Q&A with Jill Quadagno: Putting care into perspective

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The Pepper Institute's Jill Quadagno has been involved in an array of long-term care research initiatives in recent years. She expects her ongoing studies to not only identify work force problems in the long-term care community but also lead to recruitment and retention strategies that can bring relief to providers in skilled nursing, assisted-living sectors and home-care settings.

Q As a sociologist specializing in aging matters, what do you find is most often lacking in the understanding or approaches of nursing home operators and/or nurses?

A It is sometimes difficult for people who are on the front lines of care to get a sense of the larger trends. As a sociologist, my job is to identify patterns that may not be immediately obvious. For example, the growing gap between Medicaid and Medicare in the amount paid for resident care has had the effect of changing the composition of nursing home residents.
Since the early 1990s, the average age of nursing home residents has declined, more residents have been admitted from hospitals for subacute care, and there are fewer long-stay residents receiving care for chronic conditions. Not surprisingly in light of these trends, residents today are more are likely to return home.

Q You said you are studying staffing issues in the long-term care industry. What are the parameters of your study, and how does this study differ from others already done?

A There is a growing nationwide shortage of workers who provide direct care to meet the needs of an aging population. Recruiting and retaining quality workers in the long-term care system is already a major issue in most states and likely to become more so as the baby boom generation grows old. Along with my colleagues in the Pepper Institute on Aging and Public Policy, I am beginning a study of direct-care workers in all three long-term care sectors--nursing homes, assisted living facilitie, and home health agencies in Florida.
 Many studies have identified high turnover among nursing home aides as a major impediment to quality care. However, we still don't fully understand the causes of turnover, and even less is known about workers in assisted-living facilities and home health agencies, where future growth of long-term care services is most like to occur.

Q What do you hope to find out from this study? What do you hope it will lead to?

A In our research we plan to describe the individual characteristics of direct-care workers compared to other less educated workers in low-skill industries. We also plan to identify the characteristics of the work environment that influence worker retention. Specifically, we are concerned with understanding which aspects of workplace culture create "good" workplaces.
We would like to know if employers are willing to experiment with changes in the workplace to recruit or retain workers and why or why not. Finally, we would like to be able to describe individual worker characteristics that are associated with high vs. low turnover. What individual characteristics can help nursing home operators identify "good" workers?

Q You've noted there are "problems" with long-term care insurance as a product. What do you mean?

A In 1985, fewer than three dozen insurance companies offered any sort of long-term care coverage. When insurance companies began offering long-term care insurance, sales were few because the public had no confidence in the product.
The Consumers Union analyzed 94 private long-term care insurance policies in 1989 and found many were highly flawed, a situation made worse by "poorly trained and often unscrupulous agents" who misled consumers about the terms, benefits and limitations of their coverage. So prevalent were these practices that there was a "need to re-evaluate whether an agent-based distribution system [could] work for this product."  The same year a report from the House Select Committee on Aging cited widespread abuses in the sale of long-term care insurance.

Q Is there any reason to think that long-term care insurance is A) actually viable and B) will be thoroughly and widely embraced by the buying public? Why?


A Growth of long-term care insurance remained sluggish until the mid-1990s. Many people remained wary of the product and most people avoided thinking about long term care costs until they were forced to do so by a health crisis. By then they were mos