VA social workers identify factors predictive of enrollment and variability in Veterans' access to aid and attendance benefits.

The Aid and Attendance (A&A) benefit is a cash entitlement for Veterans who served in the U.S. military to obtain personal care services. Our objective was to identify factors contributing to variation in A&A enrollment across VA Medical Centers (VAMCs). We used VA data to calculate the enrollment rate among older Veterans receiving a VA pension or compensation in 2015, then purposefully sampled social work leaders at 15 VAMCs with the highest (n = 7) and lowest (n = 8) enrollment rates for interviews. All respondents viewed A&A as an important benefit. Participants at high-enrollment sites indicated strong working relationships with Veterans Benefits Administration (VBA) and Veterans Service Organizations (VSOs) with onsite presence and education about A&A facilitate access. Participants at low-enrollment sites indicated they desired education around A&A eligibility criteria and collaboration with VBA/VSOs. VA and non-VA social workers would benefit from education about VBA's benefits, and this requires collaboration with VBA representatives.

Job Characteristics Associated With Intent to Quit Among Nursing Home Employees and Managers.

BACKGROUND AND OBJECTIVES: High turnover and recruitment challenges of nursing home employees and managers are an ongoing concern. This study's objective was to examine intent to quit among all staff and assess the roles of job characteristics and job satisfaction. Employees and managers within one nursing home chain working in direct patient care or nursing were compared. RESEARCH DESIGN AND METHODS: Data came from the Work, Family, Health Network 18-month follow-up survey in 2012 (total = 1,000, managers = 101, employees = 899). A cumulative logit model controlling for demographics was estimated for intent to quit. Herzberg's Two-Factor Theory of Work Motivation guided the study. RESULTS: Employees scored significantly lower on family-supportive supervisor behaviors (FSSBs), schedule control, and decision authority than managers. Employees and managers did not differ on job satisfaction, intent to quit, or job demands. Satisfied workers had an 83% decrease in the odds of reporting an intent to quit compared to workers who were neutral or disagreed (odds ratio [OR] = 0.17, p < .0001). Decision authority (OR = 3.49) and schedule control (OR = 5.18) were independently related to greater odds of reporting an intent to quit. In contrast, FSSBs (OR = 0.69), safety compliance (OR = 0.71), and the combination of high decision authority with high schedule control (OR = 0.72) were related to lower odds of reporting an intent to quit. DISCUSSION AND IMPLICATIONS: Among nursing home staff, lower intent to quit may be achieved through improving job satisfaction, the quality of supervision, safety culture, and job enrichment through more schedule control and decision-making power.

The Effect of Nurse Aide Retention on Ohio's Nursing Home Resident Care Experience Scores: A Facility-Level Analysis.

This study examined whether certified nurse aide (CNA) retention was positively related to nursing home (NH) resident care experiences at the organizational-level. The 2017 Ohio Biennial Survey of Long-Term Care Facilities and the 2017 Ohio Nursing Home Resident Satisfaction Survey provided the key variables. Quartiles of CNA retention (0-48%, 49-60%, 61-72%, 73-100%) were created from the analysis sample (N = 667). Regression analyses clustered NHs within counties and controlled for structural characteristics, financial resources, empowered managers, resilience, quality of work-life, resident, and community characteristics. NHs in Quartile 3 of CNA retention had higher environment scores by 1.36 percentage points compared to Quartile 1 (p < .05). NHs in Quartile 4 had lower facility culture scores by 1.31 percentage points than NHs in Quartiles 1-3 (p < .05); this pattern repeated when Quartiles 3 and 4 were compared on other outcomes. Future research should explore NHs with very high CNA retention to improve understanding of the measure.

Does Higher Worker Retention Buffer Against Consumer Complaints? Evidence From Ohio Nursing Homes.

BACKGROUND AND OBJECTIVES: This study examined the relationship between nursing home (NH) quality using consumer complaints and certified nursing assistant (CNA) annual retention rates among Ohio freestanding NHs (n = 691). RESEARCH DESIGN AND METHODS: Core variables came from the 2017 Ohio Biennial Survey of Long-term Care Facilities and Centers for Medicare and Medicaid Services Automated Survey Processing Environment Complaints/Incidents Tracking System. To compare NHs, 4 quartiles of CNA retention rates were created: low (0%-48%), medium (49%-60%), high (61%-72%), and very high retention (73%-100%). Negative binomial regressions were estimated on total, substantiated, and unsubstantiated allegations and complaints. All regressions controlled for facility and county-level factors and clustered facilities by county. RESULTS: NHs in the top 50% (high and very high) of retention received 1.92 fewer allegations than those in the bottom 50%, representing a 19% difference; this trend was significant and negative across all outcomes. Using quartiles revealed a nonlinear pattern: high-retention NHs received the fewest number of allegations and complaints. The differences between high and low retention on allegations, substantiated, and unsubstantied allegations were 33% (3.73 fewer), 34% (0.51 fewer), and 32% (3.12 fewer), respectively. Unexpectedly, very high-retention NHs received more unsubstantiated allegations than high-retention NHs. DISCUSSION AND IMPLICATIONS: While higher-retention should result in fewer complaints, our results indicate that some turnover may be desirable because the very high-retention NHs performed slightly worse than those with high retention. Among the remaining facilities, fewer complaints may be achieved by improving CNA retention through higher wages, career advancement, and better training.

Pathology in Practice.

In collaboration with the American College of Veterinary Pathologists.

The One-Two Punch of High Wages and Empowerment on CNA Retention.

OBJECTIVES: The objective of this study was to examine the relationship between high wages and empowerment practices on certified nursing assistant (CNA) retention, necessary for providing high-quality care for nursing home (NH) residents. METHODS: Measures of provider-level CNA empowerment and wages from the 2015 Ohio Biennial Survey were used to estimate two regression models on retention (n = 719), one without and one with an interaction term of high wages and high empowerment. RESULTS: Only in the context of the interacted model were NHs that provided both high wages and high empowerment associated with a 7.09 percentage-point improvement in the CNA retention rate (p = .0003). Individually, high wages and a high empowerment score were not statistically significant in either regression model. DISCUSSION: Retaining CNAs in NH communities requires a combination of empowerment practices (e.g., involving CNAs in decision-making about hiring other staff) and high hourly wages.

A pilot randomized controlled trial of smartphone-assisted mindfulness-based intervention with contingency management for smokers with mood disorders.

Cigarette smoking disproportionately affects individuals with mood disorders, but smoking cessation interventions have modest effects in this population. Home mindfulness practice during abstinence incentivized via contingency management (CM) may help those in affective distress quit smoking. METHOD: Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, n = 25) or enhanced standard treatment (EST, n = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) ≤ 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day. RESULTS: Of the 49 participants, 63.3% were Latinx and 30.6% Black; 75.5% reported household incomes < $25,000. Abstinence rates for SMI-CM were 40.0%, 36.0%, and 16.0% versus 4.2%, 8.3%, and 4.2% in EST at weeks 2, 4, and 13. A generalized estimating equations (GEE) model showed significant overall differences in abstinence rates in SMI-CM versus EST (adjusted odds ratio [AOR] = 8.12, 95% CI = 1.42-46.6, p = .019). Those who received SMI-CM reported significantly greater reduction in smoking-specific experiential avoidance from baseline to 3 days prior to quit date (ß = -7.21, 95% CI = -12.1-2.33, p = .006). CONCLUSIONS: SMI-CM may increase cessation rates among smokers with mood disorders, potentially through reduced smoking-specific experiential avoidance. SMI-CM is a promising intervention, and warrants investigation in a fully powered randomized controlled trial (RCT). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Comparison of Emergency Preparedness Policies by Long-Term Care Setting Type in Ohio: Assisted Living Settings Lag Behind Nursing Homes in Key Areas.

Skilled nursing facilities (SNFs) have received regulatory attention in relation to their emergency preparedness. Yet, assisted living settings (ALs) have not experienced such interest due to their classification as a state-regulated, home- and community-based service. However, the growth in the number of ALs and increased resident acuity levels suggest that existing disaster preparedness policies, and therefore, plans, lag behind those of SNFs. We examined differences in emergency preparedness policies between Ohio's SNFs and ALs. Data were drawn from the 2015 wave of the Ohio Biennial Survey of Long-Term Care Facilities. Across setting types, most aspects of preparedness were similar, such as written plans, specifications for evacuation, emergency drills, communication procedures, and preparations for expected hazards. Despite these similarities, we found SNFs were more prepared than large ALs in some key areas, most notably being more likely to have a backup generator and 7 days of pharmacy stocks and generator fuel.

Organizational Factors Associated With Retention of Direct Care Workers: A Comparison of Nursing Homes and Assisted Living Facilities.

BACKGROUND AND OBJECTIVES: Low retention of direct care workers (DCWs), either certified nursing assistants in nursing homes (NHs) or personal care assistants in assisted living (AL), continues to be an unresolved problem. While numerous studies have examined predictors of DCW retention in NHs, little attention has been paid to differences between settings of long-term care. This study compares the predictors of DCW retention rates across both settings. RESEARCH DESIGN AND METHODS: The 2017 Ohio Biennial Survey of Long-Term Care Facilities provides facility-level information from NHs and ALs (NHs = 739; ALs = 465). We compare the factors that predict retention rates of DCWs utilizing regression analysis. The factors are structural, financial, resident conditions, staffing, and management characteristics, as well as retention strategies. RESULTS: Average DCW retention rates were 66% and 61% in ALs and NHs, respectively. Not-for-profit status was significantly associated with higher retention rates across settings. While the percent of residents with dementia and less administrator turnover were associated with significantly higher DCW retention in NHs, these were not significant for ALs. However, in the AL context, a higher county unemployment rate and DCWs' participation in resident care planning meetings were positively related to DCW retention after controlling for all other covariates, while DCW cross-training was negatively associated. DISCUSSION AND IMPLICATIONS: Retention strategies for DCWs may need to differ by setting, as a result of differing working environments, resources, and regulations.

Facility-Level Factors Associated With CNA Turnover and Retention: Lessons for the Long-Term Services Industry.

BACKGROUND AND OBJECTIVES: Certified nursing assistant (CNA) turnover and retention are critical aspects of facilities' ability to provide cost-effective, high-quality person-centered care. Previous studies and industry practice often treat turnover and retention as similar concepts, assuming that low turnover and high retention are synonymous. The study addressed the question of whether turnover and retention rates differ and if so, what those differences mean for nursing home practice, policy, and research. RESEARCH DESIGN AND METHODS: This study examines facility-level factors associated with CNA retention and turnover rates using 2015 data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, Certification and Survey Provider Enhanced Report, and the Area Health Resource File. Using bivariate tests and regression analysis, we compare rates and the factors associated with retention and turnover. RESULTS: The mean facility annual retention rate was 64% and the mean annual turnover rate was 55%. As expected, there was a statistically significant and negative correlation between the rates (r = -0.26). However, some facilities had both high retention and high turnover and some had low rates for both measures. Not all the variables that are associated with turnover are also associated with retention. DISCUSSION AND IMPLICATIONS: CNA retention is not simply the absence of CNA turnover. Given the differences, nursing homes may need to use strategies and policies designed to target a particular stability measure.

Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND.

BACKGROUND: Although individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. METHODS: In phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO≤6ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). RESULTS: The results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4times/day (≥3min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall (M=4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking (Ms=4.50/5). CONCLUSIONS: The results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders.

Isolating the Unique Effects of the Unified Protocol Treatment Modules Using Single Case Experimental Design.

The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is a cognitive-behavioral intervention designed to treat the range of anxiety, depressive, and related disorders. Thus far, the UP treatment modules have only been studied when they are delivered in their entirety and presented in a standard sequence. To personalize the presentation of the UP modules for a given patient's presentation (e.g., providing the modules in a varied order, dropping irrelevant modules), it is first necessary to establish that each module leads to change in the skill it is designed to promote, and that these changes can occur in the absence of the other modules. Using a multiple baseline design in accordance with the single-case reporting guidelines in behavioral interventions (SCRIBE), eight patients with heterogeneous emotional disorders were randomly assigned to a 1- or 3-week baseline assessment phase followed by four sessions of one of four UP modules (psychoeducation, emotional awareness, cognitive flexibility, and countering emotional behaviors). Results provide preliminary support for the notion that each UP module under study leads to change in its associated skill in the absence of the other modules (five of eight patients demonstrated reliable change in the module-specific skill). In addition, exploratory analyses suggest that the emotion awareness training and cognitive flexibility modules appeared to exhibit change specific to their associated skills, psychoeducation, and countering emotional behaviors demonstrated somewhat more broad-based change across skills.