consulted for HW program suggestions and reported slightly more opportunities to participate in decision-making and to contribute suggestions. Additionally, staff awareness of and participation in HW team-sponsored program activities was higher in the interventions sites.. Participatory HW teams with non-supervisory staff and administrator involvement generated more wellness activities than supervisor-only teams or those with no administrator involvement.

We observed that sustainability of the HW teams was highly dependent on mid-level and upper-level leadership support. HW teams were not sustained following the study period due to turnover in facility leadership, which impacted management support, financial resources, and supporting release time from job duties for nursing aides. In the CPH-NEW III SHIFT healthcare study, new participatory interventions will be implemented with existing safety committees, with formal roles assigned to mid and upper level managers during the design, implementation, and evaluation of new internal safety initiatives.

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