August 2024

The UCSF Health Workforce Research Center on Long-Term Care is about to begin its 12^th year of innovative, collaborative research to identify challenges and solutions to support the growing population of people with long-term care needs. In collaboration with the National Center for Health Workforce Analysis in the US Health Resources and Services Administration, we’ve identified four new research projects that we will launch in September – see below to learn about them! You’ll also read about our recent publications, presentations, and other highlights from the summer.

Joanne Spetz, PhD, FAAN

Director

Nurses’ experiences with telehealth in long-term care: Literature review and perspectives from nursing home staff and leaders

The literature is significantly lacking regarding nurses' specific roles, challenges, and adaptations in implementing telehealth in LTC settings during and after COVID-19. This study will examine the role of nursing staff in utilizing telehealth within LTC facilities through a literature review and interviews with nurses who work in LTC facilities.

Read more here. For more information, contact Laura Wagner.

Examining the risk of benefits cliffs for the direct care workforce

Benefits cliffs occur when an increase in income causes a worker to make too much to qualify for public benefits programs.  As a result, the worker and their family end up being worse off financially than they were before their earnings increased. Using the American Community Survey 5-Year estimates data from 2018-2022, this study will quantify the number and proportions of direct care workers who are currently navigating benefits cliffs and describe the demographic and geographic factors associated with the greatest risk.

Read more here. For more information, contact Susan Chapman.

Characteristics of the workforce in nursing homes and assisted living communities: Early insights from the National Dementia Workforce Study

There is a gap in research on the professional dementia care workforce and the extent to which their training and composition influence outcomes for people living with dementia. This project will describe the registered nurse, licensed practical/vocational nurse, and direct care worker employees of nursing homes and assisted living communities, based on the first round of data from the National Dementia Workforce Study.  

Read more here. For more information, contact Joanne Spetz.

Examining variation in clinical care team visits for hospice patients

Hospice services are provided through agencies that are required by Medicare to provide interdisciplinary care through teams that include an RN, a social worker or therapist, a physician (MD or DO), and a chaplain. This study will use Medicare claims data to examine variation in clinical care team visits to hospice patients, which has been identified as an indicator of the quality of hospice care.

Read more here. For more information, contact Lauren Hunt or Joanne Spetz.

AcademyHealth’s Annual Research Meeting Highlights

HWRC researchers and affiliates attended AcademyHealth’s Annual Research Meeting in Baltimore, which took place June 29 – July 2^nd. Here are a few highlights!

• HWRC Directors from across the U.S. were able to meet for an informal dinner during this year’s Academy Health meeting in Baltimore, and we were joined by our Project Officer, Yahtyng Sheu. Our Centers collaborate in the development and execution of studies, and we also provide camaraderie, mentorship, and support to each other. We are all excited to launch another year of projects in September!

• Amy Quan and Janet Coffman presented a poster titled “Participating in a Nurse Practitioner Fellowship Increases New Graduates Preparation for Practice,” which was selected as the Best Poster for the Health Workforce theme.

• Susan Chapman and Kezia Scales participated in the AcademyHealth interest group event, “Impact of the American Rescue Plan Act on Direct Care Workforce and Long-Term Services.”

• Sharifa Brooks-Smith-Lowe and others presented a poster entitled “Bridging Gaps in Dementia Care: Insights and Policy Implications from Family Physicians.”

• Joanne Spetz, Bianca Frogner (Director of the University of Washington’s Center for Health Workforce Studies), and Erin Fraher (Director of the Carolina Health Workforce Research Center) were on a panel titled “Challenges in Projecting Health Workforce Supply and Demand.”

• You can search for descriptions of all AcademyHealth posters and presentations here.

New Study Examines An Innovative Strategy To Support Dementia Services In Primary Care

HWRC researchers partnered with the Alzheimer’s Association to evaluate the Alzheimer’s Disease–Extension for Community Healthcare Outcomes (AD-ECHO) program. AD-ECHO was designed to strengthen PCP capacity in dementia through bi-monthly virtual meetings with a team of dementia experts. Through direct observation and interviews with 14 participants, Dr. Alissa Bernstein Sideman and her team found that participants valued the supportive learning environment and resources; knowledge gained empowered them to take more action around dementia; they identified ways of disseminating knowledge gained into their practice settings, and many desired ongoing AD-ECHO engagement. However, most identified time as a barrier to participation. Learn more by reading the full journal article published in Medical Care Research and Review. 

Direct Care Workers Face Barriers To Health Insurance And Health Care Access: New Publication

Insurance Coverage and Health Service Use Among Direct Care Workers in the United States

In a new publication, “Health Insurance Matters: Insurance Coverage and Health Service Use Among Direct Care Workers in the United States,” HWRC and PHI researchers used National Health Interview Survey (NHIS) data from 2014 to 2018 to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among direct care workers by care setting. They found that direct care workers in home and residential care settings had lower insurance coverage rates than nursing assistants in hospitals. Direct care workers also were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Medicaid insurance helped to mitigate barriers to access to care among direct care workers, illuminating the importance of policy interventions to support access to health insurance.

Recent Presentations from UCSF HWRC-LTC Investigators

California Initiative for Health Equity & Action

On May 23, 2024, Janet Coffman participated in a webinar presented by the California Initiative for Health Equity & Action entitled “Innovative Strategies to Diversify California’s Health Workforce.” A recording of the webinar is available at https://www.youtube.com/watch?v=pv1aKc1NeV0.  

American Society for Health Economists Conference

In June, several HWRC researchers presented at ASHEcon in San Diego:

• Joanne Spetz participated in the panel, “Leveraging Data to Understand the Health Workforce Caring for Patients Living with Alzheimer’s Disease and Other Dementias.”
• Ulrike Muench and Joanne Spetz presented their work on “Nurse Practitioner Employment, Roles, and Experiences at the Advent of Expanded Scope of Practice.”
• Ulrike Muench participated in the “The Effects of Nurse Anesthesia Supervision on Surgical Quality and Access” panel.

The UCSF Health Workforce Research Center on Long-Term Care (UCSF HWRC) is a dynamic hub of policy-oriented research and investigation, established through support from the National Center for Health Workforce Analysis in the U.S. Bureau of Health Workforce. UCSF HWRC closely examines the health care workforce and helps shape policies to meet expanding LTC needs. Our research includes the workforce in nursing homes, home health care, adult day care, community-based settings, and home settings, and includes all LTC occupations.

Director: Joanne Spetz, PhD, FAAN

Deputy Director: Susan Chapman, PhD, RN, FAAN

Associate Director for Research: Laura Wagner, PhD, RN, FAAN

Visit: https://healthworkforce.ucsf.edu/about

Follow on Twitter: @ucsfhwrc

This newsletter highlights new HWRC publications, as well as workforce-related research conducted by our team at the Institute for Health Policy Studies and Healthforce Center at UCSF, and other research partners.