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Funded by the Robert Wood Johnson Foundation and The Atlantic Philanthropies, Better Jobs Better Care (BJBC) was a demonstration program that sought to bring about changes in public policy and management practice that would lead to improved recruitment and retention of high-quality paraprofessional direct care workers (DCW) in nursing homes as well as in home- and community-based settings. This was to be accomplished by implementing both policy and management practice goals. Policy goals included developing initiatives related to wages and benefits, incentives for job redesign, curriculum and credentialing, professional associations, and promotion of public awareness and policies. Practice goals involved interventions related to caregiving skill development, peer mentoring, team building, top management training, supervisor training, and provider-specific interventions. The program established demonstration projects in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont which enrolled long-term care establishments across the spectrum of long-term care settings: skilled nursing facilities, assisted living facilities, home care agencies, and adult day service providers.

Conducted as part of the BJBC evaluation, which used a before-after design to assess the implementation of the interventions and their impact, this survey of the top clinical manager at each participating long-term care provider explored the establishments' organizational characteristics and management practices. One version of the survey was administered at the beginning of the demonstration (Time1), and a second version, toward the end of the demonstration (Time 2). Organizational characteristics covered by the survey include nonprofit/for-profit status, whether the establishment was free standing or part of a chain, number of competing establishments, whether the DCWs were unionized, and the type and amount of services provided. Management practices investigated by the survey include participation in care planning, communication about tasks, feedback, DCW training, management communication, organizational readiness for change, professional development, and work design practices. The survey also collected information about the racial and Hispanic origin composition of DCWs and patients/residents/clients.

Funded by the Robert Wood Johnson Foundation and The Atlantic Philanthropies, Better Jobs Better Care (BJBC) was a demonstration program that sought to bring about changes in public policy and management practice that would lead to improved recruitment and retention of high-quality paraprofessional direct care workers (DCW) in nursing homes as well as in home- and community-based settings. This was to be accomplished by implementing both policy and management practice goals. Policy goals included developing initiatives related to wages and benefits, incentives for job redesign, curriculum and credentialing, professional associations, and promotion of public awareness and policies. Practice goals involved interventions related to caregiving skill development, peer mentoring, team building, top management training, supervisor training, and provider-specific interventions. The program established demonstration projects in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont which enrolled long-term care establishments across the spectrum of long-term care settings: skilled nursing facilities, assisted living facilities, home care agencies, and adult day service providers.

Conducted as part of the BJBC evaluation, this survey interviewed DCWs at two points during the demonstration. The Time 1 interview was fielded as soon as establishments enrolled in the demonstration and provided a list of their DCWs (July 2004 to December 2006), and the Time 2 interviews were completed 12 to 28 months after the Time 1 interviews (April 2006 to June 2007). Both rounds of the survey used the same self-administered questionnaire which included questions about length of employment, job satisfaction, job rewards and problems, supervision, perceptions of quality of care, job confidence, training, intent to quit, and demographic characteristics. The survey also elicited recommendations for improving DCWs' jobs by asking the open-ended question "What is the single most important thing your employer could do to improve your job as a direct care worker?"

The National Home and Hospice Care Survey (NHHCS) was reintroduced into the field in 2007 after a 7-year break. During that time, the survey was redesigned and expanded to include a computer-assisted personal interviewing (CAPI) system, many new data items, and larger sample sizes of current home health patients and hospice discharges. All agencies that participated in the survey were either certified by Medicare and/or Medicaid or were licensed by a state to provide home health and/or hospice services and currently or recently served home health and/or hospice patients. Agencies that provided only homemaker services or housekeeping services, assistance with instrumental activities of daily living (IADLs), or durable medical equipment and supplies were excluded from the survey. The 2007 NHHCS included a supplemental survey of home health aides employed by home health and/or hospice agencies, called the National Home Health Aide Survey (NHHAS). The 2007 NHHCS data were collected through in-person interviews with agency directors and their designated staffs; no interviews were conducted directly with patients or their families and/or friends. Agency data collected, available in agency administrative records, included information on the year an agency was established, the types of services an agency provided, referral sources, specialty programs, and staffing characteristics. Data collected on home health patients and hospice discharges, available in medical records, included age, sex, race and ethnicity, services received, length of time since admission, diagnoses, medications taken, advance directives, and many other items.

The National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides, was designed to provide national estimates of home health aides employed by agencies that provide home health and/or hospice care. The NHHAS survey instrument included sections on recruitment, training, job history, family life, management and supervision, client relations, organizational commitment and job satisfaction, workplace environment, work-related injuries, and demographics.

In long-term care, frontline supervisors play a central role in direct care workers' (DCW) job quality and turnover and are critical to the implementation of management changes. To better understand supervisors' perceptions of management practices, the quality of supervision, and the effect on DCW turnover and job quality, the Office of the Assistant Secretary for Planning and Evaluation in the United States Department of Health and Human Services contracted with Pennsylvania State University to conduct this survey of supervisors participating in the Better Jobs, Better Care (BJBC) demonstration. Funded by the Robert Wood Johnson Foundation and The Atlantic Philanthropies, the BJBC demonstration -- which took place in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont -- tested innovative policy and practice models designed to improve the quality of DCW jobs in an effort to improve recruitment and retention of these workers and strengthen capacity to meet future demand for long-term care.

Frontline supervisors were interviewed from the four types of facilities and agencies that participated in the demonstration: skilled nursing facilities, assisted living facilities, home care agencies, and adult day service providers. The survey explored the supervisors' job responsibilities, formal training, job satisfaction, and thoughts about quitting. It investigated the culture of the organizations in which the supervisors worked, probed for problems with the supervisors' jobs, assessed how rewarding the supervisors felt their jobs were, inquired as to whether the supervisors felt respected by their clients, DCWs, and managers, gauged the supervisors' assessments of the overall competency level of the DCWs in their organizations, and explored the supervisors' beliefs about managerial support for the BJBC project, how well the BJBC programs were executed, and whether the overall impact of the project was positive.

In addition, the respondents were queried about management practices (e.g., rotation of assignments to different services or units, mechanisms to handle employee concerns, and approaches used to handle poor performance or negative behaviors among employees). They were also asked about DCW training, mentoring, and career ladder programs, DCW participation in patient/resident/client care plans, and communication among DCWs and between DCWs and their supervisors. Respondents were also asked what was the most important thing that their employer could do both to improve the jobs of DCWs and to improve their own ability to do their jobs as supervisors of DCWs. Additional information collected by the survey includes the supervisors' age, sex, race, Hispanic origin, educational attainment, nursing degree or license (LPN, RN, Diploma RN, BSN, MSN, or Advanced Practice Nurse), wages, and health insurance coverage.

This collection comprises three data files: (1) Supervisor Identification Instrument Data, (2) Supervisor Survey Data, and (3) Clinical Managers Who Are Also Supervisors Data. The first file contains information collected by the Supervisor Identification Instrument that was submitted to the clinical manager at each BJBC provider organization. This instrument instructed clinical managers to name all of the supervisors in their organization and to indicate which supervisory responsibilities each one performed. The second data file contains the responses to the Supervisor Survey questionnaire.The third data file contains the responses of clinical managers who also functioned as supervisors in their organization. These clinical managers responded to the same questions in the Supervisor Survey questionnaire, except for ten questions that were worded somewhat differently.