Suchergebnisse

The supply of personal care aides (PCAs), who assist people receiving home care, is a growing concern. PCA shortages result, in part, from the low wages earned by these workers. State policies have had some effect on wages. Self-direction (SD) may be associated with wages because SD allows home care recipients to hire and manage workers, including setting wages in most states. We used wage data from the Bureau of Labor Statistics to examine the association between SD and the wages of PCAs. We found implementation of SD did not have a consistent association with PCA wages, with wages improving in some states and worsening in others. We also found little difference in PCA wages between states that allow participants to set worker wages and those that do not. SD does not seem to improve PCA wages in states, so other policy strategies will be needed.

Emerging technological advances hold potential to assist the long-term care (LTC) workforce in caring for an aging population in the home and LTC settings. Technology may alter workforce needs and mitigate rising workforce demand. This study identified and assessed emerging technologies that may assist, replace, and/or support recruitment and retention of the LTC workforce and identified barriers and facilitators to their implementation. We identified a variety of technologies with applications for LTC, created a taxonomy of technology types and functions across LTC settings, and conducted semi-structured interviews with a sample of company leaders to assess perceived impact of their products and services on the LTC workforce. Thematic analysis of those interviews found that technology is not currently positioned to replace the LTC workforce but may facilitate work and support worker recruitment and retention. More rigorous evaluation of technologies in LTC and financing mechanisms are needed to support widespread adoption.

Workplace violence (WV) is a significant and growing problem for health care workers. Increased recognition of the need for improved protections has led to policy initiatives at the state and federal levels, including national Joint Commission requirements that went into effect January 2022. California's WV prevention legislation was phased in during 2017-2018 and requires hospitals to use a new incident reporting system, the Workplace Violent Incident Reporting System (WVIRS) for Hospitals. We analyzed WVIRS data collected during the first three years of its implementation, July 1, 2017 – June 30, 2020. In addition, we collected qualitative data from six California hospitals/hospital systems during 2019-2020 to better understand reporting practices. Over the three-year period, the 413 hospitals using the WVIRS reported between zero and six incidents per staffed bed. Sixteen hospitals (3.9%) reported two or more incidents per staffed bed while the rest reported fewer than two incidents. Qualitative analysis identified that reporting procedures vary considerably among hospitals. Several organizations rely on workers to complete incident reports electronically while others assign managers or security personnel to data collection. Some hospitals appear to report only those incidents involving physical harm to the worker. Regulatory guidance for reporting practices and hospitals' commitment to thorough data collection may improve consistency. As hospitals throughout the U.S. consider practice changes to comply with new WV standards, those engaged in implementation efforts should look closely at reporting practices. Greater consistency in reporting across facilities can help to build evidence for best practices and lead to safety improvements.

Thirty-three U.S. states and the District of Columbia (DC) have legalized the use of marijuana for medicinal purposes and 10 states and DC have legalized marijuana for adult recreational use. This mirrors an international trend toward relaxing restrictions on marijuana. This paper analyzes patterns in marijuana laws across U.S. states to shed light on the social and political forces behind the liberalization of marijuana policy following a long era of conservatism. Data on U.S. state-level demographics, economic conditions, and cultural and political characteristics are analyzed, as well as establishment of and levels of support for other drug and social policies, to determine whether there are patterns between states that have liberalized marijuana policy versus those that have not. Laws decriminalizing marijuana possession, as well as those authorizing its sale for medical and recreational use, follow the same pattern of diffusion. The analysis points to underlying patterns of demographic, cultural, economic, and political variation linked to marijuana policy liberalization in the U.S. context, which deserve further examination internationally.

Thirty-three U.S. states and the District of Columbia (DC) have legalized the use of marijuana for medicinal purposes and 10 states and DC have legalized marijuana for adult recreational use. This mirrors an international trend toward relaxing restrictions on marijuana. This paper analyzes patterns in marijuana laws across U.S. states to shed light on the social and political forces behind the liberalization of marijuana policy following a long era of conservatism. Data on U.S. state-level demographics, economic conditions, and cultural and political characteristics are analyzed, as well as establishment of and levels of support for other drug and social policies, to determine whether there are patterns between states that have liberalized marijuana policy versus those that have not. Laws decriminalizing marijuana possession, as well as those authorizing its sale for medical and recreational use, follow the same pattern of diffusion. The analysis points to underlying patterns of demographic, cultural, economic, and political variation linked to marijuana policy liberalization in the U.S. context, which deserve further examination internationally.

Thirty-three U.S. states and the District of Columbia (DC) have legalized the use of marijuana for medicinal purposes and 10 states and DC have legalized marijuana for adult recreational use. This mirrors an international trend toward relaxing restrictions on marijuana. This paper analyzes patterns in marijuana laws across U.S. states to shed light on the social and political forces behind the liberalization of marijuana policy following a long era of conservatism. Data on U.S. state-level demographics, economic conditions, and cultural and political characteristics are analyzed, as well as establishment of and levels of support for other drug and social policies, to determine whether there are patterns between states that have liberalized marijuana policy versus those that have not. Laws decriminalizing marijuana possession, as well as those authorizing its sale for medical and recreational use, follow the same pattern of diffusion. The analysis points to underlying patterns of demographic, cultural, economic, and political variation linked to marijuana policy liberalization in the U.S. context, which deserve further examination internationally.

The objective of this study was to explore how home care workers and the agencies that employ them interact with their state's nurse practice act in the provision of care. Using a qualitative case study approach, we selected four states with varying levels of restrictiveness in their nurse delegation regulations. We conducted interviews ( N = 45) with state leaders, agency leaders, and home care workers to learn how these policies affect the home care workforce's ability to perform care tasks for their clients in order to allow clients to remain in their own homes. We found that increased training and input from registered nurses is needed to identify appropriate health maintenance tasks to delegate to home care workers and support development of training strategies. The federal government could support the development of evidence-based guidelines for training and competency testing as well as for appropriate delegation of health maintenance tasks.

Between 2008 and 2016, there was an increase in nurse practitioners in specialty care. This study explores some differences in role and practice environment between primary care and nonprimary care nurse practitioners in the domains of time spent on activities, barriers to providing care, working to scope of practice, full skill utilization, and satisfaction. This cross-sectional quantitative study, based on data from the 2017 Survey of California Nurse Practitioners and Certified Nurse Midwives, found that nurse practitioners in nonprimary care practices have lower odds of reporting time as a barrier to practice, lower odds of reporting practice to full scope, and higher odds of reporting a hierarchical or supervisory relationship with the physician. Future exploration of these differences may shed light on ways to promote nonprimary care practice environments to foster more effective collaboration and fewer barriers to providing care.