Vermont Legislative Study Tackles Direct Care Workforce: Study Reveals that Wages, Health Coverage, Training are Keys to Retention
Published by hthier on April 7, 2008 in Press Releases .

Montpelier, VT, March 25, 2008 –An impending health care crisis has not gone unnoticed in the Green Mountain State. The number of Vermonters age 65 and older is expected to double between 2005 and 2030 while the direct-care workforce continues to decline. A new study funded by the Department of Disabilities, Aging & Independent Living, The Community of Vermont Elders, and PHI has made nine recommendations to help avert this crisis. The Legislative Study of the Direct Care Workforce in Vermont reveals that wages, benefits and training are critical to retaining workers in this field.

The study analyzed survey responses from 1,700 direct-care workers in Vermont regarding wages, benefits, training, and career development. Key findings include:

Only half of the respondents expect to receive a raise. The forces of inflation, without annual cost-of-living increases, actually decrease wages over time. The responses show that the higher the wage, the longer caregivers remain in the profession.
Only one-third of direct-care workers in Vermont receive health insurance coverage as an employment benefit. However, workers with employee-sponsored health coverage remain in their jobs an average of 2.5 years longer.
Only 42 percent of respondents received formal job training. Those caregivers who do receive professional training remain in their jobs significantly longer.
Direct-care workers currently see few opportunities for advancement because of a lack of standardized and portable curricula and credentials. However, national research shows that workers who receive training, recognition, and advancement opportunities tend to remain in their profession.
Other results from the study show that 64 percent of Vermont’s current direct-care workers are over the age of 40.
In anticipation of the report, workforce and consumer advocates (the Community of Vermont Elders, the Vermont Association of Professional Care Providers, the Vermont Center for Independent Living and PHI) joined forces at a recent town meeting that featured Vermont Senator Bernie Sanders, members of the community, and direct-care workers, who gathered to address the need to support caregivers.

Several direct-care workers spoke candidly about the profession, noting the low wages, poor benefits, and lack of training for what is a remarkably difficult job.

Deborah Lisi-Baker, the executive director of Vermont Center for Independent Living, spoke about the need to improve the lives of caretakers to address the current and expected future declines of the workforce.

Direct-care workers provide crucial hands-on assistance to persons who are unable to perform basic activities of daily living (ADL) that many take for granted. Examples of ADLs include getting out of bed, attending to personal hygiene, eating, and other such tasks. Some people need help communicating, remembering, or simply engaging in meaningful activities. These workers provide 80 to 90 percent of the hands-on care for Vermont’s elders, children and adults with disabilities, and persons with chronic conditions.

PHI, a nonprofit organization that supports quality long-term care by improving direct-care jobs and served on the study group’s advisory board, notes that the Vermont study echoes their findings that direct-care workers are truly invested in their work and want to make a positive difference in other people’s lives.

However, PHI also notes that the common industry practices—including low wages, few opportunities for advancement, lack of training, and inadequate benefits—make it difficult to attract new workers and retain current ones in this field. This problem will only grow in the future, unless the state focuses on improving the quality of direct-care jobs.

For more information on this study, visit

Alexandra Olins
PHI Northern New England Regional Director

Alan Krawitz
Youngworth Public Relations
800.615.1230, ext. 18

Oklahoma Center for Consumer & Patient Safety
PO Box 4481, Tulsa, OK 74159-0481


Contact: Hugh M. Robert, Ex Dir 918-850-0293

April 7, 2008



Tulsa, OK – The Public Health Committee in the Oklahoma House of Representatives considered the amended version of the bi-partisan approved Senate Bill 1549 this morning. Just minutes before the committee meeting was scheduled to begin, Representative Cox, the owner of several nursing homes, submitted a committee substitute which stripped out the insurance requirement. The committee members voted 10-9 to consider the committee substitute, falling one vote short of being able to hear the bill in the form already approved by the Senate.

“It is sad that Dr. Cox put his personal financial interest in front of requiring nursing homes be financially responsible,” said Hugh M. Robert, Executive Director of the Oklahoma Center for Consumer and Patient Safety. Robert went on to say “the Oklahoma Senate had overwhelmingly supported the amended bill and Dr. Cox, who purportedly operates his nursing homes without insurance, today showed his personal financial interest is more important to him than protecting his constituents or the citizens of the State of Oklahoma.”

The amended bill would have required nursing home operators to prove they have sufficient assets to cover claims of resident abuse or neglect. If the nursing home operator fails to keep sufficient assets and does not carry liability insurance the officers, directors and shareholders of the nursing home operator would be personally liable to a nursing home resident or their family when someone is abused or neglected.

One reason Dr. Cox as well as the nursing home lobby has cited for not carrying insurance is that the Medicaid reimbursement levels not being high enough to provide the owners with large profits and pay for insurance. However, this does not take into account the private pay residents and if the issue is with reimbursement rates, then Dr. Cox, in his capacity as a representative should work on reimbursement rates, not blocking a resident or family of a resident from holding responsible a nursing home who abuses or neglects a loved one.

If a nursing home resident is neglected or abused they should have a remedy. Robert comments “we require people who drive cars to carry mandatory insurance, why should nursing homes be any different.” “Forcing nursing home operators to show they are financially sound in order to have a license to take care of our elderly citizens just makes common sense, especially with the growing elderly population” Robert says. Most nursing home operators are for profit and carrying liability insurance is a legitimate cost of doing business. A nursing home does not have to choose between providing good care and being financially responsible, they should be required to do both.

About the Oklahoma Center for Consumer and Patient Safety- Please call 800-994-6025 or visit

Today we have a guest writer, Heather Johnson. who is a regular contributor to, a great site for nurses and others interested in the nursing field.  We thank Heather for help insightful contribution.  Below is her entry.

Nursing Home Workers Face Neglect, Fraud Charges

Chicago Sun-Times reports that Nurse Marty Himebaugh and nursing director Penny Whitlock of a Woodstock, Illinois nursing home have been charged with criminal neglect of their patients and fraud. Police are currently investigating the deaths of six patients, which may be related to Himebaugh’s reputation for playing "Angel of Death" to her patients. Allegedly, she gave patients overdoses of morphine when she worked at the nursing home and Whitlock failed to reprimand her.

Complaints had been filed against Himebaugh many times before she was eventually put on leave from her job in 2006. Some allege that Whitlock not only failed to discipline Himebaugh in a timely manner, she could have been encouraging the illegal actions. Authorities exhumed the bodies of three patients to determine if they had died as a result of an overdose, though results have not been made public.

In addition to criminal neglect, Whitlock has been charged with obstruction of justice after she allegedly ordered the destruction of drugs in the nursing home. Himebaugh also faces additional charges for fraudulently obtaining and illegally dispensing morphine. Police are not expected to file any more criminal charges against current or former employees of the nursing home.

According to attorney Steven Levin, who was hired by the family of an alleged victim, "It was flat out an attempt to kill people. I mean we don’t kill old people in nursing homes in this country."


Heather Johnson is a freelance writer as well as a regular contributor for, a site which covers all things related to RN. Heather welcomes your comments and emails related to job inquiries at her email address,

Arizona Daily Star reported an investigation into the lack of investigation of neglect and abuse in Arizona nursing homes.  The investigation was bold and tragic and led to the reopeing of several complaints, and the conclusion that Arizona fails to protect elderly and vulnerable nursing home residents.  Below are excerpts from the story and investigation.

tAnita McEvoy put her 92-year-old mother in a Tucson nursing home so she wouldn’t get hurt as Alzheimer’s disease took its toll. Instead, her mother shivered in bed while nursing aides took no notice. She died of hypothermia complications.

Another elderly woman, who couldn’t see well and trusted nursing aides to bathe her, did not know they used a cell phone camera to photograph her in the shower, then went to the nursing station to show the photos and laugh about them with others.

And in a third local nursing home, a nursing aide assigned to feed a confused, 84-pound woman withheld a drink and demanded that the woman say "please" and "thank you," laughing while the woman kept asking: "What do you want? Who the hell are you?"

These cases and others over the past three years have this in common: State regulators did nothing about them.   Until Friday — when investigators reopened one of the cases as a direct result of the Star’s questions.   The inspectors showed a consistent pattern of weak enforcement.
Only 15 percent of the time did they substantiate allegations of abuse, neglect or other problems in how the homes cared for some of our most vulnerable people.

The Star reviewed nearly 1,000 citations for safety problems and more than 1,100 complaints of poor care to the Arizona Department of Health Services in Pima County’s 22 nursing homes in the three years ending in 2007.  The review mirrors what federal auditors have found nationally: State inspectors miss violations, underrate the severity of the offenses, and allow homes to yo-yo in and out of compliance.

The Star’s investigation also reveals:
● The state blew its own investigation deadlines in three out of every four cases, often compromising the findings because patients and staff members are no longer around. The median case is 72 days late.
● The state doesn’t give you enough information to determine whether a home is giving consistently good care. The public can’t see the patient’s side of any given complaint. You can’t see reports the nursing homes make when a patient is harmed. And the only snapshot of how a home is performing is up to 18 months old in some cases.
● The state fined poorly performing homes only 24 times in three years, even though it wrote 958 citations. Until recently, the fines were typically so small that even your next-door neighbor could pay them — usually not much more than $1,000.
● Unlike other states that have set precise staffing standards, Arizona adheres to a vague requirement of "sufficient" staffing. That standard, set by the federal government 20 years ago, is notoriously difficult to assess.
● Unlike doctors, nursing homes don’t have to disclose if they’ve paid out judgments or settlements. Dozens of cases have been settled secretly. It could become even harder to learn about improper care, because homes are getting patients to promise not to sue if something goes wrong.
● Because the state rarely substantiates complaints, sometimes staffers who are fired at one nursing home after being accused of abuse or neglect can be hired right away at another.


Read More →

WBLT in Jackson, Ms. has an article about a resident who was so neglected in her diabetic monitoring that she will now lose her leg.  Below are excerpts from the article.

A nursing home’s responsibility is to care for those in need.  On Friday, March 28, Willie Mae Coleman was admitted to University Medical Center in Jackson for gangrene. Her left leg will be amputated.   The family blames the Pine Crest Guest Home for neglecting to give her mother the care she needed.

"It could have been avoided if her leg had been properly elevated and proper procedure would have been done," she says. "It wouldn’t have come to her having surgery."

"I think vascular disease is always preventative on several levels," said Coleman’s doctor, Huey McDaniels.

Sandra says although her mother was admitted to UMC on Friday, nobody from the nursing home that brought her here notified them. In fact, her family didn’t know she was there until Sunday. Sandra says her siblings went to visit Coleman at Pine Crest Guest Home on Sunday, but Coleman wasn’t there. That’s how they found out she was in the hospital. 

Sandra Coleman says there’s no excuse for allowing her mother to get to a point where amputation is the only option.

"If it’s happening to us, it could be happening to others there, too," said Sandra.

 Amanda Falcone has an article about Connecticut’s attempt to increase staff in nursing homes.  A  plan to raise the minimum staff-to-resident ratio in nursing homes was described as historic, necessary and long overdue at a press conference Wednesday.

The plan would provide $9.5 million in fiscal year 2008-09, which begins on July 1, to increase staff-to-resident ratios from 1.9 hours to 4.2 hours of care per day at nursing home throughout the state.   The increase for nursing homes will be sustainable, adding that after the coming fiscal year, it will probably take about $30 million in subsequent years to maintain the change.   Staffing levels at nursing homes have not been addressed in 25 years.

Nursing staffing levels are a problem across the country, and Connecticut is no exception, said Toby S. Edelman, a senior policy attorney for the Washington, D.C.-based Center for Medicare Advocacy.   Adequate nursing staff is critical to providing good care, she said.

Below is an excerpt from a great article from Dallas News about family councils in Texas.  The relatives of Texas nursing home residents have discovered there’s strength in numbers. Emboldened by a new state law, they’ve begun to organize more "family councils" at their nursing homes to advocate for better care.

"My mother was the one who taught me how to stand up and speak out, so it’s only fitting that I now step in for her," said Daisy Kincheloe, who knew she had to do something after her elderly mother fell at Doctors Healthcare Center in North Dallas.  Her mother’s accident was the last straw. Before that, she had discovered other problems that convinced her that some staff members weren’t paying enough attention.

Ms. Kincheloe and other families at Doctors have just formed the group to give each other moral support, act as added sets of eyes and ears around the nursing home, and bring grievances to the administration’s attention. By presenting a united front, family councils have persuaded nursing homes to respond more quickly to residents’ call buttons, improve the meals and even hire more staff.  Family councils are enjoying renewed attention nationwide because many of their newer leaders are baby boomers, whose generation is known for its activism.

Though administrators occasionally resist the councils at first, a growing number say they welcome the groups because they encourage family participation and accountability from staff.

Many families hesitate to bring up problems because they’re afraid the nursing home staff will retaliate against their relatives. Others complain but find their grievances fall on deaf ears.   A family council can add weight to a complaint, advocates say.


1. Determine the need. As few as two or three families can organize a council.

2. Advise the administrator. By law, nursing homes must provide private meeting space for councils.

3. Notify other families. Meeting announcements can be posted on bulletin boards. Administrators may also offer to mail notices.

4. Ask advocacy groups and the local ombudsman for help. Advocates and the state ombudsman program’s local representative can explain nursing home residents’ rights.

5. Hold your first meeting. Discuss the council’s purpose, ask the ombudsman to talk about the grievance process and invite the administrator to speak.

There is a great article about the use of the game Wii to help residents with socialization and physical therapyin nursing homes.  Wii-hab is the name of the game sweeping nursing homes across the region.
Morrell Nursing & Rehab Center in Hartsville and Bethea Baptist in Darlington are among the long-term care facilities taking part in the craze, much to the delight of their residents.  The new Wii-hab program uses the Nintendo Wii to promote exercise at the facility.   

The favorite game is Wii bowling, because it allows the residents to exercise upper body despite physical  limitations.  Residents and staff alike gather in the center’s sunny activities room to both play and watch others play such Wii games as bowling, tennis, baseball and boxing.

Mary Etheredge, activities director at Morrell, is the person responsible for bringing the program to all three of Wilson Senior Care’s facilities in the Pee Dee. She said so far, the program has been a great success.  Etheredge said the biggest challenge so far has been getting the male residents to participate.  The exercise from the Wii-hab is deceptively easy for many of the residents, Etheredge said, almost tricking them into doing rehab to make their daily lives easier.

“When they’re doing this, they really don’t realize how much they are moving,” she said. “It has them concentrating. They have to watch their eye and hand movement. It really works.”
While the tournament was going on, residents and employees gathered around Hopkins and Woodham to cheer them on with yells and clapping.

Etheredge said that sort of involvement has become almost commonplace since the Wii-hab program began at the facility. She said the Wii-hab program has made a difference in the quality of life for residents and it’s a change she plans on keeping around for a long time.

Hopefully this will become standard practice at other nursing homes.

The Moultrie Observer reported a story about another nursing home employee who sexually assaulted a resident.  How can this happen if a criminal background check was done and RNs are properly supervising the staff?

Charles David Cone, 47, of 321 12th Ave. N.W. in Cairo, was charged with sodomy and sexual battery.   An employee at the Woodlands at Cobblestone on Cobblestone Trace reported Feb. 27 that Cone allegedly touched a 92-year-old male patient inappropriately. The patient stated there were two separate incidents, one on Feb. 25 and the other the next day.

According to a warrant for Cone’s arrest, he is accused of putting the patient’s penis in his mouth on Feb. 26. Cone allegedly fondled the patient’s genitals on Feb, 25,

Executive Director Joann Sloan said Cone was terminated from his job at Woodlands immediately after the alleged incident was reported.  “Our standard of practice and our goal is to provide a safe environment for our patients,” Sloan said.

WFTV in Florida had an article about a nursing home allowing one of their residents to fall NINE times from a her wheelchair.  This is neglect.  Why didn’t they try a safety device like a tray or belt?  I wonder if they were given her the right amount of medication or if they were using the medications as a chemical restraint?   Hopefully the family will get some answers during the lawsuit. 

The falls caused Ruth Boelke to prematurely die. The nursing staff failed to follow the doctor’s orders and best safety practices by failing to use a safety device to prevent Ruth from falling out of  her wheelchair.   The home’s director said it did call her doctor a few days before she died and sent her to the hospital. The family claims the nursing home should have called for help sooner.