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The Quest for Caregivers: Helping Seniors Age with Dignity.

California State Dept. of Employment Development, Sacramento.2001-04-00

136p.

Publication and Product Orders, Employment DevelopmentDepartment, 7000 Franklin Blvd., Bldg.1100, Sacramento, CA95823. Tel: 916-262-2162; Web site:http://www.calmis.cahwnet.gov/htmlfile/pubs.htm. For fulltext: http://www.calmis.cahwnet.gov/specialreports/Caregiver-2001.pdf.Information Analyses (070)EDRS Price MF01/PC06 Plus Postage.

Adult Day Care; Caregiver Role; *Caregiver Training;Caregivers; Compensation (Remuneration); *Demand Occupations;Employment Projections; Frail Elderly; Health Personnel;Helping Relationship; Home Health Aides; Labor Demands; LaborForce Development; *Labor Needs; *Labor Turnover; Long TermCare; Nurses Aides; *Older Adults; Population Trends;Vocational Education*California

There is a potential crisis in caring for the elderly inCalifornia as the over-65 population is expected to double by 2020 andseveral demographic dynamics a lower growth rate in the population segment ofwomen aged 24-54 that traditionally care for seniors; increasingparticipation of women in the workforce who have traditionally been at-homecaregivers for seniors; and a robust economy offering many competing entry-level occupations at comparable or higher wages may contribute to a shortageof caregivers. Legislation passed in July 2000, the Caregivers TrainingInitiative, directed the.Employment Development Department to develop anunderstanding of the labor supply-demand principles affecting workers inentry-level direct care occupations in relationship to nineteen othercomparable occupations competing for the available labor force. Caregiveroccupations may be viewed as less desirable compared to competing occupationsfor the following reasons: (1) wages are often lower; (2) there is lessaccess to affordable benefits such as health insurance; (3) there is agreater chance for occupational injury or illness; (4) there are greatertraining and certification requirements; and (5) there is less opportunityfor advancement. The following suggestions are made to improve caregiverrecruitment and retention: conduct exit interviews and identify bestpractices; develop core competencies and career paths; and give financialincentives. (Contains 6 appendices, 21 exhibits, and 35 references.) (MO)

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-01EmpioymentDevelopmentDepartment

State of California

TheQuestfor

CaregiversHelping Seniors Age with Dignity

Employment Development DepartmentLabor Market Information Division

Information Services GroupOccupational Research Unit

April 2001

3

Table cyq Contents

List of Exhibits

Executive Summary

Introduction

Page

II

Background 1-1

Caregiver Occupations in Focus 2-1

How Did I End Up in This Job? The Job Selection 3-1

ProcessThe Competition 4-1

Skills Knowledge - Abilities 5-1

Training, Licensing and Certification 6-1

Wages Caregivers vs. the Competition 7-1

Benefits and Hours 8-1

Physical Requirements 9-1

Values: The Key to Job Satisfaction 10-1

Values: Relationships 11-1

Values: Achievement 12-1

Values: Recognition 13-1

Values: Advancement 14-1

Values: Working Conditions 15-1

Values: Support 16-1

Values: Independence 17-1

Interests: A Forecaster of Job Satisfaction 18-1

Industrial Injury and Workplace Violence 19-1

Stressors 20-1

Career Ladders for Caregivers 21-1

Recommendations for Recruitment and Retention 22-1

PPENDOCES

Bibliography

Table of Contents

4

us.R EmMAts

Number TftOeExhibit 1.1 Forecasted Population of Women and SeniorsExhibit 2.1 Distribution of Nurse Aides by IndustryExhibit 2.2 Difficulty in Finding Nurse Aide Applicants Who Meet Employers' Hiring StandardsExhibit 2.3 Distribution of Home Health Aides by IndustryExhibit 2.4 Difficulty in Finding Home Health Aide Applicants Who Meet Employers' Hiring StandardsExhibit 2.5 Difficulty in Finding Personal and Home Care Aides Who Meet Employers' Hiring

Standardsr Exhibit 3.1 Sample Career Choice Evaluation Sheet

Exhibit 4.1 Competing OccupationsExhibit 4.2 Brief Descriptions of Competing OccupationsExhibit 5.1 Skill Level Comparison of Caregiver and Competing Occupations for the 10 Most Important

Skills for Caregiver OccupationsExhibit 5.2 Skill Level Comparison of Caregiver and Competing Occupations for the 10 Most Important

Skills in Competing OccupationsExhibit 5.3 Comparison of Level of Knowledge Required by Caregiver and Competing Occupations for

the 10 Most Important Areas of Knowledge for Caregiver OccupationsExhibit 5.4 Comparison of Level of Knowledge Required by Caregiver and Competing Occupations for

the 10 Most Important Areas of Knowledge for Competing OccupationsExhibit 5.5 Comparison of the Ability Level in Caregiver and Competing Occupations for the 10 Most

Important Abilities for Caregiver OccupationsExhibit 5.6 Comparison of the Ability Level in Caregiver and Competing Occupations for the 10 Most

Important Abilities for Competing OccupationsExhibit 7.1 Average Hourly Wages Earned by Selected Caregivers in 1999Exhibit 7.2 Poverty Guidelines Compared to Caregiver Average EarningsExhibit 7.3 Competing Occupation Entry Wages Compared to Federal Poverty Guideline ($8.20/hr)Exhibit 7.4 Average Wages for Caregiver and Competing OccupationsExhibit 7.5 How Much Can Earnings Grow?Exhibit 9.1 Level of Physical AbilitiesExhibit 10.1 Values and Corresponding NeedsExhibit 10.2 Comparison of Mean Values for Caregivers and Competing OccupationsExhibit 11.1 Extent to Which Occupation Satisfies Relationships ValueExhibit 12.1 Extent to Which Occupation Offers Opportunities for AchievementExhibit 13.1 Extent to Which Occupation Offers Opportunities for RecognitionExhibit 14.1 Extent to Which Occupation Offers Opportunities for AdvancementExhibit 15.1 Extent to Which Occupation Offers Desirable Working ConditionsExhibit 16.1 Extent to Which Occupation Offers Supportive ManagementExhibit 17.1 Extent to Which Occupation Offers Opportunity for IndependenceExhibit 18.1 Holland Work Environment and Personality TypesExhibit 18.2 Holland Codes for Caregiver and Competing OccupationsExhibit 19.1 Nationwide Rates of Workplace Injury and IllnessExhibit 19.2 California Rates of Workplace Injury and IllnessExhibit 19.3 California Occupational Injury and Illness RatesExhibit 20.1 Comparison of Potentially Stressful Job Characteristics for Caregiver and Competing

OccupationsExhibit 20.2 1998 Number of Nonfatal Occupational Injuries and Illnesses Involving Days Away from

Work-National DataExhibit 21.1 Comparison of Knowledge Levels Required for Nursing and Caregiver OccupationsExhibit 21.2 Comparison of Ability Levels Required for Nursing and Caregiver OccupationsExhibit 21.3 Comparison of Skill Levels Required for Nursing and Caregiver OccupationsExhibit 21.4 Optional Career Paths by Education Level

List of Exhibits

EnecuUve Summary

California Trainhig initiative (CTI)California is facing a potential crisis in caring for the elderly as the over-65 population isexpected to nearly double by 2020. In July 2000, as part of the Governor's Aging withDignity Initiative, Governor Davis signed legislation establishing the Caregivers TrainingInitiative (CTI) to address the impending shortage of caregivers. The CTI focuses onthe recruitment, training, and retention of direct caregiver occupations. The Initiativefunds a series of regional partnerships to test service delivery methods. The Initiativeinstructs Employment Development Department (EDD) to study labor supply anddemand factors.

BackgroundSeveral demographic dynamics contribute to the potential shortage of caregivers:

O A lower growth rate in the population segment (women ages 24-54) that traditionallycares for seniors

O Increasing participation of women in the work force reduces the number of traditionalat-home caregivers for seniors and youth

O A robust economy offers many competing entry-level occupations at comparable orhigher wages

Apart from the issue of workforce availability to enter caregiver occupations, variousstudies cite annual turnover rates in caregiver occupations ranging from 42 to over 100percent.

Scope of ReportCaregiver and Competing Occupations The CTI legislation also directed theEmployment Deyelopment Department (EDD) to concentrate on developing anunderstanding of the labor supply-demand principles affecting workers in entry-leveldirect care occupations in relationship to other occupations competing for the availablelabor force. Three entry-level caregiver occupations are the focus of this report: NurseAides (including Certified Nurse Assistants), Home Health Aides, and Personal andHome Care Aides.

Entry-level caregiver occupations compete with other entry-level occupations forworkers in a tight labor market. Health care providers are on a quest for caregivers, andworkers entering the workforce are on a quest for a "good" job. "Good" jobs are definedas jobs that provide a living wage, benefits, and opportunity for advancement.

Executive Summary

Nineteen competing occupations were selected for comparison to entry-level caregiveroccupations based on the following criteria:

O Expected California job growth of at least 10,000 jobs between 1998 and 2008O Training requirements ranging from short-term on-the-job training to completion of

vocational training provided in post-secondary vocational schoolsO Employment which allows workers to provide service to others

Occupational AttributesValues and Interests - Job satisfaction is directly related to the degree that a person'svalues and corresponding needs are satisfied by his or her work environment. Jobsatisfaction leads to employee retention. The Relationships work value is one of sixwork values with twenty-one corresponding needs identified by the OccupationalInformation Network (0*NET), a comprehensive occupational database developed bythe Department of Labor (See Appendix D). Occupations that satisfy the Relationshipswork value allow employees to provide service to others and work with co-workers in afriendly non-competitive environment. Persons who are attracted to and would stay incaregiver jobs are persons with a high Relationships work value. Persons with a lowRelationships value are not well suited for caregiver occupations.

While a high Relationships work value might attract workers who possess that value tocaregiver occupations, the same value could create a values conflict if wages andbenefits would not allow them to provide sufficiently for their family, or staff-to-patientworkload might not allow them to provide the quality of care they think is needed. Suchvalue conflicts could cause workers to reluctantly leave caregiver occupations.

Along with values, interests contribute to work satisfaction. Interest patterns are quitesimilar for caregiver and competing occupations. The similarity of interest factors incaregiver and competing occupations offers both positive and negative implications forcaregiver employers. The positive note is that workers in those competing occupationscould also find a person-work environment fit for themselves in caregiver occupations,other factors being equal. On the negative side, the similarity in interest types makes iteasier for workers to leave caregiver jobs for the competing occupations and still remainin a work environment that fits their personality type.

Skills, Knowledge, and Abilities Comparing the skills, knowledge, and abilities (SKAs)needed to successfully learn and perform the tasks for caregivers in contrast to thoseneeded for competing occupations, several facts emerge:

The Quest for Caregivers

o There are more similarities than differences in SKAso One can generalize that those persons considering caregiver occupations could just

as successfully pursue the competing occupations based upon skills, knowledge,and abilities

o Caregivers require more knowledge acquired through a combination of educationand on-the-job training. Potential caregivers who like the idea of work where theynurture and contribute to the well being of other people may be intimidated by theclassroom training and testing involved for certification if they did not havesuccessful school experiences in the past

o Caregivers require significantly more static strength ability (See Exhibit D.4 inAppendix D)

o Caregivers require more knowledge of principles and processes for providingcustomer and personal services including needs assessment techniques, qualityservice standards, and alternative delivery systems

The static strength ability requirements for caregiver occupations should be animportant consideration in the hiring process to ensure that applicants not only have thestrength required, but are able to sustain the strength.over the workday. Some of thehigh turnover in caregiver occupations may be attributed to the high incidence ofworkplace injury and illness in the health services industry. Back injuries account foralmost half the injuries in nursing homes. Only truck drivers and laborers have higherinjury rates.

Wages, Benefits, and Hours - In California, entry-level earnings for nurse aides, homehealth, and personal and home care aides on average fall under the federal povertyguidelines. In fact, in many areas of California the average wage for experiencedcaregiver aides falls below this guideline for workers who have dependents. Thedifference between wages earned by caregivers and those offered for competing jobs inthe labor market is substantial in many cases. Fifty-seven percent of the competingoccupations earn more than caregivers at the entry level. Moreover, the opportunity toearn more each year on the job appears limited for caregivers. Seventy-four percent ofthe competing occupations are more likely to receive medical insurance benefits thancaregiver occupations.

Caregiver occupations exist in a 24/7 environment, meaning workers are likely to workweekends and nights. Many competing occupations also require evening or weekendshifts. While these hours may be unappealing to some workers, other people mayprefer such hours.

The earnings and benefit gap, paired with the higher responsibilities required forcaregivers, may be one reason for the high turnover rate among these workers.

Executive Summary

Advancement and Career Ladders Getting ahead is an important aspect of work. "Notgetting ahead" is an oft-given reason for job dissatisfaction and moving on to anotherjob or employer. On average, caregiver occupations offer less opportunity foradvancement than the competing occupations. Caregiver occupations are moredependent upon further education for advancement than many of the competingoccupations where job performance is a key element for advancement.

Programs exist in partnership with community colleges and the California StateUniversity system to create nursing career ladders:O Nursing Aide to Certified Nursing AssistantO Certified Nursing Assistant to Licensed Vocational NurseO Licensed Vocational Nurse to Registered Nurse

Participation in such career ladders requires an extraordinary degree of commitmentfrom the worker to attend training programs in off-hours when one already has aphysically and emotionally demanding job during work hours. Traditionally, educationprograms in nursing have required full-time student status, which can be a furtherbarrier to workers climbing a career ladder in nursing careers, and requiring an ongoingincome while attending extended advancement training.

ConclusionsCaregiver occupations may be viewed as less desirable compared to competingoccupations:o Caregiver wages are lower than many of the competing occupationso Caregivers have less access to affordable benefits such as health insuranceo Caregivers have a greater chance for occupational injury or illnesso Caregivers have greater training and certification requirements than competing

occupationso Caregivers have less opportunity for advancement

The high turnover level in caregiver occupations suggests that workers find somethingabout the job or working conditions which causes them to leave. It also suggests thatthe selection process fell short of making an appropriate fit between worker and job.

Occupational Supply Side StrategiesChanging demographics and economic conditions have curtailed the supply of workersavailable for low-wage occupations that offer little prospect for advancement. Given thesupply-demand labor market realities, health care providers could take some of thefollowing steps to more successfully recruit and retain workers in health careoccupations:

The Quest for Caregiversi iv

o Exit interviews Better information regarding the reasons caregivers quit their jobsis needed to determine patterns of turnover and dissatisfaction to help set prioritiesfor change. The health care industry should establish a standard format for exitinterviews and share such information through professional associations.

o Best practices The industry should identify those employers who have lowerturnover and fewer incidents of occupational injuries and illness. These employerscan be looked to for "best practices" in employee scheduling, hiring and selectionprocesses, employee training, and laborsaving techniques that prevent back injuries.

o Values-based marketing Caregiver employers and professional associationsneed to market caregiver occupations to appeal to the Relationships value usingtelevision and other media. They need to change the public's view of caregiveroccupations.

o ssessment - Use available assessment tools in the selection process to obtainappropriate person-job matches for caregiver occupations.

o Core competencies and career paths Develop career ladders and career pathsfor health care occupations using the National Skills Standard Board process tofacilitate portable competencies between health care occupations and reduceredundancy in curriculum content.

o Financial incentives Reward employees financially for staying and recruitingothers to the profession. Provide affordable health benefits and paid leave. Useprofit sharing or some form of employee ownership to retain workers.

o Workplace reengineering Investigate redesign of caregiver occupations andworkplace to include more of the motivating factors: achievement, recognition,responsibility, and advancement. Employers might want to reengineer theworkplace so frontline workers can participate in care giving decisions.

There is no one, or easy, answer to make caregiver occupations a "good" job in theeyes of job and career seekers. The most important part of the answer lies in targetingpeople who would see caregiver occupations as an opportunity to do good; i.e., personswith a high Relationships work value. Part of the solution is to improve the wages,benefits, and working conditions. Another facet of the solutions mix is collaborationbetween health care segments, employee organizations, and educators to establish skillstandards and career paths.

The Quest for Caregivers was written from the point of view of persons selecting a jobor career and the factors they might consider in making that choice (see Exhibit 3.1).For some seekers, caregiver occupations would not be a good match. For others, acaregiver occupation could add up to a rewarding career choice.

Executive Summary

' 1 0

IhtociLactrion

Legislation The 2000-01 Budget introduced the Governor's Aging with DignityInitiative. The overall legislative intent is to enhance thedevelopment of innovative community care options to enableseniors to live in their homes or with their families for as long aspossible rather than move into a nursing home.

As part of the Governor's Aging with Dignity Initiative, GovernorDavis signed AB 2876 on July 7, 2000.1 This legislation includesthe Caregiver Training Initiative that addresses issues surroundingthe impending shortage of caregivers:

O RecruitmentO TrainingO Retention

The intent of this legislation is to establish an advisory council toidentify strategies and develop recommendations to recruit, train,and retain direct caregivers such as certified nurse assistants,certified nurses, licensed vocational nurses, registered nurses, andto fund regional demonstration projects to address thesestrategies.

EDD The Caregiver Training Initiative designates the Employmentdesignated Development Department (EDD) as the administrative entity. As

the designated administrative entity, the Department willcollaborate with the Department of Social Services to:

O Lead a work group responsible for staff support to the advisorycommittee;

O Develop the criteria for regional collaborative programs, and thenumber of staff to be assigned to regions;

O Develop the selection process for funding regional collaborativeprograms (under the direction of California Health and HumanServices Agency);

O Select a program proposal from each region that best meets theestablished criteria;

O Distribute funds to local agencies to establish the regionalprograms;

O Evaluate or contract for the evaluation of the regionalcollaborative programs funded under the Caregiver TrainingInitiative.

Introduction

11

Labormarketsupplly anddemand

Report

The Department's role under the Caregiver Training Initiative is toimprove the understanding of the labor market supply and demandprinciples that affect workers in direct care occupations.Specifically, the legislation requires the Department to develop andanalyze information on the following factors:

1. Alternative occupations competing for available labor2. The effect of conditions in other occupations using similar skill

sets on the supply of labor in occupations related to health careproviders and caregivers

3. Occupational ladders for health care providers and caregivers4. The efforts by county welfare departments to increase interest

in the health care provider and caregiver industry5. Factors that draw individuals into or push them away from

entering the health care provider or caregiver industry6. Ways that nursing homes, long-term care facilities and in-home

care provider communities can improve the quality ofemployment of health care providers and caregivers

7. The treatment of staff in nursing homes and long-term carefacilities

8. Worker compeneation claims and claims of workplace violencedue to patients with Alzheimer's disease or dementia

9. Benefit packages10. On-the-job training for career advancement as a health care

provider or caregiver in nursing homes or long-term carefacilities or advancement in fields related to an occupation as ahealth care provider or caregiver

This preliminary report summarizes EDD's initial research andcomparative analysis of the caregiver occupations and theircompeting entry-level occupations to identify the issues affectingcaregiver recruitment, training, and retention.

1 Assembly Bill AB 2876, (Chapter 108, Statutes of 2000) Chapter 7, 11020 (a) through 11024 (c),Caregiver Training Initiative.


12

Background

ging The population of citizens over 65 years of age is expected to nearlypopulation double by the year 2020 as the "baby boom" generation approachescreates the golden years. The growing population of older people presentsdemand societal challenges to provide quality health and personal care for

this group.

Trends Historically, older family members were frequently cared for at home,affecting often by a relative. In recent years, more women are workingdemand outside the home and are unavailable to provide this service. Even

new mothers are returning to the labor force in record numbers.Recent Census Bureau data indicates,that "in 1998, 59 percent ofthe 3.7 million women with infants under the age of one year wereactive participants in the labor market. This number has risenconsiderably from the 31 percent labor force participation rate of1976.1 The increasing trend toward mothers entering or reenteringthe workforce further decreases the supply of individuals whotraditionally cared for the aging population.

Additionally, cultural changes and technological advances havecontributed to the increasing mobility of modern society, leading todramatic changes in the family unit during the last century. It can nolonger be assumed that younger family members will live nearby orbe available to care for aging family members. Expanded mobilityhas contributed to the geographic separation of family members,which creates additional demands for caregiver services.

Trends In the past, women 24 to 54 years of age typically cared for seniors.affecting However, the population of potential caregivers is not expected toworkforce increase as dramatically as the aging population.2 The growth ratesupply for women 24 to 54 years of age is slower than that of the baby

boom generation, and will not support the increased demand forcaregivers as shown in Exhibit 1.1. Further demographic data onmales and femalet may be found in Appendix A.

Background

EXHIBIT 1.1 Forecasted Population of Women and Seniors

900000080000007000000600000050000004000000300000020000001000000

0

Forecasted Population of Women and Seniors

Year 2000

OWomen Age 24 - 54

Year 2020

EAU Seniors 65 plus

Trends Employers currently experience difficulty in recruiting and retainingaffecting employees in caregiver positions. The situation is exacerbated by theworkforce fact that as the population ages, experienced employees currentlysupply working in caregiver occupations will begin to retire, further reducing(continued) the pool of qualified caregivers.

Another factor affecting workforce availability is an economy that is atits strongest in decades. The result is a very tight labor market with ahigh availability of entry-level occupations vying for the attention ofworkforce participants. Many of the competing occupations may offeradditional advantages over the caregiver occupations: higher wagesand benefits, less formal training requirements, and less physicaldemand than caregiver occupations.

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The Quest for Caregivers1-2 14

Summary To summarize, the challenge to develop a sufficient supply of well-trained caregivers is significantly affected by:

o A projected doubling of the population over 65 years of age bythe year 2020;

o A lower growth rate in the population segment that traditionallycares for seniors;

o Increasing numbers of mothers participating in the workforcefurther reducing the numbers of the traditional caregivers forseniors and youth;

O An increasing trend toward geographic separation of immediatefamily members;

O The retirement of aging, experienced caregivers who are nolonger available to provide continuing care;

o A robust economy offering many competing entry-leveloccupations at comparable or higher wages, with less physicaldemands, available to attract new entrants to the labor market.

1 Paraprofessional Healthcare Institute, A Preventable Labor Crisis Within Long-term Care, August,1999, Bronx, New York, p. 1.Retrieved from: http://www.directcarealliance.orb/sections/Dubs/Dreventable2.htm

2 "Record Share of New Mothers in Labor Force, Census Bureau Reports," United States Departmentof Commerce News Release, October 24, 2000.Retrieved from: httix//www.census.gov/Press-Release/www/

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1-3 15Background

Focus

Care Over CaccupsUons lin Focus

The Caregiver Training Initiative directed the EmploymentDevelopment Department to "Develop a strategy to improveunderstanding of the demand and supply of labor and the labormarket dynamics for low-skilled workers who choose occupationssuch as certified nurse assistants.°

The principle entry-level caregiver occupations facing criticalshortages and high turnover rates in California are Nursing Aides,Home Health Aides, and Personal and Home Care Aides. Togetherthey represent about 125,000 workers, and comprise the targetcaregiver occupations in this study.2

This section looks at each of the three occupations and describesworkforce distribution, turnover and separation rates, supply, jobgrowth, and common tasks performed on the job.

Workforce distribution lists industries where workers are typicallyemployed, such as hospitals, nursing care facilities, or residential carehomes. Included with each facility type is the percentage of allworkers within the selected occupational group who work in that kindof facility.

Turnover is defined as the annual number of workers needed by agiven establishment to replace those who have left. Data weredeveloped based on the assumption that historical trends willcontinUe into the future.

Separations are defined as an estimate of the number of peopleexpected to leave the occupation permanently during a given period,whether for another occupation, retirement, or personal reasons.Data were developed based on the assumption that historical trendswill continue into the future.

Caregiver Occupations in Focus

Murree aDdes and assMarTas(Includes Certified Nursing Assistants (CNAs) and Orderlies)

Nurse Aides work under the direction of nursing or medical staff to provide auxiliaryservices in the care of patients.

here dothey work?

Nurse Aides and Assistants are principally employed in fiveindustries: nursing and personal care facilities, hospitals, residentialcare facilities, personnel supply services (temporary agencies), andhome health care services.

EXHIBIT 2.1 Distribution of Nurse Aides by Industry

Personnel Supply Home Health CareServices Services

4% 3%Residential Care

Facilities11%

Hospitals27%

Nursing andPersonal Care

Facilities55%

Source: Employment Development Department, Labor Market Information Division; CaliforniaProjections of Employment 1998-2008

Job Growth The California Projections of Employment reports there were 88,500nurse aides working in 1998 and projects 19,400 new positions will becreated for the classification Nurse Aides, Orderlies and Attendantsbetween the years 1998 and 2008.3 This number, along with the13,700 separations estimated for that time period, brings the numberof estimated job openings to 33,100.

Whars the A definitive measure of the supply of nurse aides and assistants is notsupply? available; however, we do collect information that provides a collateral

measure of labor supply problems. Between 1997 and 1999, theCalifornia Cooperative Occupational Information System (CCOIS)conducted surveys in 34 California counties, asking 332 employers ofnurse aides to indicate the difficulty in finding applicants (trained oruntrained). Results appear in Exhibit 2.2 below.

The Quest for Caregivers2-2

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Nurse elides and assiistards (continued)

Separationandturnoverrates

EXHIBIT 2.2 Difficulty in Finding Nurse Aide Applicants Who Meet Employers'Hiring Standards

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

Difficulty of Finding QualifiedNurse Aide Applicants

0 Experienced 0 Inexperienced

Not Difficult A Little Difficult Somewhat Very DifficultDifficult

Source: Employment Development Department/Labor Market Information Division; CaliforniaCooperative Occupational Information System; 1997, 1998, 1999 data

The Labor Market Information Division projects a 16 percentseparation rate of nurse aides between 1998 and 2008, or 13,700workers. These figures estimate the number of workers who willleave the occupation permanently for other types of work orretirement and do not represent the thousands of nurse aides wholeave the job and return to the same type of work a few months later.

Turnover for this occupation is another picture altogether. The"Hidden Health Care Workforce"4 study published in 1999 by theCalifornia Twenty-First Century Workforce Project at University ofCalifornia, San Francisco, reports a turnover rate of over 100 percentannually for nurse aides. Presuming their estimate is accurate, thismeans every year the average California nursing home employerneeds to hire more nurse aides than the total number of nurse aidepositions within the firm.

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Caregiver Occupations in Focus2-3

18

Tasks Nursing Aides, Orderlies and Assistants perform the following taskson a daily basis:

Patient Care These duties include feeding patients, assisting withpersonal hygiene, measuring and recording food and liquid intake andoutput, measuring and recording vital signs, helping patients to walk,lifting or transporting ill or injured persons, and observing andunderstanding body response variations. CNAs can also administersome medications and use on-line medical record systems. ,

Non-patient Duties These include setting up and cleaning procedureequipment, processing patient records, and scheduling appointments.

The Quest for Caregivers2-4 1 9

[Him H Oth AdesCare for elderly, convalescent, or disabled person in the home of the patient. Performduties such as changing bed linen; preparing meals; assisting in and out of bed;bathing, dressing, and grooming; administering oral medications under doctors'orders or direction of nurse.

Where dothey work?

Job Growth

Home Health Aides are employed principally in the following fiveindustries: home health care services, residential care facilities,nursing and personal care facilities, hospitals, and individual andfamily services.

EXHIBIT 2.3 Distribution of Home Health Aides by Indust

Home HealthCare

Services36% 11

ResidentialCare22%

and Familylndiyidua4VNursing

andPersonal

FacilitiesCare

Services1

13%7%Hospitals

12%

Source: Employment Development Department, Labor Market Information Division; CaliforniaProjections of Employment 1998-2008

Home Health Aide is one of the fastest growing occupations inCalifornia, ranking 1 9th of all occupations. The California Projectionsof Employment estimates there were 23,300 home health workersemployed in 1998 and projects a total of 11,300 new positions will becreated between the years 1998 and 2008. This number, along withthe 4,000 separations estimated for that time period, represents a 48percent growth rate and brings the number of estimated job openingsto 15,300 for the ten-year period.

These numbers do not represent self-employed workers, which couldinclude as many as 40,000 additional workers. The Department ofHealth Services reported 62,767 certified home health aides on"active status" in California in November 2000.5


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Horns IleaDM Akkes (continued)


hat's thesupply ofhome healthaides?

Based upon national trends, the Labor Market Information Divisionprojects 35 percent of home health workers will separate from theirjobs for other types of work or retirement between 1998 and 2008.

Over the 1997-1999 period, 292 employers in 22 California countiesor large metropolitan areas were surveyed by the CCOIS and askedto gauge their difficulty in finding home health aides, trained oruntrained.

EXHIBIT 2.4 Difficulty in Finding Home Health Aide Applicants Who MeetEmployers' Hiring Standards

a)co

45%

0 40%0.

35%

se.30%

25%

UJ 20%

a)15%

co 1 0%

c25%

0_ .0%

Difficulty of Finding QualifiedHome Health Aides

Experienced 0 Inexperienced

Not Difficult A Little Difficult Somewhat Difficult Very Difficult

Souece: Employment Development Department/Labor Market Information Division; CaliforniaCooperative Occupational Information System; 1997, 1998, 1999 data

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Tasks Some of the important occupation-specific tasks Home Health Aidesmay perform includes changing bed linens, assisting patients into andout of bed, to the lavatory, and up and down stairs. They giveprescribed oral medication under written directions; purchase,prepare, and serve food for patient and other members of familyfollowing special prescribed diets. They massage the patient andapply preparations and treatment, such as liniment or alcohol rubsand heat-lamp stimulation. They maintain records of servicesperformed and of the apparent condition of patients. They entertainthe patient by reading or playing games. They may also obtainhousehold supplies and run errands.

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22


PetreonsH and Home Care ZAkdes(Alternate Titles: In-home-support services (IHSS) Workers, Companions)

Perform a variety of tasks at a place of residence, such as bathing, cooking, feeding,shopping, and keeping house.

here dothey work?

in-homesupportiveservices(H-iSS)

Over 90 percent of Personal and Home Care Aides work inside singlefamily dwellings. The remaining workers are found in residential careor adult day care facilities, employed by residential care facilities,home health care services, individual and family services, and nursingand personal care facilities.

Most personal and home care aides are hired through the In-HomeSupportive Services (IHSS) program, under the direction of theDepartment of Social Services, providing personal home careservices for eligible low-income seniors, the blind, and disabled toenable them to remain in their homes.

There are three modes of service delivery for IHSS services:O Homemakers are county employees who work for the blind or

disabled. There are a very small number of homemakers.O Individual Providers comprise the vast majority of IHSS

employees.O Contract Counties employ a third party contractor who assigns

providers to the recipients and produces provider payroll checks.There are approximately twelve contract counties.

Generally, the recipient of home services acts as the employermaking hiring and training decisions.

Legislation, AB 1682, passed on July 12, 1999 requires everycounty to establish an employer of record for IHSS employees byJanuary 1, 2003. The counties may establish either a public authorityor a nonprofit consortium to act as an employer of record. Theestablishment of an employer of record provides IHSS employeeswith a means to negotiate for wage and benefit increases. Currently,there are eight public authority counties.

Wages are paid from a combination of federal, state, and countyfunds. The most usual payment combination is from state and countyfunds. IHSS provider wage rates may vary from county to county.Contract counties and larger counties such as San Francisco and LosAngeles tend to pay a little more.

The Quest for Caregivers2-8 23 BESTCOPY AVAILABLE

Fcqrsonell end Forms Care /Midas (continued)(Alternate Titles: In-home-support services (IHSS) Workers, Companions)

Job Growth


What's thesupply forpersonaland homecare aides?

The California Projections of Employment estimates a total of 6,200new positions will be created for the classification Personal and HomeCare Aides between the years 1998 and 2008. This number, alongwith the 4,400 separations estimated for that time period, brings thenumber of estimated openings to 10,600. This figure clearlyunderestimates the numbers of these aides, due to the nature of theiremployment.

According to the California Department of Social Services, there areabout 230,000 in-home-supportive services (IHSS) workers employedin California residences and paid for from a number of governmentfunding sources.6 In addition to these workers are many uncountedaides who are self-employed and paid directly by the client or family.These workers are employed in the Private Household industry, whichis not tracked by the California Projections of Employment.

Based on national trends, the Labor Market Information Divisionprojects a 32 percent separation rate of Personal and Home CareAides between 1998 and 2008.

Over the 1997-1999 period, 54 employers in four California countiesor large metropolitan areas were surveyed by the CCOIS and askedto gauge their difficulty in finding inexperienced personal and homecare aides, trained or untrained. The results in Exhibit 2.5 show 77percent of all employers reported Some degree of difficulty in findingworkers for their vacancies, with 24 percent indicating no difficulty inrecruiting.

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2-9 2 4

Personel and Home Cue AOdes (continued)(Alternate Titles: In-home-support services (IHSS) Workers, Companions)

Tasks

EXHIBIT 2.5 Difficulty in Finding Personal and Home Care Aides Who MeetEmployers' Hiring Standards

50%

45%

ct. 40%

CC 35%

30%

-a. 25%

LU 20%

15%a)cr)

10%

5%

0%

Difficulty of Finding QualifiedPersonal and Home Care Aides

0 Experienced 0 Inexperienced

Not Difficult A Little Difficult Somewha Very DifficultDifficult

Source: Employment Development Department/Labor Market Information Division; CaliforniaCooperative Occupational Information System; 1997, 1998, 1999 data

Personal and home care aides advise and assist family members inplanning nutritious meals; purchasing and preparing foods, and usingcommodities from surplus food programs.

They regularly assist the client with dressing, undressing, and toiletactivities, and explain and demonstrate hygiene principles. Aidesregularly provide social stimulation to the client, playing games andconversing. They train family members to provide bedside care,evaluate the needs of the individual served, and plan for continuingservices. Aides prepare and maintain records of assistance given,and may obtain information for clients for personal and businesspurposes.


Assembly Bill 2876 Chapter 7, 11022c, 1-10.

2 Employment Development Department, Labor Market Information Division, California Projections ofEmployment 1998-2008.

3 Ibid.

4 The Hidden Health Care Workforce: Recognizing, Understanding and Improving the Allied and AuxiliaryWorkforce. Center for Health Professions, University of California, San Francisco, July 1999, p. 71.

5 California Department of Health Services, November 2000. Note: This figure may change substantiallydue to new regulations that include criminal background checks upon biennial renewal.

6 California Department of Social Services, November 2000.

Caregiver Occupations in Focus2-11

How 190d 0 End Up h Th0s Job? T Job Se0ect0on Process

Point of view Numerous articles and reports exist about the shortage ofcaregivers. Many of these are written from the point of view of healthcare administrators and policy planners facing mounting staffingcrises. Others are written from the point of view of families trying tofind appropriate care for their loved ones. Some studies are writtenfrom the perspective of employee representatives concerned withworking conditions for caregivers.

llow did 1end up inthis job?

This study examines caregiver occupations from another point ofviewthe job seeker and the employment and training staff assistingjob seekers. When an individual is entering the world of work, whatleads them to select, or not select, caregiver occupations?

"How did I end up in this job?" is a question everyone has askedthemselves at some time in their work life. If one asks that questionoften, the questioner is likely in an occupation that is not a goodmatch for their skills, knowledge, abilities, interests, or values. Asuitable person-job fit has not been made. How did they get there?

A fortunate few persons seem to be "called" to a vocation and knowfrom early years what kind of work they want to do. Others receivevocational guidance in school. Many others arrive at a time in theirlife when they must find employment and have no answer to theblank on the application form that asks "Type of work you areseeking." Their response often is anythingan answer that theyhope communicates their willingness and eagerness to work. Whatthat answer actually signals is that the person needs help: Help inknowing themselves; help in understanding the world of work; help inassessing their options; help in making an employment and trainingplan; and help in seeking a job that matches that plan. Relativelyfew people obtain that kind of help or go through the steps that leadto a career plan.

Happenstance frequently plays a role in finding employmentparticularly in low wage jobs. Most individuals possess a limitedview of the possible work opportunities available to them. Their viewof the world of work is formed from the jobs held by their family andfriends and what they might see portrayed on television which addsup to a fairly narrow picture. One's social circle greatly influencesthe job choices an individual makes.

How Did I End Up in This Job? The Job Selection Process3-1

2'1

Finding a job Both job seekers and employers use a variety of approaches to finda job or fill a vacancy. Job search methods can be categorized intotwo types of strategies: Informal and Formal.

InformalStudies of job search methods over the last 20 years report thatbetween 25 and 60 percent of hires come from informal job searchstrategies.1

Informal job search methods, often referred to as networking, involveinforming friends, relatives, acquaintances, and neighbors one isseeking employment and asking their advice. Getting jobs throughother people is the most successful method to find employment,especially in low wage jobs.

Employers prefer the informal job search for several reasons:O Cost is non-existent compared to the formalized search methods

of employment agencies and newspaper advertisingO It is easy to limit the size of the applicant poolO People refer those whom they judge would fit in the organization

and reflect well on themO Employee referrals effectively screen for the "soft skills" such as

work habits and ability to get along with coworkers, customers,and supervisors

O Turnover is lower for employees found through informalrecruitment means

What is missing in this informal social network of job seeking is anyassurance that the job seeker is pursing a job that will be a goodmatch for them. Their need to have a job may be met withoutdeveloping self-knowledge or applying any criteria as to the job'sappropriateness for their skills, knowledge, abilities, values, interests,or even financial needs.

FormalFormal job search methods include public and private employmentagencies, unions, school placement services, and advertisingthrough newspapers and other media such as the Internet or even a"Help Wanted" sign in the window.

The Quest for Caregivers 28

Finding a job Employers find both advantages and disadvantages to the formalized(continued) recruitment methods.

Advantages Disadvantageso Some agencies screen and 0 Agency fees

refer only qualified applicants 0 Advertising costso Generates a larger applicant o Unscreened applicants from

pool when needed some agencies and newspaperO May generate an excess of

applications that require costlyprocessing

Does the job Whichever job search method they use, most people take the first jobfit? they are offered.2 Job seekers may follow the crowd of their social

peers to a job that is not a good fit for them although they meet theminimum qualifications. Social networks may be ethnicallyhomogeneous which sometimes lead to ethnic groups clustering inoccupational niches.3 While this might make the job easier to obtainfor those with access to that social network, the very ease of accessmay divert job seekers from exploring a wider range of jobopportunities.

Do job seekers fare better in obtaining an appropriate job match forthemselves if they use an employment agency? Not necessarily.Agency personnel are often paid on commission based on placementsmade. Thus, it is in their financial interest to place as many people aspossible. They will assess the ability or potential of the person to do ajob adequately so they refer only qualified applicants to the employer.However, they probably are less concerned, if even aware, whetherthe applicant would be happy with the type of job. The job seeker whowalks into a private, for-profit agency and states anything as their jobobjective is putting their future in the hands of others who will directthem to the opportunity of the moment. Happenstance thendetermines whether a job is a satisfying match for their skills,knowledge, abilities, interests, and values.

A "good" Having achieved their goal of getting a job, job seekers begin tojob? realize all jobs are not created equal and determine that what they

really want is a "good" job. "Good," of course, lies in the eyes of thebeholder, but the qualities most persons desire in their employmentare found in what is known as the primary labor market. Primary labormarket is a term used by sociologists who divide the world of work intoprimary and secondary labor market segments.4

How bid I End Up in This Job? The Job Selection Process3-3

°4 9

A "good"job?(continued)

impilcationsforrecruitmentandretention

Characteristics of Primary Labor Market Jobs5o Reasonable job securityo On the-job-trainingo Opportunities for advancement

Equitable pay and benefitso Usually with large firmso Often unionized

Characteristics of Secondary Labor Market Jobso Low wageso Few or no benefitso Short term employmento Low skill requirementso Little training offeredo Not much opportunity for advancemento Usually with smaller firmso High turnover

Secondary labor market jobs are generally filled by youth, minorities,and other disadvantaged workers without the education or skills toaccess the primary labor market jobs. As workers grow both in jobskills and job search skills, they will seek the greener pastures oforganizations offering primary labor market jobs.

Finding those "good" jobs can be elusive. It is not as simple astargeting the large organizations. One outcome of recent trends toflexible and leaner operations is that more organizations maintain acore of well-paid workers and use temporary workers for peripheraltasks or contract out those tasks to other firms. Thus anorganization may be made up of both primary and secondary labormarket jobs.

Entry-level caregiver jobs are competing with other kinds of entry-level jobs. Exhibit 3.1 replicates a typical career exploration anddecision-making worksheet. Such evaluation tools are used incareer resource centers with youth and adults to compareinformation about career and job opportunities and make decisionsbased on a combination of objective and subjective information.How will caregiver occupations fare as job seekers assess the entryopportunities available to them in caregiver occupations ascompared to other entry-level job opportunities?


3 0

EXHIBIT 3.1 Sample Career Choice Evaluation SheetFactors in a Career Choice

Listed below are aspects of a career or job choice that can make thedifference between your satisfaction or dissatisfaction. Considereach factor in relation to your preferences and needs. Use careercenter staff and resources to help you find the information. Talk topeople in the field. Indicate with a + or sign whether an occupationsatisfies your preferences for each factor.Specific Work PerformedWhat tasks are performed in the job? Would I be primarily workingwith people, information, or things? Is that what I want to do? Arethese the kind of people I like to help or serve?Skills, Knowledge, and AbilitiesDo I possess the skills and abilities needed to enter the occupation?Do I have the potential to develop them?Do I enjoy using these skills?PreparationAm I willing and able to get the training required?Do I have the time and money needed for training?Are there differentways to enter the occupation?Physical CapabilityAm I physically able to do this kind of work?Work SettingWhere would I work? Is this a setting I would like?What are the condons (indoors/outdoors, nois etc?2ValuesIs this workcompatible with my values?Will this kind of work help me reach my long-range goals?InterestsWould I like this kind of work enough to make career?HoursWhat are the usual hours'? Full-time or part-time? Is shift work rewired?CompensationWhat salary could I expect at the entry level? What do experiencedworkers earn? Are there chances for overtime or bonuses?What kind of benefits could I expect in this field?Does the salary meet my needs?Licenses and CertificatesAre certificates or licenses required? Can I qualify for them?Employment OpportunityWhat are my chances for finding work in this field?Are there job openings now? In the future? Where are they?Will I be competitive?Opportunity for AdvancementWhat are my chances of moving up in the field?What is the typical way to advance?Am I willing and able to do what it takes to advance?

I 0

Results: Total the number of positive responses (+) for eachoccupation under consideration. Which occupation is the best matchfor you?Source: Employment Development Department, Labor Market Information Division

How Did I End Up in This Job? The Job Selection Process3-5

31. BESTCOPYAVAILABLE

1 Julia R. Hen ly, "Mismatch in the Low-Wage Labor Market: Job Search Perspective," in The Low-WageLabor Market: Challenges and Opportunities for Economic Self-Sufficiency, The Urban Institute,Washington, D.C., 1999.Retrieved from: http://aspe.hhs.gov/hsp/IwIm99/henly.htm

2 Robert Wegman et al., Work in the New Economy, JIST Works, Inc., Indianapolis, IN, 1989, p. 91.

3 Hen ly, p 4.

4 Ibid., p. 103.

5 Wegman, p. 103


le Comp® Mon

The Picture an inexperienced job seeker about to venture forth into thecaregiver world of work. Many occupational choices are possible for thechoice neophyte job seekereven those who possess only basic education

and training. Why would that job seeker choose a caregiveroccupation?

Availability: Caregiver occupations are widely available in allcommunities.

Preparation: Caregiver occupations require short-term training.On-the-job training often is available.

Work Values: Caregivers provide service to others. Work values areoverall qualities of work important to a person's satisfaction. Thework value, Relationships, is the highest value for caregiveroccupations. Occupations that satisfy the Relationships work valueallow employees to provide service to others and work with co-workers in a friendly non-competitive environment.

Often work values are not a conscious consideration in careerchoice. Consequently, employee dissatisfaction may result whenpersonal and work values are not in synch. Such mismatches anddissatisfaction can be reflected in lower employee retention rates.

Criteria for Potential candidates for caregiver occupations can consider a widecompeting range of occupations with similar training and wages as they makeoccupations their career choices. Competing occupations were selected for

comparison with caregiver occupations based on the followingcriteria:

O Expected California job growth of at least 10,000 jobs between1998 and 2008

O Training requirements ranging from short-term on-the-job trainingto completion of vocational training provided in post-secondaryvocational schools

O 0*NET Relationship value of 50 or above, on a scale of 100,indicating at least a moderate opportunity to provide services toothers and satisfy the Relationship value'

4-1

33

The Competition

Criteria forcompetingoccupations(continued)

Labor Market Information Division (LMID) staff identified 19occupations that meet these criteria. The occupations are listed inExhibit 4.1 along with three entry-level caregiver occupationshighlighted in bold. Persons seeking employment with little or notraining could reasonably expect to discover and consider any of theseoccupations during their career exploration or job search activities.

Note: One exception was made to the job growth criteriaEmergencyMedical Technicians and Paramedics. While the projected jobopenings are fewer than 10,000, it is possible the actual demand foremergency ambulance services will accelerate beyond projections asthe aging population swells.

EXHIBIT 4.1 - Competing Occupations

Occupation

25thPercentileIfflages2

Adjustment Clerks (Customer Service Representatives) $10.41Cashiers $6.27Child Care Workers $6.70Combined Food Preparation and Service Workers a$6.07Correctional Officers and Jailers $18.27Counter Clerks & Rental Clerks $6.33Dental Assistants $10.63Emergency Medical Technicians and Paramedics $8.24Fitness Trainers and Aerobics Instructors $10.15Food Preparation Workers $6.54General Office Clerks $8.64Home Health Aides $7.15Medical Assistants $10.00Nursing Aides, Orderlies, and Attendants $7.23Personal and Home Care Aides $6.61Receptionists and Information Clerks $8.05Retail Salespersons $6.50Security Guards $6.78Shipping, Receiving and Traffic Clerks $7.83Social and Human Service Assistants $9.40Teacher Assistants $7.94Waiters and Waitressesb a$6.04i*Growth Plus Openings Due to Separations**OJT = On-the-Job Training. Also see Appendix B for training definitions.Short OJT less than one month; Moderate OJT is one to 12 months; Long OJT is more than 12 monthsNinirnum wage raised to $6.25 an hour effective January 1, 2001. b Data on tips not provided:Source: Employment Development Department/Labor Market Information Division

Training**3

Short OJTShort OJTShort OJTShort OJTLong OJTShort OJT

Moderate OJTVocational Classes

Moderate OJTShort OJTShort OJTShort OJT

Moderate OJTShort OJTShort OJTShort OJTShort OJTShort OJTShort OJT

Moderate OJTShort OJTShort OJT

ProjectedNumberof Job

Openings*1998-20084

18,300217,500

17,200137,80022,20038,40020,300

7,80015,70099,700

191,30015,30044,00033,10010,60087,100

234,40089,60031,50015,60033,600

165,100


34BEST COPY AVA

EXHIBIT 4.2 Brief Descri tions of Corn etin Occu ations

Adjustment clerks(customer servicerepresentatives)

Cashiers

Child care workers

Combined foodpreparation andservice workers

Correctional officersand jailers

Counter and rentalclerks

Dental assistants

Emergency medicaltechnicians andparamedics

Fitness trainers andaerobics instructors

Food preparationworkers

General office clerks

Interact with customers to provide information in response to inquiries aboutproducts and services and to handle and resolve complaints. Excludeindividuals whose duties are primarily sales or repair.

Receive and disburse money in establishments other than financial institutions.Usually involves use of electronic scanners, cash registers, or relatedequipment. Often involved in processing credit or debit card transactions andvalidating checks.

Attend to children at schools, businesses, and institutions. Perform variety oftasks such as dressing, feeding, bathing, and overseeing play. Does notinclude preschool teachers or teacher aides.

Perform duties that combine both food preparation and food service.

Guard inmates in penal or rehabilitative institution in accordance withestablished regulations and procedures. Includes deputy sheriffs who spendthe majority of their time guarding prisoners in county correctional institutions.

Receive orders for repairs, rentals, and services. May describe availableoptions, compute cost, and accept payment.

Assist dentist at chair, set up patient and equipment, keep records, andperform related duties as required.

Administer first aid treatment and transport sick or injured persons to medicalfacility, working as a member of an emergency medical team.

Instruct or coach groups or individuals in exercise activities and thefundamentals of sports. Demonstrate techniques and methods of participation.Observe participants and inform them of corrective measures necessary toimprove their skills.

Perform a variety of food preparation duties other than cooking, such aspreparing cold foods and shellfish, slicing meat, and brewing coffee or tea.

Varied clerical duties assigned in accordance with the office procedures ofindividual establishments that may include a combination of bookkeeping,typing, stenography, office machine operation, and filing.

4-3

35

The Competition

EXHIBIT 4.2 Brief Descriptions of Competing Occupations (continued)

Medical assistants

Receptionists andinformation clerks

Retail salespersons

Security guards

Shipping, receiving,and traffic clerks

Social and humanservice assistants

Perform administrative and certain clinical duties under the direction ofphysician. Administrative duties may include scheduling appointments,maintaining medical records, billing, and coding for insurance purposes.Clinical duties may include taking and recording vital signs and medicalhistories, preparing patients for examination, drawing blood, andadministering medications as directed by physician.

Answer inquiries and obtain information for general public (e.g., customers,visitors, and other interested parties). Provide information regarding activitiesconducted at establishment; location of departments, offices, and employeeswithin organization; or services in a hotel.

Sell to the public any of a wide variety of merchandise, such as furniture,motor vehicles, appliances, or apparel. Include workers who sell lessexpensive merchandise where a knowledge of the item sold is not a primaryrequirement. Does not include cashiers.

Stand guard at entrance gate or walk about premises of business orindustrial establishment to prevent theft, illegal entry, fire, vandalism,violence, or infractions of rules. Direct patrons or employees and answerquestions relative to services of establishment. Control traffic. May use apatrol car.

Verify and keep records on incoming and outgoing shipments. Prepare itemsfor shipment. Duties include assembling, addressing, stamping, and shippingmerchandise or material; receiving, unpacking, verifying, and recordingincoming merchandise or material; and arranging for the transportation ofproducts.

Assist professionals from a wide variety of fields, such as psychology,rehabilitation, or social work, to provide client services, as well as support forfamilies. May assist clients in identifying available benefits and social andcommunity services and help clients obtain them. May assist social workerswith developing, organizing, and conducting programs to prevent andresolve problems relevant to substance abuse, human relationships,rehabilitation, or adult daycare.

Teacher assistants Arrange work materials, supervise students at play, and operate audio-visualequipment under guidance of a teacher.

Waiters andwaitresses

Take food orders and serve food and beverages to patrons in diningestablishments.


1 Department of Labor, 0*NET (Occupational Information Network), 1998. 0*NET contains over 450standardized descriptors of skills, abilities, interests, values, knowledge, and work content.

2 Employment Development Department, Labor Market Information Division, OES Employment andWages by Occupations 1999.Retrieved from: http://www.calmis.ca.gov/file/occup$/oes$.htm

3 Employment Development Department, Labor Market Information Division, Employment Projections byOccupation.Retrieved from: http://www.calmis.ca.gov/htmlffle/subiectioccproj.htm

4 Ibid.

The Competition4-5 37

SKAs

SM011s Kno Madge - Abilnes

Skills, knowledge, and abilities (SKAs as personnel analysts oftenrefer to them) are the building blocks of occupations and theirassociated tasks. Any given job has requirements for the type andlevel of skills, knowledge, and abilities needed to satisfactorilyperform the job. Personnel recruiters seek a good match betweenthe skills, knowledge, and abilities stipulated by the job and the SKAsfound in job applicants.

Likewise, each applicant for a job has a distinctive combination ofskills, knowledge, and abilities to offer employers. These SKAs areacquired through previous work and life experiences as well astraining and education. Skills are portable and go with workers asthey change jobs or careers.

Skills that are common to many occupations are known as cross-functional or transferable skills. Communication skills, for example,are important to many different kinds of jobs:

Skills Employers identify the SKAs required for a job through job analysisanaDysis that specifies the tasks to be performed and the knowledge, skills,

abilities, and other personal characteristics necessary to do the work.Job analysis assesses the relative frequency and importance of thetasks, skills, and abilities. Job analysis is the means of linking thecontent of the job with the content of training and assessment.2

Individuals assess their skills when entering the workforce orchanging jobs to determine the job opportunities that would bestmatch their present SKAs and/or what kind of SKAs they need toacquire for the workplace. For some individuals this analysis may beas casual as comparing themselves to requirements posted in wantads. Other individuals may participate in a formal analysis of theirSKAs through testing and evaluation in a career resource orassessment center. Many self-help books, such as Richard Bolles'What Color Is Your Parachute,3 help individuals identify their skills.Such skills self-assessment tools enable individuals to makeoccupational choices based upon more understanding of themselvesin relation to workplace needs.

Employers and job seekers are both searching for the best matchthat they can get between the worker's SKAs and the job'srequirements.

5-1 38Skills-Knowledge-Abilities

Ten mostimportantcaregiverskills

Ten mostimportantskils forcompetingoccupations

Exhibit 5.1 shows the ten most important skills for caregiveroccupations and compares the level of skills needed for caregivers tothose required by competing occupations. Caregiver and competingoccupations are quite close in skill levels required. Caregiverrequirements are slightly higher for Service Orientation and SocialPerceptiveness. Skill definitions and standard scale with benchmarklabels may be found in Appendix D.

EXHIBIT 5.1 - Skill Level Comparison of Caregiver and Competing Occupationsfor the 10 Most Important Skills for Caregiver Occupations

10 Most Important Skills for Caregivers

Active Listening

Coordination

Information Gathering

Judgment & Decision Making

Monitoring

Problem Identification

Service Orientation

Social Perceptiveness

Speaking

Writing

10

-r-

20 30 40 50 60 70 80 90 100Skill Level

Standard Scale 0-100

O Mean Skill Level for Caregiver Occupationso Mean Skill Level for Competing Occupations

Source: Trefoil, Occupational Viewer 2000 with 0*NET in it

Caregiver and competing occupations share eight of the ten mostimportant skills. The difference is in four skills: judgment & decisionmaking and monitoring make the caregiver top ten, but mathematicsand reading comprehension replace them in the competingoccupations' top ten. Exhibit 5.2 lists the ten most important skills forthe competing occupations and the level of skill required for bothcompeting occupations and caregiver occupations. The requiredlevel for caregivers again somewhat exceeds those required of thecompeting occupations.

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EXHIBIT 5.2 - Skill Level Comparison of Caregiver and Competing Occupationsfor the 10 Most lm ortant Skills in Corn etin Occu ations

10 Most Important Skills for Competing Occupations

Active Listening

Coordination


Mathematics


Reading Comprehension

Service Orientation


Speaking

Writing

0 10 20 30 40 50 60 70 80 90 100

Skill LevelStandard Scale 0-100

O Mean Level of Skill for Caregiver OccupationsO Mean Level of Skill for Competing Occupations


Caregivers and workers in the competing occupations havecomparable skills. The skill levels demanded by these occupationsare moderate. Based upon skill level requirements alone, jobseekers could easily choose from among any of the caregiver andcompeting occupations.

Knowledge The Occupational Information Network (0*NET) defines knowledge"as a collection of discrete but related and original facts, information,and principles about a certain domain."4 Knowledge is acquired in avariety of ways: study, observation, investigation, and experienceboth work and avocational. Some knowledges are more generalthan others in that they are essential to successful performance indiverse kinds of jobs, while other knowledges are occupation-specific.

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5-3

4 0

Skills-Knowledge-Abilities

Knowledge(continued)

Caregiver and competing occupations share six common generalknowledges out of their ten most important areas of knowledge:

o Clericalo Customer and Personal Serviceo English Languageo Mathematicso Psychologyo Public Safety and Security

Exhibits 5.3 and 5.4 show the ten most important areas of knowledgethat caregiver and competing occupations use and compare the levelof knowledge required. The most important caregiver knowledgescontain four occupation-specific knowledges: biology, chemistry,medicine and dentistry, and therapy and counseling. The mostimportant knowledges listed for competing occupations containsknowledges of general application only.

EXHIBIT 5.3 Comparison of Level of Knowledge Required by Caregiver andCompeting Occupations for the 10 Most Important Areas of Knowledge forCaregiver Occupations

10 Most Important Areas of Knowledge for Caregivers

Biology

Chemistry

Clerical

Customer and Personal Service

English Language

Mathematics

Medicine and Dentistry

Psychology

Public Safety and Security

Therapy and Counseling

0 10 20 30 40 50 60 70 80 90 100

0 Caregiver Occupations Mean0 Competing Occupations Mean

Level of KnowledgeScale 0-100



5-4 4 1 BESTCOPYAVA1LABLE

EXHIBIT 5.4 Comparison of Level of Knowledge Required by Caregiver andCompeting Occupations for the 10 Most Important Areas of Knowledge forCompeting Occupations

10 Most Important Areas of Knowledge for CompetingOccupations

Clerical

Communications and Media

Computers and Electronics


Education and Training

English Language

Mathematics

Psychology


Telecommunications

1

I

II

1

1

1

1

I I

1

1I

It

I I

II

1

tI

0 10 20 30 40 50 60 70 80 90 100

'Level of KnowledgeStandard Scale 0-100

0 Mean Level for Caregiver Occupations0 Mean Level for Competing Occupations

Source: Trefoil Occupational Viewer 2000 with 0*NET in it

Much of the occupation-specific knowledge for caregivers would beacquired in classrooms or on-the-job training. Customer andPersonal Service knowledge often is derived from an individual'ssocialization experiences in growing up as much as from classroomtraining. Knowledge definitions, standard scale, and benchmarklabels may be found in Appendix D.

Abilities Abilities are fairly constant traits that determine an individual'spotential for performing a range of assorted tasks. Possession ofunderlying abilities determines the degree to which one can learnnew skills and tasks. For example, to develop the skill of piloting anairplane, one must have the underlying abilities of spatial orientationand multi-limb doordination.5

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5-5 4 2

AboOlties 0*NET classifies abilities into four types:6(continued) o Cognitive abilities

o Psychomotor abilitieso Physical abilitiesO Sensory abilities

The distribution of the ten most important abilities amongst the abilitycategories is similar for caregiver and competing occupations. Thesimilar distribution of abilities important to caregiver and competingoccupations between the ability types means the emphasis oncognitive, psychomotor, physical, or sensory abilities would not differnoticeably from one occupation to the next.

Ability levels required for caregiver and competing occupations arefairly close with one exception: static strength. Caregiveroccupations require significantly more ability in static strength thanthe competing occupations.

EXHIBIT 5.5 Comparison of the Ability Level in Caregiver and CompetingOccupations for the 10 Most Important Abilities for Caregiver Occu ations

10 Most Important Abilities for Caregivers

Information Ordering

Manual Dexterity

Near Vision

Oral Comprehension

Oral Expression

Problem Sensitivity

Speech Clarity

Static Strength

Written Comprehension

Written Expression1- -t t0 10 20 30 40 50 60 70 80 90 100

0 Mean Level for Caregivers

0 Mean Level for Competing Occupations

Ability LevelStandard Scale of 0-100



5-6 4 3 BESTCOPYAVAILABLE

Abilities Six abilities are common to both caregiver and competing(continued) occupations' lists of the ten most important abilities: Manual

dexterity, oral comprehension, oral expression, speech clarity, staticstrength, and written expression. All abilities are in the moderaterange on the standard scale. Ability definitions, standard scale, andbenchmark labels may be found in Appendix D.

EXHIBIT 5.6 Comparison of the Ability Level in Caregiver and CompetingOccupations for the 10 Most Important Abilities for Com eting_pations

10 Most Important Abilities for Competing Occupations

Arm-Hand Steadiness

Manual Dexterity

Memorization

Number Facility

A" Oral Comprehension

Oral Expression

Speech Clarity

Speech Recognition

Static StrengthI

Written ExpressionI

0 10 20 30 40 50 60 70 80 90 100

Ability LevelStandard Scale 0-100

0 Mean Level of Ability for Caregiver OccupationsO Mean Level of Ability for Competing Occupations


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'4 4

impiicationsforrecruitmentandretention

Looking at the SKAs needed to successfully learn and perform thetasks for caregiver and competing occupations, several facts standout:O There are more similarities than differences in SKAsO Caregivers require more knowledge acquired through a

combination of education and on-the-job trainingo Caregivers require significantly more static strength abilityo Caregivers require more knowledge about handling customers

Recruitment efforts need to both attract qualified applicants andcatch the attention of applicants who will stay. To accomplish this,recruiters need to address:

Public Contact Experience Applicants with previous public contactexperience, paid or volunteer, will have a better understanding ofwhat serving people is like. Applicants who accept caregiverpositions without prior customer or personal service experience havelittle idea of the stresses of that kind of work, whether they have thepersonal qualities to handle it, or if they would get satisfaction fromthe work.

Static Strength Realistic assessment of applicants compared to thestrength requirements of caregiver jobsboth level of strength andfrequency of needing to useshould be part of applicantassessment and selection process. Inappropriate matches will resultin worker injury, lost productivity, higher insurance rate, and higherturnover. All of these are costly outcomes for employers of aninappropriate match between worker and job.

In Search of Skills Standards for 2000 & Beyond, Employment Development Department, Labor MarketInformation Division, February 1996.

2 Ibid.

3 Richard N. Bolles, What Color Is Your Parachute?, Ten Speed Press, Berkeley, CA, 2000.

4 Edwin A. Fleishman et al, "Knowledges" in Norman J. Peterson et al Volume I: Report, Development ofPrototype Occupational Information Network (0*NET) Content Model, Utah Department of EmploymentSecurity, 1995, p. 4-1.

5 Fleishman, op.cit., p. 10-2.

6 Fleishman, op.cit., p. 10-8.


Traininglevels

Trainingrequirementsfor caregiveroccupations

Tnning, Lncenshg & cerrtificenon

The caregiver occupations face the difficult challenge of competingwith numerous entry-level occupations with similar or higher wagesthat do not require classroom training or certification prior to entryinto employment. In contrast, the caregiver occupations requireclassroom training, supervised clinical training and certification orlicensure from the California Department of Health Services.

The training, licensing and certification requirements for entry-leveloccupations competing with the caregiver occupations varysignificantly.

The competing occupations were compared against the Bureau ofLabor Statistics (BLS) training levels, a classification system thatprovides a national measurement of how much training orexperience an occupation requires for most workers to becomeproficient. BLS has identified 11 training levels ranging from short-term on the job training (level 11), to first profes-sional degree(level 1), for a physician. See Appendix B for more details on eachof the training levels.

While the BLS training level is useful as a general indicator, it doesnot address the state of California's specific licensing or certificationrequirements for certain occupations.

Caregiver occupations have more pre-employment requirementsthan competing entry level occupations.

In Home Health Supportive Services (IHSS) According to theDepartment of Social Services, IHSS workers must meet thefollowing qualifications:

o Be at least 18 years of age, or obtain a work permit if under 18.o Fingerprint criminal background check is not required though

some counties request a background check.o Formal training is not required; however, some counties offer

voluntary basic caregiver training. The patient or the patient'sfamily trains the IHSS caregiver. As the employer, the patient isresponsible for hiring, training, supervising, and firing decisions.

Personal and Home Care Aides Training requirements vary fromstate to state. In some states, including California, no formaltraining is required.

Training, Licensing & Certification

6-1 4 6

Trainingrequirementsfor caregiveroccupations(continued)

Home Health Aides Certification by the Department of HealthServices requires:

0

0

Applicant must be at least 16 years of ageHealth screening and TB testCompletion of 120 hours of home health aide training in aprogram approved by Department of Health ServicesCriminal background checkA passing score on a final exam administered by the trainingprogram'

Nursing Aides, Orderlies and Attendants Certification by theDepartment of Health Services requires:

O Applicant must be at least 16 years of ageO Health screening and TB testO Completion of a minimum of 150 hours of nurse assistant

training in a program approved by the Department of HealthServices

O Applicants must successfully pass a nurse assistant certificationand competency exam after completing a state-approvedprogram

O Criminal background check2

Training No prerequisite training requirementsrequirementsfor competMg Eleven of the nineteen competing occupations (58 percent) do notoccupations require a license, certificate or classroom training:

O Adjustment Clerks 0

(Customer Service 0

Representatives) 0

O CashiersO Combined Food Preparation 0

and Service Workers 0

O Counter Clerks & RentalClerks 0

O Fitness Trainers & AerobicsInstructors

Food Preparation WorkersGeneral Office ClerksReceptionists & InformationClerksRetail SalespersonsShipping, Receiving, & TrafficClerksWaiters and Waitresses


Training Fingerprinting and on-the-iob training requiredrequirementsfor competing The following competing occupations require fingerprinting and on-occupations the-job training:(continued)

implicationsforrecruitmentand retention

O Correctional Officers & JailersO Social & Human Service AssistantsO Teacher Assistants

License, certificate or classroom training required

The following competing occupations require a California statelicense, certificate or classroom training:

O Child Care WorkersO Dental AssistantsO Emergency Medical

Technicians and Paramedics

o Security GuardsO Medical Assistants

Potential caregivers may like the idea of work where they nurtureand contribute to the well being of other people but may beintimidated by the classroom training and testing involved forcertification if they were not good students in school. They maythink, "Why experience all that anxiety when there are other jobsthat pay just as much or better without going to school?"

1 California Trade and Commerce Agency and Employment Development Department, California'sProfessional & Business License Handbook, August 1999, p. 161.

2 Ibid., p. 163.

Training, Licensing & Certification

4 8

Wage data

Wages - CareOvers vs..R Compethllon

Wages for entry caregiver occupations vary depending ongeographic location, health care setting, and level of experience.Wage data below represent 1999 employer wage reports collectedby the California Occupational Employment Statistics (OES) Surveyunder the direction of the U.S. Department of Labor. Information forin-home supportive services (IHSS) workers was supplied by theCalifornia Department of Social Services.

Nurse aide The beginning average wage for nurse aides in California is $7.23wages, per hour. Average hourly earnings for all experience levels of theseincluding workers is $8.78. High wages (75th percentile) reported for thecertified occupation averaged $9.95 per hour. Several counties are listednursing along with the statewide data in the table below to illustrateassistants variances that occur as population density and economics change.

Data suggest that wages paid by long-term care facilities are muchlower for nurse aides than those paid by hospitals in California. A1996 Office of Statewide Health Planning (OSHPD) study showednurse aides in skilled nursing facilities earn 67 percent of what theircounterparts make in hospitals.1

Home health Home health aides earn, on average, $9.73 per hour in California.aide wages Wage ranges from entry to high earnings are broader for these

workers than either nurse aides or personal and home care aides.The average entry wage in California for home health aides isreported at $7.15 per hour, with the statewide average for highearners (75th percentile) at $11.29 per hour. Large metropolitanareas such as San Francisco and Sacramento report average highearnings of $15.13 and $13.09, respectively; however, in rural areassuch as Shasta County high earnings are significantly lower at $8.11per hour. Of note is the Los Angeles metropolitan area, which showshigh earnings average of $9.32, significantly lower than the statewideaverage.

Wages Caregivers vs. the Competition

Personal Average wages for personal and home care aides range from $6.61and home per hour for new workers to $9.29 at the high-end earnings level.care aides, However, wages for the 230,000-plus in-home support servicesincluding (IHSS) workers are not included in this survey. Their wages varyHISS according to geographic location and type of provider. Those paidworkers directly by individuals generally earn minimum wage ($6.25 per hour

as of Jan. 1, 2001), but some earn as much as $7.25 per hour. IHSSworkers paid by public authorities earn from minimum wage to $9.70per hour. Third party contractors pay IHSS workers between $5.89and $9.70 per hour.2

EXHIBIT 7.1 Average Hourly Wages Earned by Selected Caregivers in 1999

Caregiver job titleand geographic area 25th Percentile

Averagewage, all

levelsTop

75th percentile

Nurse aides, Statewide $7.23 $ 8.78 $ 9.95San Francisco Area $9.10 $10.43 $12.65Los Angeles Area $6.95 $ 8.21 $ 9.66Sacramento Area $7.54 $ 8.99 $10.03Fresno and Madera Cos. $6.76 $ 7.50 $ 8.39Riverside/San Bern. County $6.81 $ 7.99 $ 9.00Redding Area (Shasta Co.) $6.84 $ 7.61 $ 8.58

Home health aides, Statewide $7.15 $ 9.73 $11.29San Francisco Area $9.24 $12.07 $15.13Los Angeles Area $7.37 $ 9.32 $10.80Sacramento Area $7.40 $10.27 $13.09Fresno and Madera Cos. $6.24 $ 8.00 $ 8.76Riverside/San Bern. County $6.45 $ 8.30 $ 9.73Redding Area (Shasta Co.) $7.08 $ 7.85 $ 8.16

Personal & home care aides, Statewide3 $6.61 $8.23 $ 9.29San Francisco Area $6.77 $8.34 $ 9.75Los Angeles Area $6.80 $8.81 $10.95Sacramento Area $6.79 $8.16 $ 8.75Fresno and Madera Cos. $6.81 $7.80 $ 8.35Riverside/San Bern. County $6.53 $7.63 $ 8.44Redding Area (Shasta Co.) $6.42 $7.96 $ 9.10

Source: California Employment Development Department/Labor Market Information Division, Occupational Employment Statistics(OES) Survey, 1999


5 0

Federalpovertyguidelines,caregiveroccupations,and thecompetition

Lower livingincome level

The 2000 federal poverty guidelines issued by the U.S. Departmentof Health and Human Services are used to determine whether anindividual's or family's income would make them eligible for subsidypayments. These guidelines determine a family's eligibility forassistance such as food stamps, Head Start childcare assistance,and the National School Lunch Program.

While it is commonly accepted that the cost of living in the state ofCalifornia is higher than most other states, the federal povertyguidelines in 2000 are as follows:

Size of Family Unit Federal Poverty Guideline1 $ 8,3502 $11,2503 $14,1504 $17,050

In California, entry-level earnings for nurse aides, home health andpersonal and home care aides on average fall under this federalpoverty level. In fact, in many areas of California the average wagefor experienced caregiver aides falls below this guideline for workerswho have dependents.

A 2000 study by the Institute of Health and Policy Studies estimatesthat 9 percent of California workers live in a household whose totalannual income is less than 125% of the federal poverty level.4

The Lower Living Standard Income Level (LLSIL) is determined bythe U.S. Department of Labor and establishes five Local WorkforceInvestment Areas in the state. Income criteria vary for each area.

70% Lower Living Standard Income Level Applicants must earnless than 70 percent of the LLSIL to qualify for economicallydisadvantaged status and receive certain services under theWorkforce Investment Act (WIA) Title I programs. Income for a four-person family in California ranges from $9.58 per hour in countiessuch as Humboldt, Imperial, and Mendocino, to $10.42 per hour forhigher-cost areas such as San Francisco, Marin, and Alamedacounties. Under these guidelines, nurse aides and personal homecare aides who earn average wages and who are sole supporters ofa four-person family all would qualify for economically disadvantagedstatus. Home health aide average earnings come in just above thislevel at $9.73 per hour.

Wages Caregivers vs. the Competition7-3

51

Lower living 100% Lower Living Standard Income Level The 100 percent LLSILincome ievei is the level the U.S. Department of Labor considers the minimum(continued) earning level for self-sufficiency. The 100 percent LLSIL for a family

of four in California ranges from $13.68 per hour (Humboldt, Imperial,and Mendocino counties) to $14.89 per hour (San Francisco, Marin,and Alameda counties).

EXHIBIT 7.2 Poverty Guidelines Compared to Caregiver Average Earnings

$15.00$14.50$14.00$13.50$13.00$12.50$12.00$11.50

$11.00$10.50$10.00

$9.50$9.00$8.50$8.00$7.50$7.00$6.50$6.00

Caregiver Earnings vs. Poverty Standardsfor Family of Four in California

01:10131:11 100% Lower Living Standard Income Level $14.18*ODEICI 70% Lower Living Standard Income Level $9.33*

Federal Poverty Guidelines - $8.20*Average California Hourly Wage for Occupation

slas_s_p_o_p_pooriociaocl00000000poricioorioaciociocionnaciogsociao

10 00000000 cl000000popoopoocloci000cioo

$9.73 $8.78 $8.23

Home Health Aides Nursing Aides, Orderlies, Personal & Home Ca e& Attendants Aides

*For comparison purposes, annual wages in the Federal Poverty Guidelines and the Lower LivingStandard Income Level were converted to hourly wages. The five Local Workforce InvestmentArea incomes were averaged to determine a statewide income. See the Workforce InvestmentAct Directive5 for geographic-specific income information.

Sources: California Employment Development Department, Labor Market InformationDivision, Occupational Employment Statistics (OES) Survey, 1999; U.S. Department ofHealth and Human Services federal poverty guidelines; and U.S. Department of LaborLower Living Standard Income Level 2000

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52

EXHIBIT 7.3 Competin Occu ation Ent Wa es Corn ared to Federal Povert Guideline $8.20/hr.

Entry workers who earn below federalpoverty guideline

65 Entry workers who earn above federalpoverty guideline

o

o

o

o

.0

0

o

0

o

o

o

0

o

Waiters & waitressesCombined food preparation & service workers

CashiersCounter clerks & rental clerksRetail salespersonsFood preparation workersPersonal & home care aidesChild care workersSecurity guardsHome health aidesNursing aides, orderlies & attendantsShipping, receiving & traffic clerks

Teacher assistantsReceptionists & information clerks

0

0

0

0

o

0

Emergency medical technicians & paramedicsGeneral office clerksSocial and human service assistantsMedical assistantsFitness trainers and aerobics instructorsAdjustment clerks (Cust. service rep.)

Dental assistants

Correctional officers & jailers

Source: U.S. Department of Health and Human Services, Feb. 2000

What thecompetition and their competing occupations are illustrated in Exhibit 7.4.earns: More

Wage comparisons between the selected caregiver occupations

Data show that salaries for occupations competing for the entrylabor pool vary, in some cases dramatically. Included arestatewide average hourly salaries, average entry wage, andaverage high earnings (75th percentile) paid to workers inCalifornia.

The data show that, compared with large growth occupations thatrequire similar lengths of training, entry caregivers can expect toearn less than most. Wages for the three caregiver aideoccupations fall into the 35-45th percentile of the group.

Wages Caregivers vs. the Competition

EXHIBIT 7.4 - Average Wages for Caregiver and Competing Occupations

25th Average 75thCaregivers Versus the Competition In California Percentile Wage Percentile

Correctional officers and jailers $18.27 $21.06 $24.75Dental assistants $10.63 $13.40 $15.91Adjustment clerks (Customer service representatives) $10.41 $14.20 $17.59Fitness trainers and aerobics instructors $10.15 $17.73 $24.08Medical assistants $10.00 $12.73 $15.11Social and human service assistants $ 9.40 $12.64 $14.94General office clerks $ 8.64 $11.31 $13.40Emergency medical technicians & paramedics $ 8.24 $12.99 $16.28Receptionists and information clerk $ 8.05 $10.43 $12.06Teacher assistants $ 7.94 $ 9.85 $11.39Shipping, receiving, and traffic clerks $ 7.83 $10.72 $12.78NURSING AIDES, ORDERLIES, & ATTENDANTS $ 7.23 $ 8.78 $ 9.95HOME HEALTH AIDES $ 7.15 $ 9.73 $11.29Security guards $ 6.78 $ 8.68 $ 9.40Child care workers $ 6.70 $ 8.38 $ 9.53PERSONAL & HOME CARE AIDES $ 6.61 $ 8.23 $ 9.29Food preparation workers $ 6.54 $ 7.90 $ 8.79Retail salespersons $ 6.50 $ 9.69 $10.47Counter and rental clerks $ 6.33 $ 8.58 $ 9.62Cashiers $ 6.27 $ 8.76 $ 9.50Combined food preparation and service workers $ 6.07 $ 7.20 $ 7.68Waiters and waitresses $ 6.04 $ 6.90 $ 6.82

Source: California Employment Development Department/Labor Market Information Division, OccupationalEmployment Statistics (OES) Survey, 1999

Chance toearn morewithexperience?Not for manycaregivers

How much opportunity is there for entry caregivers to earn more asthey remain on the job? Not much, it turns out.

Looking at competing occupations, fitness trainers and emergencymedical technicians and paramedics enjoy the broadest rangebetween entry and high earnings. Fitness trainers earn an average$13.93 more per hour from the time they start work to high endearnings, and EMTs and paramedics enjoy an average $8.04 moreper hour with experience and seniority.

By comparison, nurse aides and personal and home care aides canexpect to earn $2.61 and $2.68 more per hour, respectively, overtime within their occupation. This does not include IHSS workers inCalifornia who generally earn minimum wage.'

Home health aides can expect to earn an average $4.85 more perhour between entry and high end wages while on the job.


EXHIBIT 7.5 How Much Can Earnings Grow?

Occupations Ranked by Wage Rangethe Difference Between Entry and High End Wages

Fitness trainers & aerobics instructors

Emergency medical technicians & paramedics

Adjustment clerks (Customer service representatives)

Correctional officers and jailers

Social & human service assistants

Dental assistants

Medical assistants

Shipping, receiving, & traffic clerks

General office clerks

HOME HEALTH AIDES

Receptionists & information clerks

Retail salespersons I

Teacher assistants

Counter & rental clerks

Cashiers I

Child care workers I

NURSING AIDES, ORDERLIES, & ATTENDANTS

PERSONAL & HOME CARE AIDES

Security guards

Food preparation workers

Combined food preparation & service workers

Waitersand waitresses I

$0 $5 $10 $15

Hourly Pay

$20 $25 $30

0 High End Earnings

0 Entry Wage

Source: California Employment Development Department/Labor Market Information Division, OccupationalEmployment Statistics (OES) Survey, 1999

implicationsforrecruitmentandretention

The difference between wages earned by caregiver aides and thoseoffered for competing jobs in the labor market is substantial in manycases. Moreover, the opportunities to earn more each year forcaregivers who stay on the job appears limited.

This gap, paired with the higher responsibilities required forcaregivers, may be one reason for the high turnover rate amongthese workers, and leads one to speculate that longstandingcaregivers stay for reasons other than earnings.

BEST COPY AVAILABLE

Wages Caregivers vs. the Competition7-7

55

1

The Hidden Health Care Workforce: Recognizing, Understanding and Improving the Allied and AuxiliaryWorkforce, The Center for Health Professions, University of California, San Francisco. July, 1999; p. 86.

2 California Department of Social Services, 1999 data.

3 Does not include In-Home Supportive Services (IHSS) workers.

4 California Work and Health Survey, Institute of Health and Policy Studies, University of Californiaat SanFrancisco; 2000.Retrieved from: http://medicine.ucsf.edu/programs/cwhs/2000/tocday1.html

5Employment Development Department, Workforce Investment Division, Workforce Investment ActDirective No. WIAD99-1, June 26, 2000.

6Based on 25th Quartile average statewide wage as reported in the California Employment DevelopmentDepartment/Labor Market Information Division, Occupational Employment Statistics (OES) Survey,1999.Retrieved from: http://medicine.ucsf.edu/programs/cwhs/1999/davone/report.html

7 U.S. Department of Health and Human Services, March 2000.


Bens Ms and Kours

Caregiver Attractive benefit packages can serve to offset low wages or lack ofbenefits advancement opportunities. The availability of benefit packages for

caregivers varies widely. There is a great difference in pay level andbenefits between hospitals and private skilled nursing facilities.Government sponsored and large privately run hospitals are the mostlikely employers to offer benefits.

While full-time caregivers are more likely to receive benefits than part-time caregivers, studies indicate that on a nationwide basis caregiveremployers, particularly long-term care facilities and home healthagencies, very often do not offer medical benefits.

When medical plans are available, caregivers frequently cannot affordto pay the costly premiums. A 1996 survey of 324 long-term carefacilities in California showed that, on average, CNAs are required topay 40.8 percent of the premium for medical coverage for themselvesand their family.1 The average CNA wage at that time was $6.92 anhour, or approximately $1200 a month gross, for a full-time employee.Employee monthly contributions for medical insurance ranged from$60 to $69 a month for themselves and as high as $327 a month tocover a family.2

Faced with this added monthly deduction to an already relatively lowpaycheck, many CNAs are unable to participate. Additionally, most ofthe surveyed employers indicated a 30-hour per week minimumworkweek for an employee to be eligible for benefits.

Employer Each year the EDD's Labor Market Information Division (LMID), insurveys cooperation with local partners, administers confidential employer

surveys to gather occupational data and publish annual occupationaloutlook reports.3 These surveys detailed in Appendix C suggest thaton the average 65% of all competing occupations offer medicalinsurance compared to:

O 44% of Personal and Home Care AidesO 54% of Home Health AidesO 77% of Nurse Aides and Orderlies

On the average 57% of all the competing occupations offer sick leavebenefits compared to:

O 40% of Personal and Home Care AidesO 46% of Home Health AidesO 69% of Nurse Aides and Orderlies

8-1

57

Benefits and Hours

Employersurveys(continued)

The data suggests that nursing aides and orderlies are more likely toreceive benefit packages than Home Health Aides or Personal andHome Care Aides. However, the figures in Appendix C may appearhigher than actual practice because hospitals and governmentfacilities with larger human resource departments may have beenmore likely to respond to the employer surveys than smaller facilities.

Comparison Many of the competing occupations receive benefit packagesincluding medical insurance More frequently than the entry-levelCaregiver occupations.4

A higher percentage of employers for the following competingoccupations offer health insurance benefits than employers forPersonal and Home Care Aides, and Home Health Aides:

HISSIn-homesupportiveservices

0 Correctional Officers & Jailers 0 Retail Salespersons0 Dental Assistants 0 Cashiers0 Emergency Medical 0 Teacher Assistants

Technician 0 Child Care Workers0 Social & Human Service 0 Receptionists & Information

Assistants Clerks0 General Office Clerks 0 Shipping, Receiving, & Traffic0 Adjustment Clerks (Customer Clerks

service representatives) 0 Combined Food Preparation0 Medical Assistants and Service Workers

Generally, individual Home Health Aides employed through the IHSSprogram throughout the state earn minimum wage and do not receivebenefits.

By statute, (Welfare and Institution code section 12302.2) the IHSSprogram pays for workers compensation, state disability insurance(SDI), social security (FICA), and unemployment insurance. Countiesusing public authority and contract service providers may offermedical insurance.

The following IHSS providers may elect to participate in StateDisability Insurance (SDI), a program funded by employee paidpremiums:

O Parents caring for a childO Spouse caring for another spouseO Non relatives (if their earnings are a minimum of $750 per

quarter)


DHSSOn-homesupportiveservices(continued)

Hours

Full-time/part-time

Work days:MondaythroughFriday/weekends

Shift

Flextime

Additionally, qualifying individual providers may contribute to socialsecurity (FICA):o A child over 21 years of age caring for a parento Any non relative

Occupational work hours may serve to attract or repel potential jobapplicants as individual employment needs vary greatly. Forinstance, students, parents with young children, or family caregiversmay prefer to work part-time, while those who are "head ofhousehold" may need to work full time to support their families. Workhours that may be highly prized by one individual may not be practicalfor the lifestyle of another.

The majority of occupations that compete with caregiver occupationsoffer opportunities for both full-time and part-time employment hours.For example, salespersons, cashiers, receptionists and teacher's aidepositions all offer both full-time and part-time hours to accommodateemployee preference and business needs.

Caregiver occupations offer work shifts Monday through Friday andmay require working weekends and holidays, as many patientsrequire 24-hour care. Some of the competing occupations alsorequire weekend and holiday shifts: cashiers, correctional officers,waiter/waitresses, and retail salespersons to mention a few.Weekend work is common for some occupations and may appeal tocollege students or individuals with dependents, to allow time forschool attendance or child care/adult care during the weekday.Therefore, weekend and holiday work shifts may be consideredadvantageous depending upon personal need.

Caregiver occupations offer a variety of shifts: days, evenings, andgraveyard shifts are all available since many patients require aroundthe clock care. Although graveyard shifts have a limited appeal, thecaregiver occupations offer shift flexibility which may attract studentsor parents pursuing shifts to work around the demands of theirpersonal lives.

Flextime scheduling generally entails working nine or ten hour days toobtain one day off every week or every other week. Normally, onlylarge organizations offer flextime arrangements. Very little data isavailable on flextime opportunities for either the caregiver orcompeting occupations.

8-359

Benefits and Hours

implicatiorusforrecruitmentandretention

Affordable medical coverage is an important incentive to attract andretain workers. However, some individuals may not be concernedabout the lack of affordable medical benefits:o Persons covered by their spouses' health planso Retirees with benefits looking for a second careerO Full-time students who have a school health plan

Targeted marketing could turn the realities of shift and weekendwork from a liability in the eyes of many to an asset. Somesegments of the population might prefer working swing or graveyardshifts and/or weekend shifts:O Studentso Two-parent families committed to raising their children with one

parent always at home with the childrenO People who need to support themselves but also want their days

free for other activities important to them

1 California Assoc. of Homes and Services for the Aging and the California Assoc. of Health Facilities,1996, quoted by The Center for the Health Professions, "The Hidden Health Care Workforce," UCSF,San Francisco, July 1999, P. 70.

2 The Center for the Health Professions, op cit, p. 126-127.

3 Employment Development Department/Labor Market Information Division, California CooperativeOccupational Information System.

4 Ibid.


60

P lyscM Requrzemen2s

Physical Physical demands differ extensively from occupation to occupation.requirements While some occupations are sedentary, others are physically

demanding, requiring twisting, bending and heavy lifting. What oneindividual may consider as light physical activity may be highlyexerting or injurious to another. It is important for job seekers toconsider their physical abilities and limitations as well as their skillsand personal interests when exploring potential occupations in orderto achieve a satisfying job match.

The Occupational Information Network (0*NET) provides thedetails, definitions, degree of importance, and level of abilityrequired for physical abilities.' Appendix D contains detailedcomparisons of the level of physical abilities important to caregiverand competing occupations.

Trunk 0*NET defines trunk strength as the ability to use the abdominalstrength and lower back muscles to support part of the body continuously

over time without fatiguing. For the caregiver occupations, trunkstrength is most important to nursing aides, orderlies andattendants. This physical ability is also important to the followingcompeting occupations: fitness trainers and aerobic instructors; foodpreparation workers; guards and watch guards; medical assistants;shipping, receiving, and traffic clerks; and waiters and waitresses.

Extent Extent flexibility is the ability to bend, stretch, twist, or reach out withfiexibiiity the body, arms, or legs. Extent flexibility is an important physical

trait for nursing aides, orderlies, and attendants. Of the competingoccupations, extent flexibility is also important to athletic trainers,guards and watch guards, medical assistants, waiters andwaitresses.

Static Static strength is defined as the ability to exert maximum musclestrength force to lift, push, pull, or carry objects. This attribute is extremely

important for nursing aides, orderlies, and attendants. They requirea higher level of static strength than any other competing orcaregiver occupations.

Physical Requirements9-1 61

Stamina

Explosivestrength

Comparison


Stamina is the ability to exert one's self physically over long periodsof time without getting winded or out of breath. Stamina issomewhat important to home health aides and nursing aides,orderlies, and attendants. In comparison, stamina is important tothe following competing occupations: fitness trainers and aerobicinstructors, correctional officers and jailers, guards and watchguards, and waiters and waitresses.

Explosive strength is the ability to use short bursts of muscle forceto propel oneself (as in jumping or sprinting), or to throw an object.Explosive strength is of very little importance to the caregiveroccupations. However, explosive strength is important to several ofthe competing occupations: correctional officers and jailers andguards and watch guards.

EXHIBIT 9.1 Level of Physical Abilities

Extent Value Scale 1 to 100

4°. a)

Caregiver Occupationsth

:Ix

Lu LT_

ce

co e7)

a

Ca

(7) 151oE).

w

Nursing Aides, Orderlies, & Attendants 45 48 79 21 21

Personal & Home Care Aides 20 20 31 9 3Home Health Aides 29 23 51 23 9

Mean for Caregiver Occupations 31 30 54 18 11Mean for Competing Occupations 35 34 35 22 20

Source: Department of Labor, Occupational Information Network (0*NET)

The strength requirements for caregiver occupations should be animportant consideration in the hiring process to ensure theapplicants not only have the strength required, but are able tosustain the strength over the workday.

Employee training in proper lifting techniques as well as use ofassistive devices could help retain employees by preventinginjuries.

1 Department of Labor, 0*NET (Occupational Information Network), 1998. 0*NET contains over 450standardized descriptors of skills, abilities, interests, values, knowledge, and work content.


ork values

Vadues: The Key to Job SelstecUon

Job satisfaction is directly related to the degree to which a person'svalues and corresponding needs are satisfied by his or her workenvironment.

People repeatedly accept job offers with little or no consideration asto whether the job satisfies any of their needs beyond wages andbenefits. Many people are neither consciously aware of their needsnor realize that occupational choice could offer a means to fulfillsome of those needs. Individuals may by chance land in anoccupation that satisfies them or they may never find satisfaction intheir job choices.

ssesshig Individual values are formed when young and alter over time invalues . response to changing life experiences. Individuals vary significantly

in the importance to them of these needs and values.

Each need and value is on a continuum that could be charted withthese indicators of a value's importance to an individual:

O "not very important"O "on the fence about"O "give lip service to"o "take action accordingly"

An abundance of work values assessment tools and exercises existto make individuals mindful of their own values and the role valuesplay in making a satisfying occupational choice. Some of these toolsare administered and interpreted by a counselor; others are self-administered. Despite the availability of assessment tools, valuesare an often disregarded aspect of making a career or job choice.

Satisfiers Elimination of dissatisfying characteristics from a job would notand automatically make the job satisfying according to the Motivation-dissatisfiers hygiene Theory developed by Frederick Herzberg.' Herzberg's

theory is based on the idea that the opposite of dissatisfaction is notsatisfaction. His theory has been a strong influence on job designsince the late 1950s.

VALUES: The Key to Job Satisfaction10_1 6 3

Satisfiersanddissatisfiers(continued)

Needs andvalues

Herzberg's theory espouses two types of work values: (1) Jobcontext (hygiene factors) cause or prevent dissatisfaction by theirabsence or sufficiency; and (2) motivating factors associated with jobcontent increase job satisfaction. Examples of both factors are listedbelow:

Job Context Motivation Factorso Supervision 0 Achievemento Company policy 0 Recognitiono Salary 0 Responsibilityo

o

Working ConditionsSecurity

0 Advancement

Until recent years, even those job seekers savvy about their ownvalues were largely left to their own devices in determining whichoccupations offered the best possibilities for satisfying those values.Work values and occupational research existed but was not easilyaccessed.

Computer databases make it possible to link work values with otheroccupational information. 0*NET2 as well as commercialassessment products now deliver work values information to theusers' fingertips.

Six values and their twenty-one corresponding needs are describedin detail in Exhibit 10.1. Each occupation in 0*NET was assessedby occupational analysts using the following scale measuring theextent to which the value or need is characteristic of the occupation:

100

0

Extremely Characteristic

Characteristic

Not Characteristic


EXHIBIT 10.1 Values and Corres ondin Needs

Standardized Work VaiuesRELATIONSHIPSOccupations that satisfy this work value allowemployees to provide service to others and workwith co-workers in a friendly non-competitiveenvironment.

SUPPORTOccupations that satisfy this work value offersupportive management that stands behindemployees.

WORKING CONDITIONSOccupations that satisfy this work value offer jobsecurity and good working conditions.

ACHIEVEMENTOccupations that satisfy this work value areresults oriented and allow employees to use theirstrongest abilities, giving them a feeling ofaccomplishment.RECOGNITIONOccupations that satisfy this work value offeradvancement, potential for leadership, and areoften considered prestigious.

INDEPENDENCEOccupations that satisfy this work value allowemployees to work on their own and makedecisions.

Corresponding Needso Social Service Workers on this job have

work where they do things for other peopleo Moral Values Workers on this job are never

pressured to do things that go against theirsense of right and wrong

o Co-workers Workers on this job have co-workers who are easy to get along with

O Supervision, Human Relations Workers onthis job have supervisors who back up theirworkers with management

O Company Policies and Practices Workers onthis job are treated fairly by the company

o Supervision, Technical Workers on this jobhave supervisors who train their workers well

o Security Workers on this job have steadyemployment

o Activity Workers on this job are busy all thetime

o Variety Workers on this job have somethingdifferent to do every day

o Independence Workers on this job do theirwork alone

o Working Conditions Workers on this jobhave good working conditions

o Compensation Workers on this job are paidwell in comparison with other workers

o Achievement Workers on this job get afeeling of accomplishment

o Ability Utilization Workers on this job makeuse of their individual abilities

o Social Status Workers on this job are lookedup to by others in their company and theircommunity

o Advancement Workers on this job haveopportunities for advancement

o Authority Workers on this job give directionsand instructions to others

o Recognition Workers on this job receive

o

recognition for the work they_ do .

Autonomy Workers on this job plan theirwork with little supervision

o Creativity Workers on this job try out theirown ideas

o Responsibility Workers on this job makedecisions on their own

VALUES: The Key to Job Satisfaction10-3

Satisfaction EXHIBIT 10.2 Comparison of Mean Values for Caregivers and CompetingOccupations

Mean of AllValues

Recognition

Support

Relationship

Independence

Achievement

WorkingConditions

0 10 20 30 40 50 60 70 80 90 100

Extent Value Satisified by OccupationStandard Scale 0-100

O Mean of Value for Caregiver Occupations

12 Mean of Value for Competing Occupations


"Can't get no satisfaction" by the Rolling Stones could be a themesong for both the caregiver and competing occupations as the Meanof All Values for both groups of occupations register below the 50point mark on the 100 point scale in Exhibit 10.2. The Relationshipswork value has the highest potential for realization in both thecaregiver and competing occupations. Detailed value and needsscales can be found in Appendix D. Sections 11 through 17 examineeach value as it plays out in caregiver and competing occupations.

Frank J. Landy and Don A. Trumbo, Psychology of Work Behavior, The Dorsey Press, Homewood, IL,1976, p. 301-303, 330-331.

2 Department of Labor, 0*NET (Occupational Information Network), 1999.Retrieved from: http://online.onetcenter.orq

3 Ibid.


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Relationships

Correspondingneeds

Satisfying theRelationshipvalue incaregiveroccupations

Comparison

VALUES: ReMonshlips

Occupations that satisfy the Relationships value allow employees toprovide service to others and work with co-workers in a friendly non-competitive environment.

Three corresponding needs feed into the Relationships value:o Social Service Workers do things for other people.o Moral Values Workers are never pressured to do things that go

against their sense of right and wrong.O Co-workers Workers have co-workers who are easy to get

along with.

Caregiver occupations appear ideal for satisfying all three needsthat make up the Relationships value. Caregivers help people aspart of a team effort to deliver health care services.

Potential values conflict

Individuals with a high Relationships value could experience valuesconflict in caregiver occupations under several circumstances:

O The comparatively low wages of caregiver occupations couldconflict with workers' needs to provide for their families. Thosewith high Relationships values could be drawn to caregiveroccupations, but a sense of duty to their family's welfare couldprevail over the lure of caregiver occupations.

o In some caregiver situations, workers might feel that conditionssuch as staff-to-patient ratios prevent them from delivering thequality of care their moral values dictate as necessary. In suchcircumstances, workers might seek other types of employmentor other employers to relieve their frustration at not being able toprovide quality care.

EXHIBIT 11.1 Extent to Which Occupation Satisfies Relationships Value

Caregiver Occupations

Nursing Aides, Orderlies, & AttendantsPersonal & Home Care AidesHome Health Aides

Mean for Competing Occupations

Extent ValueScale 1 to 100

756461

61

Source: Trefoil, Occupational Viewer 2000 with O'NET in it

11-1 67VALUES: Relationships

Comparison(continued)

Implicationsforrecruitmentand retention

Among the competing occupations, only emergency medicaltechnicians offers more opportunity for satisfying the Relationshipsvalue than nursing aides, orderlies, and attendants.

Seven of the competing occupations, however, come as close orcloser to satisfying the Relationships value than do home healthaides and personal and home care aides:

o Fitness Trainers and 66 0 Medical Assistants 69Aerobic Instructors 0 Teacher Aides & Clerical 67

o Child Care Workers 70 Assistantso Dental Assistants 67 0 Waiters & Waitresses 68o Human Service Workers 61

The Relationships value is at the heart of caregiver occupations andsearch for that value among applicants ought to be central to theassessment and hiring process for caregiver occupations.Recruitment and hiring processes that identify related applicantvalues will result in hiring caregivers that stay with the job longerbecause they are more apt to find it satisfying.

If worker retention is an objective, value assessment becomes thestart of selecting and referring applicants with affinity for the workthose applicants most likely to stay with the job. Employers coulduse values in their recruitment strategy in two ways:

o Develop recruiting promotional materials that feature theRelationships value in word and picture.

o Cultivate referral sources that use values assessment as part oftheir process. Let sources know that the caregiver positions offerthose with a high Relationships value opportunity to fulfill thatneed.


chievement

VALUES: AcNevement

Occupations that satisfy the Achievement value are resultsoriented and allow employees to use their strongest abilities,giving them a feeling of accomplishment.

Corresponding The Achievement work value includes two needs:needs 0 Achievement Workers get a feeling of accomplishment.

0 Ability Utilization Workers make use of their individual abilities.

Satisfying thechievement

value incaregiveroccupations

Achievement is relative to individual ability, circumstances, andvalues. Just getting the job is the first achievement. From therethe achievements grow as one masters the skills and tasks.

Caregiver occupations offer the setting to experience dailyachievements for the person who has high relationships values.The degree to which the Achievement value can be met incaregiver occupations depends on two factors:

Person-Job Fit Is there a good match between the individual'sabilities, values, and the caregiver job? Over-qualified individualsmay feel frustrated about not being able to use their skills. Under-qualified staff will be struggling to meet the status quo.

Staff to Patient Ratio The more patients a staff member has toserve, the more likely it is that simply getting through the day is anachievement. This is not the same kind of satisfying achievementas having encouraged a patient to eat more than they usually door coaxing a smile out of a homesick patient.

Potential Time could again create a values conflict if patient-staff ratios dovalues conflict not allow caregivers enough time with patients to do their job in

such a manner that they can experience achievement.

12-16D

VALUES: Achievement

1

Comparison EXHIBIT 12.1 Extent to Which Occupation Offers Opportunities for Achievement

Opportunity for AchievementOccupations Are Arranged in Order of MeanEntry Level Salary From Lowest to Highest

Combined Food Preparation & Service Workers

Cashiers

Counter Clerks & Rental Clerks

PERSONAL AND HOME CARE AIDES

Retail Salespersons

Food Preparation Workers

Child Care Workers

Security Guards

Waiters & Waitresses

HOME HEALTH AIDES

NURSING AIDES, ORDERLIES & ATTENDANTS

Shipping, Receiving & Traffic Clerks

Teacher Assistants

Receptionists & Information Clerks

Emergency Medical Technicians & Paramedics

General Office Clerks

Social & Human Service Assistants

Medical Assistants

Fitness Trainers & Aerobics Instructors

Adjustment Clerks (Customer Service Reps.)

Dental Assistants

Correctional Officers & Jailers

d '

0 10 20 30 40 50 60 70 80 90 100

Extent Scale 0-100


The Quest for Caregivers12-2 70 BESTCOPYAVAILABLE

Comparison(continued)

Implications forrecruitment andretention

Fitness trainers and emergency medical technicians offer higherlevels of opportunity to experience Achievement, but most of thecompeting occupations are in the same range as the caregivers.The achievement in these occupations may be to leave them forsomething better.

Achievement is a powerful motivator, and caregiver employersneed to look at ways to build more opportunities for achievementinto the jobs. Recruiting individuals with high values forrelationship and Achievement could relate the achievementopportunities to patient progress activities as well as careerladders.

12-3

71

VALUES: Achievement

Recognition

Correspondingneeds

Satisfying theRecognitionvalue incaregiveroccupations

Comparison

VAWIES: RecognKlion

Occupations that satisfy the Recognition work value offeradvancement, potential for leadership, and are often consideredprestigious.

Four needs make up the Recognition work value:O Social Status Workers are looked up to by others in their

company and their community.O Advancement Workers have opportunities for advancement.O Authority Workers give directions and instructions to others.O Recognition Workers receive recognition for the work they do.

Caregiver Occupations would seem to offer the daily opportunity forthe simple "thank you" kind of recognition for the services providedto patients and their families by caregivers. Other than that,caregiver occupations offer little satisfaction of Recognition needs,and workers who crave recognition will need to look elsewhere.Caregivers who have a high need for recognition may feelfrustrated.

Values Conflict Even the simple thank you may not be forthcomingif patients have had to wait for services. Providing services in atimely manner may be beyond the control of the caregiver inunderstaffed circumstances.

EXHIBIT 13.1 Extent to Which Occupation Offers Opportunities for RecognitionExtent Value

Caregiver Occupations Scale 1 to 100


273931

Mean for Competing Occupations 38Source: Trefoil, Occupational Viewer 2000 with O'NET in it

While caregiver occupations offer little opportunity for recognition,neither do the competing occupations.

13-1

72

VALUES: Recognition

implications forrecruitment andretention

According to the Herzberg theory, recognition is one of themotivating factors. Efforts at employee recognition such as"employee of the month" awards are well intended but do notcompensate for inadequate job context (hygiene) factors asdiscussed in Section 10.


VALUES: Acivancemema

Advancement Advancement is a need within the Recognition value that meritscloser examination because of its significance to many people.

Getting ahead Getting ahead is an important aspect of work. "Not getting ahead"is an oft-given reason for job dissatisfaction and moving on toanother job or employer. The term is somewhat vague in meaningand may signify the user has only a nebulous idea that where theyare at present is not where they should be.

What does "getting ahead" suggest? It could mean a feeling ofcompetency about the job duties and a readiness to take on newresponsibilities. It could mean keeping financially ahead of inflationor upgrading the family standard of living. The term is open tointerpretation, but in the context of discussing their employmentsituation, speakers are probably referring to two related concerns:advancement and wages.

An astute job seeker considers the possible opportunities foradvancement when choosing a career and seeking employment.Many job seekers, however, take the first job opportunity presentedwithout assessing its advancement potential.

Advancement, on the other hand, is not everyone's goal. Manypeople find a niche where they feel comfortable with theircompetency to do the job well, take satisfaction in the contributiontheir work makes, and do not feel compelled to advance for thesake of advancement. Some reluctantly seek advancement solelyfor the financial gain and would otherwise be content with lesserpositions.

Others might want advancement but are unwilling or unable to paythe price for advancement: further education and training. Barriersto further training include child care, domestic responsibilities,transportation, tuition expenses, and academic readiness.Successful pursuit of further education in addition to a caregiver'sphysically and emotionally demanding workday requires a supportsystem and exceptional motivation.

Factors in Advancement opportunities depend on many factors. Some ofadvancement these factors are under the control of the organization, some in

control of the employee. Some are economic conditions outside thecontrol of either the employee or the organization.

14-1

74

VALUES: Advancement

Factors inadvancement(continued)

Economic FactorsO Labor market supply and demandO Demographics such as population age spreadO Growing or stagnant economy

Organization Factorso Size of organizationo Career development policies and programso Recruitment processeso Training programso Employee retention strategies

Employee Factorso Skills, knowledge, abilitieso Attitudeo Attendanceo Professional developmento Self-management skillso Support system

Comparison Caregiver occupations offer less opportunity for advancement thanthe average competing occupations according to the 0*NEToccupational analysis presented in Exhibit 14.1. These figures areaffirmed by surveys reported in The Hidden Health Workforcestating that fewer than 25 percent of certified nurse assistantsadvance in long-term care facilities./ Opportunity for advancementis a low-level characteristic of caregiver occupations, and those whowant the opportunity to advance might be well advised to chooseanother career area.

Caregiver occupations are more dependent upon further educationfor advancement than many of the competing occupations wherejob performance is a key element for advancement. Educationshould be a major consideration when an individual is consideringcaregiver occupations. Persons with aversion to further classroomtraining, and who also desire opportunities for promotion, shouldlook at other occupations.


75

EXHIBIT 14.1 Extent to Which Occupation Offers Opportunities for Advancement

Opportunitity for Advancement


Retail Salesperson

Adjustment Clerks (Customer Service Representatives)

Social Service & Human Service Assistants




Dental Assistants


Cashiers

Combined Food Preparation & Service Workers

Teacher Assistants

Medical Assistants



Child Care Workers

PERSONAL & HOME CARE AIDES

Emergency Medical Technicians & Paramedics

NURSING AIDES, ORDERLIES & ATTENDANTS

Security Guards

HOME HEALTH AIDES

Waiters & Waitresses

0 10 20 30 40 50 60 70 80 90 100

Extent Scale 0-100


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14-3

7 6

VALUES: Advancement

Career Career ladders are formal programs identified by organizations orladders industries to support the efforts of employees to advance through

experience and/or education. Career ladders enhance the ability ofemployers to retain skilled employees in their workforce and are avaluable part of succession planning.

Most current career ladder efforts for caregiver occupations aredirected toward nursing. Programs exist in partnership withcommunity colleges and the California State University system tocreate nursing career ladders:o Nursing Aide to Certified Nursing AssistantO Certified Nursing Assistant to Licensed Vocational NurseO Licensed Vocational Nurse to Registered Nurse

Traditionally, nursing programs have only accepted students whocould attend full-time. This leaves out students who must support afamily but could work toward the LVN or RN degrees at a slowerpace.

Some caregivers see advancement as moving to a job which getsthem away from the bedside. Career ladders could be developedfor those no longer interested in direct patient care. For example,nursing home administrator positions require a bachelor's degree inany major plus an internship. If staff can pursue a bachelor's innursing, why not pursue a degree that leads to becoming a nursinghome administrator? See Section 21, "tamer Ladders," forsuggestions of other occupations within the health services industrythat might be suitable career ladders for employees who desire tomove away from the bedside or have to because of physical injury.

Some employers offer tuition reimbursement as an incentive foremployees to develop further skills and licensing in health careersubjects. A few employers offer time off to attend training.

1 The Hidden Health Care Workforce, The Center for Health Professionals, University of California, SanFrancisco, 1999, p. 122.


77

Workingconditions

Correspondingneeds

Satisfying theWorkingConditionsvalue incaregiveroccupations

Potentialvalue conflict

Comparison

VALUES: Worldng Condtlions

Occupations that satisfy the Working Conditions value offer jobsecurity and good working conditions.

Six corresponding needs comprise the Working Conditions value:o Security Workers have steady employment.o Activity Workers are busy all the time.o Variety Workers have something different to do every day.o Independence Workers do their work alone.o Working Conditions Workers have good working conditions.o Compensation Workers are paid well in comparison with other

workers.

Half of the needs that comprise Working Conditions would becategorized as hygiene or maintenance values in Herzberg's1model: Compensation, security, and working conditions. If theseneeds are not met, good workers will leave for greener pastures.

Most people work to provide the best quality of life for their familythat they can. The low compensation and benefits offered to mostcaregivers would conflict with that value and drive them to seekother employment.

EXHIBIT 15.1 Extent to Which Occupation Offers Desirable Working Conditions





484851

49


As a whole, the group of competing occupations and caregiveroccupations are valued about the same in desirable workingconditions. A closer look at compensation or California wages ispresented in Section 7 of this report. Detailed value and needsscales can be found in Appendix D.

15-1

78

VALUES: Working Conditions

implicationsforrecn.s itmentand retention

"You get what you pay for" is an old maxim. A variation on thatcould be "You keep what you pay for." Such truisms might beignored when high unemployment exists and people will take andhang on to jobs out of fear, but the economy and populationdemographics have changed. People have more choices. Newtechnology also makes information about job choices easilyaccessible to people leading them to make more informed job andcareer decisions.

1 Frank J. Landy and Don A. Trumbo, Psychology of Work Behavior, The Dorsey Press, Homewood, IL,1976, p. 301-303, 330-331.


79

Support

Correspondingneeds

SatisfyingSupport valuein caregiveroccupations

Valuesconflict

Comparison

VALUES: &Ippon

Occupations that satisfy the Support value offer supportivemanagement that stands behind employees.

Three corresponding needs comprise the Support value:o Supervision, Human Relations Workers have supervisors who

back up their workers with management.o Company Policies and Practices Workers are treated fairly by

the company.o Supervision, Technical Workers have supervisors who train

their workers well.

Workers in caregiver occupations need Support whether theypersonally hold that value high or not. Caregivers answer to somany peoplesupervisors, peers, patients, and publicall makingdemands upon them. Caregivers have a genuine need for clearpolicies and procedures and a need to know that management willback them up in applying those policies. Knowing they are insensitive personal situations, dealing with sick or infirm patientsfurther adds to the need for a supportive managementenvironment.

Individual caregivers who possess high Support values are likely tobecome quite stressed if Support is not present.

EXHIBIT 16.1 Extent to Which Occupation Offers Supportive Management

Caregiver OccupationsNursing Aides, Orderlies, & AttendantsPersonal & Home Care AidesHome Health Aides



555234

56

Source: Trefoil, Occupational Viewer 2000 with O'NET in it

Home health aides occupations receive the lowest Support value ofall the caregiver and competing occupations. This may be due tothe isolated nature of their work.

16-1

80

VALUES: Support

implications Stress induced by inadequate Support could drive workers to seekfor types of jobs where responsibilities were clearly stated andrecruitment consequences of error were not potentially life and death matters.and retention

The Quest for Caregivers16-2 8 .1

VALUES: hcispendence

Ondependence Occupations that satisfy the Independence work value allowemployees to work on their own and make decisions.

Corresponding Three needs structure the Independence work value:needs 0 Autonomy Workers plan their work with little supervision.

0 Creativity Workers try out their own ideas.0 Responsibility Workers make decisions on their own.

Satisfying theindependencevalue incaregiveroccupations

Valuesconflict

Comparison

Individuals with a strong Independence value most likely will noteven consider caregiver occupations in an institutional setting.Caregivers with a taste for independence could satisfy this needthrough working in private residential settings.

Caregivers who work in private homes may have more feeling ofindependence and responsibility as they are physically removedfrom the intervention of other health care team members and thepatient may be almost totally dependent on them.

Caregivers in a nursing home work at the end of a long chain ofcommand: doctor, administrators, RNs, and LVNs. Additionally,they have to answer to and deal with the patient and the patient'sfamily and friends. There is very little room for independentbehavior.

EXHIBIT 17.1 Extent to Which Occupation Offers Opportunity for Independence





11

4732

35


Of the competing occupations, only onefitness trainers andaerobic instructorsoffers a fairly high degree of opportunity tosatisfy the Independence value.

VALUES: Independence17-1


Persons who exercise a strong Independence value are likely tofind another type of employment as quickly as possible. They alsohave the potential of creating upheaval in a teamwork environment.

Workers may thrive better where they have some say as to thecare of "their" patients. Long term care redesign efforts couldidentify and work on this by enlisting paraprofessionals in the datacollection needed to support Total Quality Management (TQM)improvement efforts. Job enrichment measures possibly could bedesigned into long term care jobs to give more independencewithout sacrificing quality control. For example, could the CNAdecide in which order to attend to assigned patients?

Would those with a high need for creativity find more gratification inthe role of activity or recreation coordinator at the nursing home?


[InWesRs: A Forecaster ag Job SaUeacUon

lnterests Along with values, interests contribute to work satisfaction. Interestsgenerally refer to the like or dislike of activities. The interestcomponent of Department of Labor's Occupational InformationNetwork (0*NET) draws on the research of John L. Holland1 whoseinterest assessment theory and related assessment tools are widelyused in schools, colleges, and one stop centers. Holland'spersonality-based theory2 makes the following assumptions:3

o People's occupations are extensions of their personalitieso People working in an occupation have similar personality

characteristicso Human personalities and work environments can be classified

into six categories of vocational personalities and environmentsas seen in Exhibits 18.1 and 18.2

Holland's theory proposes that people function best and find jobfulfillment in work environments that are in harmony with theirpersonalities. Vocational assessment tools based on Holland'stheory are used in high schools, colleges, and employment programsfor adults.

EXHIBIT 18.1 Holland Work Environment and Personality TVDeSFEcncr ne.scalpon SymbeA

Realistic

Investigative

Artistic

Realistic occupations frequently involve work activitiesthat include practical, hands-on problems and solutions.They often deal with plants, animals, and real-world

I materials like wood, tools, and machinery. Many of theoccupations require working outside, and do not involvea lot of paperwork or working_closely.with others.Investigative occupations frequently involve workingwith ideas, and require an extensive amount of thinking.These occupations can involve searching for facts andfiguring out problems mentally.Artistic occupations frequently involve working withforms, designs, and patterns. They often require self-expression, and the work can be done without followinga clear set of rules.

JI

Social

Social occupations frequently involve working with,communicating with, and teaching people. Theseoccupations often involve helping or providing service toothers.

5

Enterprising

Conventional

Enterprising occupations frequently involve starting upand carrying out projects. These occupations caninvolve leading people and making many decisions.Sometimes they require risk taking and often deal withbusiness.Conventional occupations frequently involve followingset procedures and routines. These occupations caninclude working with data and details more than withideas. Usually there is a clear line of authority to follow.

--14

C

18-1BESTCOPTAVAILABLE

Interests: A Forecaster of Job Satisfaction

84

The blend

interests incaregiverandcompetingoccupations

A 100 percent type for either individuals or occupations does notexist. No person is similar to only one category, nor does anoccupation fit only one type. Rather, each person and eachoccupation is a blend of several types. Each occupation isrepresented by a three-letter Holland code. The first letterrepresents the most important type. The second and third lettersrepresent type characteristics found within the occupation indescending order. According to the Holland research "Alloccupations tolerate a range of types; but some types appear tocope more successfully with an occupation's demands than doothers."

The Holland codes for the caregiver and competing occupations aresummarized in Exhibit 18.2 and fully detailed in Appendix E.

EXHIBIT 18.2 Holland Codes for Caregiver and Competing Occupations

Caregiver Occupations R I AS E C Symbol*

Nursing Aides, Orderlies, &AttendantsPersonal & Home Care AidesHome Health Aides

Mean for Caregiver OccupationsMean for Competing Occupations

*Realistic *Investigative *Arfistic

72 28 2261 17 1761 17 2265 21 2052 25 24

8983898764

5033223550

3328333159

SRESRESRCSRESCR


*Social *Enterprising *Conventional


More often than not, if an individual's interests were satisfied bycaregiver occupations, those interests would also be satisfied by thecompeting occupations.O 47 percent of the competing occupations as well as all three

caregiver occupations have S (Social) as their first typeo 68 percent of the competing occupations contain S somewhere in

their codeo 74 percent of the competing occupations as well as all three of

the caregiver occupations have codes that contain an R(Realistic)

o 79 percent of the competing occupations contain the E(Enterprising) or C (Conventional) in their code


5

Implicationsfor recruitingandretention

There is less distinction and more blurring of distinctions among lowlevel occupations. The similarity of interest factors in caregiver andcompeting occupations offers both positive and negative implicationsfor caregiver employers.

On the negative side, the similarity in interest types makes it easierfor workers to leave caregiver jobs for the competing occupationsand still remain in a work environment that fits their personality type.

The positive note is that workers in those competing occupationscould also find a person-work environment fit for themselves incaregiver occupations, other factors being equal. What would be theincentive that would draw them from the competing occupations tocaregiver occupations?

1 J.L. Holland, Making of vocational choices: A theory of vocational personalities and work environments,(3rd ed.), Psychological Assessment Resources, Inc., Odessa, FL, 1997, cited by James Rounds et al,Development of Occupational Interest Profiles for 0*NET, National Center for 0*NET Development,Raleigh, N.C., 1999, p. 2.

2 Ibid.

3 Judith M. Ettinger [Ed.], Improved Career Decision Making in a Changing World, Garrett Park Press,Garrett Park, MD, 1991, p. 4-4.

Gary D. Gottfredson, John L. Holland, Dictionary of Holland Occupational Codes, PsychologicalAssessment Resources, Inc., 3rd ed. Odessa, Florida, p. 13.

18:3

86

Interests: A Forecaster of Job Satisfaction

MustglaD anhay and Work Macs Viidence

Danger ahead It is the rare job seeker who investigates an occupation's industrialillness or accident rate. Some occupations readily convey theimage of potential danger: Law enforcement officers, firefighters,crop dusters, race car drivers, and miners. How many job seekerswould imagine they are putting their health in jeopardy by caring forthe elderly and infirm? Danger is not the public perception ofcaregiver occupations.

Nationwide Industrial injury rates vary markedly depending upon theinjury data occupation. Nursing homes are among the top twenty fastest

growing industries in the United States. The caregiver occupationsalso have the distinction of having one of the highest illness andaccident rates. While back injuries account for a quarter of all theinjuries reported in the private sector, back injuries account foralmost half of the injuries in nursing homes according to the ServiceEmployees International Union (SEIU).1

Bureau of Labor Statistics data indicate:

0 Annual injuries and illness rates in the Health Services Industryfrom 1992 through 1998 were consistently higher than the AllPrivate Sector Industry rate.

0 Health Services Industry injury and illness rates have decreasedover 24% from 1992 through 1998.2

Exhibit 19.1 provides the incidence rates of injuries and illnessesreported in private industry workplaces nationwide. Incidence ratesare based on the number of reported cases per 100 equivalent full-time workers.

EXHIBIT 19.1 Nationwide Rates of Workplace Injury and Illness

Year 1992 1993 1994 1995 1996 1997 1998Health Services 10.2 9.6 9.4 9.2 9.1 8.4 7.7All Private 8.9 8.5 8.4 8.1 7.4 7.1 6.7Industry

Source: Department of Labor, Bureau of Labor Statistics

California Bureau of Labor Statistics data for 'California injuries and illnessinjury data indicate annual injuries and illness rates in the Nursing and

Personal Care Industry from 1996 through 1998 were close todouble the All Private Sector Industry rate.3

Industrial Injury and Workplace Violence19-1

Californiainjury data(continued)

Exhibit 19.2 provides incidence rates of injuries and illnessesreported in all industries within California. Incidence rates arebased on the number of reported cases per 100 equivalent full-timeworkers.

EXHIBIT 19.2 California Rates of Work lace Injury and Illness

YearNursing & Personal CareHealth ServicesAll Industries

199612.88.47.1

199714.39.67.1

199811.98.76.7

19999.08.76.3


Nursing and personal care aides suffer the largest percentage ofinjuries of the health services industry.

EXHIBIT 19.3 California Occupational Injury and Illness Rates

California Occupational Injury and Illness Rates

1998c

I {

1999

1997

I1996+ t t

0 2 4 6 8 10 12 14 16

Incidence Rate Per 100 Full-Time Workers

18 20

CI All Industries

CI Health Services

Ea Nursing & Personal Care


Workplace Limited information is available on the occurrence of non-fatalViolence assaults in the nursing home industry. However, a report published

by the National Institute for Occupational Safety and Healthindicated that nursing home assaults comprised 27 percent of the22,400 work place assaults in 1992.4 The source of the injury in 45percent of the cases was a health care patient. The CaliforniaDivision of Occupational Safety and Health developed publication,Guidelines for Security and Safety of Health Care and CommunityService Workers5 to respond to the problem.

BESTCOPY AVAILABLE


8 8

Workplaceviolence(continued)

lmplicationsforrecruitmentand retention

As the population of older people continues to grow, the numbers ofpatients suffering from Alzheimer's disease and other forms ofdementia will increase in nursing facilities. Violent behaviorsassociated with dementia related illnesses may result in increasedworkplace violence.

Only those who may know, or know of, caregivers and other healthcare personnel who have been injured on the job would be wary ofthe risk inherent in these occupations. When making careerdecisions, informed applicants may weigh the risk of occupationalillness or injury against the advantages offered by a job such aswages, benefits, status, or career advancement opportunities.

It is unknown to what extent caregiver occupations are perceived asa risky occupation among potential applicant groups or how awarethose applicants are of the limitations a back injury places on futureemployment options. The adverse influence on recruitment wouldprobably not be great because of low public awareness.

The effect on worker retention, however, could be significant. Whencaregivers see their co-workers suffering back injuries, and reducedjob opportunities, it could motivate them to find a less risky jobbefore they, too, have limiting injuries.

1 Service Employees International Union (SEIU). Caring Till It Hurts. 1997, p. 2.

2 Department of Labor, Bureau of Labor Statistics, "Occupational Injuries and Illnesses: Industry data."Retrieved from: http://stats.bls.gov/oshhome.htm

3 Ibid.

4 "Violence in the Workplace," Current Intelligence Bulletin 57, Publication No. 96-100, U.S. Departmentof Health and Human Services, National Institute for Occupational Safety and Health, DHSS (NIOSH),July 1996, p. 1.Retrieved from http://www.cdc.gov/niosh/violnonf.html

5 Division of Occupational Safety and Health, Guidelines for Security and Safety of Health Care andCommunity Service Workers, "Nonfatal Assaults in the Workplace," March 10, 1998, p. 1-2Retrieved from http://www.dir.ca.gov/dosh/dosh publications/hcworker.html

19-3Industrial Injury and Workplace Violence

89

Job stress

&Tossers

Life can be stressful. Healthy stresses, such as the challenge oflearning something new, set the adrenaline racing. Frustratingminutiae of daily life, from burnt toast to traffic snarls, can culminatein feelings of stress. For some people, their job is another source ofstress.

The National Institute of Occupational Safety and Health (NIOSH)defines job stress as "the harmful physical and emotional responsesthat occur when the requirements of the job do not match thecapabilities, resources, or needs of the worker. Job stress can leadto poor health and even injury.°

Stress Some job stress is caused by a mismatch between the person'scaused by characteristics and the job's requirements, for example:mismatch

o Persons who are excessively fearful of disease might findworking in a caregiver or healthcare setting stressful.

o Exceptionally shy individuals might be stressed by the nearlycontinuous social interaction required of caregivers.

o Unruly or physically aggressive patients might produce stress in atimid caregiver.

Individuals with different personal characteristics could deal withthese same situations with less feelings of stress. Recruitment andselection processes that result in a good person-job fit can minimizestress generated by an inappropriate match of worker to job.

20-1 9 0Stressors

Stressinduced byworkingconditions

Stress incaregiverjobs andcompetingoccupations

While an inappropriate match of person to job can be the origin ofsome job stress, the majority of job stress is caused by workingconditions that most people would find stressful. NIOSH lists six jobconditions that contribute to job stress:2

1. The Design of Tasks - Heavy workload, infrequent rest breaks,long work hours and shift work; hectic and routine tasks that havelittle inherent meaning, do not utilize workers' skills, and providelittle sense of control.

2. Management Style Lack of participation by workers in decision-making, poor communication in the organization, lack of family-friendly policies.

3. Interpersonal Relationships - Poor social environment andlack of support or help from coworkers and supervisors.

4. Work Roles Conflicting or uncertain job expectations, toomuch responsibility, too many "hats to wear."

5. Career Concerns Job insecurity and lack of opportunity forgrowth, advancement, or promotion; rapid changes for whichworkers are unprepared.

6. Environmental Conditions Unpleasant or dangerous physicalconditions such as crowding, noise, air pollution, or ergonomicproblems.

Working conditions that contribute to stress will vary amongindustries and industry segments, specific employers, managers,and supervisors.

While recognizing that the job as a source of stress depends uponspecific workers and settings, some standardized measures ofoccupational characteristics that often bring about stress can becompared from occupation to occupation. Exhibit 20.1, Comparisonof Potentially Stressful Job Characteristics for Caregivers andCompeting Occupations, looks at eight occupational characteristicsthat could trigger job stress for many individuals.

The eight characteristics selected relate to one or more of thefollowing NIOSH stress spawning conditions: design of tasks, workroles, or environmental conditions.


EXHIBIT 20.1 Comparison of Potentially Stressful Job Characteristics forCare iver and Corn etin Occu ations

Diseases/InfectionsFrequency of Exposure

Deal with Physically Aggressive People

Responsibility for Health and Safety of Others

Diseases/InfectionsDegree of Injury Likely

Diseases/Infections--Likelihood of Injury

Job-Required Social Interaction

Consequences of Error

Importance of Being Sure All Is Done

OMean for Caregiver OccupationsOMean for Competing Occupations

1 11

1 1

1 1 1

I I I I I

10 20 30 40 50 60 70 80 90 100


Source: Trefoil, Occupation Viewer 2000, O*NET in it

See Appendix D for characteristic and scale definitions and specificdata for caregiver and competing occupations.

BEST COPY AVAILABLE

20-3

92

Stressors

Howstressful arecaregiverjobs?

Implicationsforrecruitmentandretention

Indicators of job stress include objective measures of absenteeism,illness, turnover rates, and performance problems according theNIOSH report.3 The following addresses these measures forcaregiver occupations:

TurnoverThe annual turnover rate for caregivers is reported as 42 percent,67.8 percent, or over 100 percent by various studies.4 No exitinterview data has been collected from caregivers to pinpoint thecauses of this turnover.

Absenteeism and IllnessNurse aides and orderlies have the third highest number ofoccupational injuries or illnesses requiring days away from workcompared to other occupations according to national data from theBureau of Labor Statistics.5 Only truck drivers and laborers havemore. Exhibit 20.2 displays available data on the competing andcaregiver occupations related to absenteeism and occupationalinjury and illness.

EXHIBIT 20.2 1998 Number of Nonfatal Occupational Injuries and IllnessesInvolving DaysAvjay from WorkNational Data

OccupationNumber of

Injuries andIllnesses

Number ofWorkers

Incidence RatePer 1000 Workers

Nursing aides, orderlies 84,100 1,366,600 61.5Cashiers 26,100 3,197,800 8.2Sales workers 22,900 4,056,500 5.6Miscellaneous food preparation 22,000 1,256,300 17.5Shipping & receiving clerks 18,500 999,900 18.5Waiters & waitresses 15,500 2,018,600 7.7Health aides 10,400 745,700 13.9Guards and police, except public 9,500 1,026,700 9.3

Sources: Bureau of Labor Statistics, Compensation and Working Conditions, Summer 2000Bureau of Labor Statistics, Office of Employment Projections

The high turnover level in caregiver occupations suggests thatworkers find something about the job or working conditions stressfulenough to leave. Turnover is costly. Recruiting, advertising, jobfairs, training and lost productivity are but the obvious costs. Moniesspent to identify and ameliorate those conditions could actuallyimprove the bottom line.


1 National Institute for Occupational Safety and Health (NIOSH), Stress...At Work, 1999, p. 5.Retrieved at http://www.cdc.00v/niosh/stresswk.html

2 Ibid., p. 7.

3 Ibid., p. 13.

4 The Hidden Health Care Workforce, The Center for Health Professionals, University of California, SanFrancisco, 1999, p. 71.

5 Bureau of Labor Statistics, "Occupational Injuries and Illnesses and Work-related Fatalities TechnicalNote," Compensation and Working Conditions, Summer 2000.

Stressors20-5

Career Ladders kpoo Caregiivers

Career Career ladders are occupational classification structures that allowladders or an individual to progress in an organization. Individuals advancecareer through successful performance of the current job and by acquiringpaths? skills from additional education or training that will prepare them for

the next job level, or rung, on the career ladder.

Formal career ladders exist primarily in organizations large enoughto have a hierarchy of related occupations plus enough growth andturnover to allow for movement up the ladders. To move up a careerladder requires more than just accumulating time in an organization;one must demonstrate competence and the readiness to take onnew responsibilities.

The use of career ladders serves two important functions inorganizations:

Employee Retention Career ladders improve morale and provide anincentive for good employees to stay with an organization when theysee opportunities to advance. Employers can save on costlyturnover and recruitment expenses.

Succession Planning Career ladders enable organizations to planfor the skills, knowledges, and abilities they need now and in thefuture in their workforce.

In smaller organizations, career ladders may be informal and dependupon the ability of employees to identify potential opportunities, andposition or prepare themselves for advancement. Mentoringrelationships between experienced employees or supervisors directemployees toward possible career paths.

Career path is probably a more accurate term than career ladder toreflect the type of movement that occurs in the workplace today.Twenty years of corporate flattening, downsizing, rightsizing, andoutsourcing have curtailed formal career ladders in organizations.Instead, individuals take a job, develop skills, and take their skillswhere they find the best return for their investment of time.Sometimes career paths are lateral rather than up as "ladder"implies. Lateral career moves allow workers to transfer their skills toa different, but related, occupation. Monetary gain is usually not themotive for lateral career moves. For example, a nurse aide who canno longer work in that occupation because of back injuries may moveto a position as an activity assistant or medical records clerk.

21-1 95Career Ladders for Caregivers

SkDH Related to career ladders, but different, are the occupational skillstandards standards established by some industries. Such skill standards are

recognized within an industry and are portable from employer toemployer and across geographic boundaries. Skill standards spellout precisely the competencies needed and the way to acquire thosecompetencies. Skill standards certify an employee's competenciesto any employer within an industry. The National Skill StandardsBoard (NSSB) has identified 15 industry sectors that share similarskill requirements.1 Health and Human Services is one of the 15industry sectors that NSSB hopes will participate in establishing skillstandards in a coordinated manner.

Nursing Most current career ladder efforts for caregiver occupations arecareer directed toward nursing. Programs exist in partnership with°adders community colleges and the California State University system to

create nursing career ladders:O Nursing Aide to Certified Nursing AssistantO Certified Nursing Assistant to Licensed Vocational NurseO Licensed Vocational Nurse to Registered Nurse

Traditionally, nursing programs have only accepted students whocould attend full time. This leaves out students who must support afamily but could work toward the LVN or RN degrees at a slowerpace.

Some employers offer tuition reimbursement as an incentive foremployees to develop further skills in health career subjects. A fewemployers offer time off to attend training.

Several factors contribute to an individual's efforts to successfullyclimb a hierarchical career ladder:O Aptitude to develop the required skills, knowledge, and abilitiesO Academic readiness to pursue further educationo Financial incentive to make the necessary sacrificeso Emotional support and encouragement from family, friends, and

employerso Desire to achieve and advance


96

Nursing Exhibits 21.1, 21.2, and 21.3 compare information from the 0*NETcareer database on the skills, knowledge, and ability (SKA) levels for theladders three caregiver occupations and licensed vocational nurses (LVNs),(continued) and registered nurses (RNs). The most important ten of each of the

three characteristics--knowledge, ability and skills--were selected.Many of the most important SKAs were common to the fiveoccupations so the lists only vary slightly in length: 13 knowledges,14 abilities, and 12 skills. Characteristics in each chart are listed inorder of level for RNs from lowest to highest.

SKA gap? Since the education requirements for the occupations vary from highschool diploma to an associate or bachelors' degree, it is to beexpected that the SKAs would reflect those differences.

The difference is most pronounced in ability level requirements.Abilities enable individuals to learn the skills necessary to performthe tasks of the occupation. This is the foundation from which theknowledge and skills develop.

21-3

97

Career Ladders for Caregivers

EXHIBIT 21.1 Corn sarison of Knowled e Levels Re uired for Nursin and Cares iver Occu ations

Most Important Knowledges to Nursing Occupationsand the Level of Knowledge Required

EZIPersonal & Home Care Aides 0 Homes Health Aides 0 Nursing Aides, Orderlies & Attendants IS LVN 0 RN

Communications and Media

Mathematics


Clerical

Administration and Management

English Language

Psychology

Chemistry

Therapy and Counseling

Biology

Medicine and Dentistry

Education and Training


VV"c"Cs'i3

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I

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SSZIKS:SZgSSZCS:RCSSZ

1 I

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....V.F4:4.1.4446:40:41tiCaetia4trX.V.W.SZNYSIO:44):101023

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-ITCAPV.V.W.NICIX401:Creilltilie;gaitiKACVAKVIVIiMgot0:1,144.4540.41:4Z.V.:V...W..4

0 10 20 30 40 50 60 70 80 90 100

Level RequiredStandard Scale 0-100

BESTCOPYAVAILABLE



9 8

EXHIBIT 21.2 Comparison of Ability Levels Required for Nursing and Caregiver Occupations

Most Important Abilities for Nursing Occupationsand the Level of Ability Required

0 Personal and Home Care Aides 0 Home Health Aides 0 Nursing Aides, Orderlies, and Attendants 0 LVN 0 RN

Number Facility

Manual Dexterity

Time Sharing

Static Strength

Speech Clarity

Memorization

Inductive Reasoning

Written Expression

Problem Sensitivity

Near Vision

Information Ordering

Written Comprehension

Oral Expression

Oral Comprehension

1'NcVst \

4.1n1013/ZWIlf.a.lra. PA OZ1in.^VZV%1

I

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IIlks NILW11,101711

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I

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1

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Icsst "sc\cs\ .1

}

I

--4,0 10 20 30 40 50 60


70 80 90 100

Source: Trefoil, Occupational Viewer 2000 with 0*NET in it BEST COPY AVAILABLE

21-5

99


cn

EXHIBIT 21.3 Com arison of Skill Levels Re uired for Nursin Occu ations and Care iver Occu ations

Most Important Skills to Nursing Occupations and the Level of Skill Required

fa Personal & Home Care Aides 0 Home Health Aides 0 Nursing Aides, Orderlies, & Attendants ISILVN 0 RN

Judgment and DecisionMaking


Writing



Monitoring

. Critical Thinking

Coordination

Speaking

Service Orientation

Active Listening

Reading Comprehension

11.7111\ 110111011111:410111.111. '111101,1167

1,5.1001,0114105:VraVAIWArairallfilaralifilfaN'alfingQWW41102

11.10111. NIL '111.111,\ '11h. 11.-11.,1110111671116'

Egv5.,.....5.orgwrokr...v.vofekitimmr.mrekerofiNtinwrivr..whoti.v.;

1011116-11010110111011h, .........................

Ih."111011h. 15."1110111. 116111011

r.....rAravinor..Fmrolorivrgriloisemr.sowti.lem.-.14.1,-..v.rokrzwoorgvr...v:i.le

N110110111101111.1111.1111.111.111

101110110111011011i '116111671110111kW.11011

11,111161111.1 "110111.'141110111.,11011.111011011.7

05.10.11:110.111,414.10110.114.14.1KNIaVAKinfillfalANKINIFAVrOles

k'111.1.1111.1111:116,11.111..

rall"..idraVra.lei.lifilfi.1105.1hOilfektealiteleArallOW5.10iViSrallfArelfiLleAiri.105.1KOW

111.1116110111011101101116111 111111101101161111.

rAr....K.wrivtisr..."...rootivrivroleivroorowwrokr...vr..vronra..n.

0 10 20 30 40 50 60 70


80 90 100

Source: Trefoil, Occupational.Viewer 2000 with O*NET in it


BEST COPY AVAILABI

Careerpaths otherthannursing

implicationsforrecruitmentandretention

While nursing career ladders offer the most opportunity foradvancement due to volume of jobs, nursing is not the only careerpath. Caregiver occupations provide foundation skills and knowledgethat individuals can use to pursue other health careers dependingupon their abilities, interests, and resources. Those caregivers thatwish a career in the health services industry have a wide range ofchoices available with varying education, skill, and certificationrequirements. Some career paths are within skilled nursing facilities;others are in other health care settings such as hospitals or medicaloffices and clinics.

Some caregivers see advancement as moving to a job which getsthem away from the bedside. Career options within skilled nursingfacilities for those no longer interested in direct patient care becauseof personal choice or physical injury include recreation, billing andrecord keeping, reception, social service occupations. Where eachskilled nursing facility has many nursing assistants, only a few of theother positions are needed at each site.

Exhibit 21.4 lists occupations requiring a bachelor's degree or lessfound within the four segments of the health care industry where mostemployment occurs: Hospitals; Medical Offices; Nursing and PersonalCare Facilities; and Home Health Care Facilities. The occupationsare clustered by education level generally required according to theBureau of Labor Statistics (See Appendix 8). Within each cluster,occupations are listed in order of the estimated number of jobopportunities a year across all industries in California.

See Appendix F for resources that provide detailed occupationalinformation for career exploration purposes.

Career ladders can be an incentive for individuals to take a job andgrow their career within an organization. When a significantdifference in SKAs exist between the entry occupation and the top ofthe career ladder, it increases the complexity of the recruitmentprocess. With career ladders in mind, recruiters must not onlydetermine whether the candidates could perform the caregiveroccupations, but whether they have the potential to participate incareer ladders leading to LVN and RN positions, or other positions inthe organization.

BEST COPY AVAILABLE


EXHIBIT 21.4 Optional Career Paths by Education Level

Occupation

AverageAnnual

CAJobs

Open a

1998-2008

SHORT ON-THE-JOB TRAININGNursing Aides, Orderlies, & Attendants 3,304Home Health Aides 1,531Personal & Home Care Aides 1,052Pharmacy Aides 357Psychiatric Aides 103MODERATE ON-THE-JOB TRAININGMedical Assistants 4,402Dental Assistants 2,030Social & Human Service Assistants 1,555Pharmacy Technicians 554Dispensing & Measuring Opticians 315Electroneurodiagnostic Technologists 18Electrocardiograph Technicians 14Statistical Clerks 70LONG-TERM ON-THE-JOB TRAININGHousekeeping Supervisors 265POST-SECONDARY VOCATIONAL EDUCATIONLicensed Vocational Nurse 2,193Medical Secretaries 833Emergency Medical Technicians 780Surgical Technicians 474Psychiatric Technicians 150ASSOCIATE DEGREERegistered Nurse 8,156Dental Hygienists 1,177Medical Records Technicians 1,054Radio logic Technologists 668Respiratory Therapists 625Medical & Clinical Laboratory Technologists 549Physical & Corrective Therapy Assts. & Aides 520Cardiology Technicians 138Occupational Therapy Assistants & Aides 127Dietetic Technicians 84Radiation Therapists 64Nuclear Medicine Technologists 40BACHELOR'S DEGREERecreation Workers 1,834Medical & Clinical Laboratory Technicians 750Physician's Assistants 524Occupational Therapists 262Dieticians & Nutritionists 257Recreational Therapists 35BACHELOR'S DEGREE AND WORK EXPERIENCEMedicine and Health Services Managers 1,317

Percent Employed in Industry: b

usa) 2 cr,o

7:3 CZC 0 CCI

U) 0co Tri 0

:o icn (7)12 tiI al

u_a ? 2coo 0 = a) cz o asi 2 z a_ u_ m 0

25.4 0.5 50.7 3.111.4 2.8 13.7 30.3

1.9 0.0 6.2 15.847.2 9.9 0.4 0.447.2 0.2 18.3 0.0

8 74.7 3.2 0.10.4 2.2 0.0 0.04.5 1.3 1.6 0.4

10.2 0.3 0.0 0.012.2 1.7 0.0 0.0

85 15 0.0 0.077.8 20 0.7 0.030.1 6.1 1.2 0.3

9.9 0.5 10 0.1

36.2 12.7 25.7 6.816.3 59.7 1.5 1.217.5 1.2 0.0 0.078.8 15 0 0.575.4 2 1.7 0.0

64.9 8.7 6.3 4.80.2 0.8 0.0 0.9

26.8 46.1 12.7 3.755.7 33.7 0.2 0.092.4 3.2 1 0.053.1 16.6 0.1 0.029.6 7.4 10.1 0.680.6 18.4 0.3 0.020.7 7.9 12.6 0.249.4 4.8 35.4 0.263.1 26.4 0.0 0.082.2 16.7 0.0 0.0

0.6 0.2 6.3 0.136.5 23.9 0.3 0.419.7 64.5 0.5 0.035.1 1.4 10.5 5.332.7 15.3 8.1 1.3

48 0.2 27.7 0.1

39.3 22.6 8.1 3.5

Source: Employment Development Department, Labor Market Information Divisiona Number of job openings in all industries. b Primary health care employers. Percentage will not add to 100since only four industries are represented in this data.


102BESTCOPY AVAILABI. r

implications If candidates do have the potential and expectations forfor advancement, then management would be wise to have programsrecruitment that support such career ladders: mentoring, child care, time off forand education, flexible scheduling, opportunities to use new skills.retention(continued) Nursing and convalescent homes do not have as large a variety of

health care occupations within them as hospitals. It would not berealistic that every entry-level nurse aide could eventually climb acareer ladder to RN. Many would not have the ability or the desire.However, they might target other health-related occupations in otherhealth care settings. Knowing there are career paths that start inconvalescent homes and lead elsewhere could attract interestedworkers who want to establish foundation skills in health care.

1 National Skill Standards Board, Built to Work, A Common Framework for Skills Standards, 2000, p. 7.Retried from http:// www.nssb.org

21-9 103Career Ladders for Caregivers

RecommendsUons km0 RecnAment and [RsteMon

Caregiveroccupationsat acrossroad?

Exitinterviews

Bestpractices

Caregiver occupations have existed for years in the secondary labormarket. Changing demographics and economic conditions havecurtailed the supply of workers available for low-wage occupationsthat offer little prospect for advancement. Sections 5 through 21examined in detail entry-level caregiver occupations andoccupations competing for novice job seekers. Caregiveroccupations compared unfavorably in significant points:o Caregiver wages are lower than many of the competing

occupationso Caregivers have less access to affordable benefits such as

health insuranceo Caregivers have a much greater chance for occupational injury

or illnesso Caregivers have greater training and certification requirements

than competing occupationso Caregivers have less opportunity for advancement

Given the supply-demand labor market realities, what steps canhealth care providers take to recruit more workers and retain themin health care occupations?

It is easy to assume that caregivers leave their jobs for better payand working conditions because those shortcomings seem obvious.Better information regarding the reasons caregivers quit their jobs isneeded to determine patterns of turnover and dissatisfaction to helpset priorities for change. The health care industry should establish astandard format for exit interviews and share such informationthrough professional associations. Such information would beinvaluable to individual employers and, in the aggregate, to theindustry as a whole. Design of an exit interview needs to includeinformation as to whether workers are changing occupation as wellas changing employer. If so, what kind of occupations will they goto? Exit information would be most valuable if it could beconsidered in contrast to or along with information about employeelongevity in the occupation and performance rating from supervisor.

The industry should identify those employers who have lowerturnover and fewer incidents of occupational injuries and illness.These employers can be looked to for "best practices" in employeescheduling, hiring and selection processes, employee training, andlabor-saving techniques that prevent back injuries.

22-1Recommendations for Recruitment and Retention

104

Marketing to Persons attracted to caregiver occupations will be persons who holdvaiues the work value Relationships in high regard. Caregiver employers

and professional associations need to market caregiver occupationsto appeal to the Relationships value. Marketing materials need tosend the message that caregivers are "people who care aboutpeople" to paraphrase the words from the Barbra Streisand song.Caregivers are the people you want holding your hand when you'resick. Persons with these values are persons who are more likely tochoose the work despite the wages and working conditions. Theywill carry on for the sake of the people they are helping andbecause of the great personal satisfaction they receive by helping.A team of marketing and advertising experts could develop acampaign that includes the following elements:o Public service spots showing caregivers in actiono Caregiver statements about the rewards of working with the

elderlyo Statements from the elderly about the difference caregivers

make in their liveso Emphasize that only special people have what it takes to be a

caregiver. Phrases from the Richard Adler and Jerry Ross song,Heart, catch the spirit of caregiver occupations: "You gotta haveheart, miles and miles of heart...You can be a hero..."

Not many occupations offer the opportunity to be a hero(ine) everyday, though few people see caregiver occupations that way. It willtake a concerted marketing campaign to communicate that view.Appeal to people who are seeking work that makes a meaningfulcontribution.

Assessment By selecting individuals who have the interest and skills to make agood "job-person match" for caregivers, training providers can focustraining on individuals with a good chance of success. Similarly,employers can hire workers who are more likely to stay on the job.There are many assessment instruments available to aid in makinga good person-job match. In order to improve retention in thecaregiver industry, the Caregiver Training Initiative collaborativeregions should make use of assessment tools such as the newassessments available through the U.S. Department of Labor'sOccupational Information Network (0*NET). These threeassessments are currently available as paper-and-pencilinstruments and will soon be available in a computer version:


105

Assessment o Interest Profiler -- Participants identify and learn about broad(continued) interest areas most relevant to their work-related interests. The

tool helps users discover the type of work activities and tasksthat they would like and find exciting on the job.

o Work Importance Locator -- This assessment helps users clarifywhat they find most important in jobs. Participants can identifyoccupations included in 0*NET that they are likely to findsatisfying based on the similarity between what is important tothem in a job and the characteristics of the occupations.

o Abilities Profiler An ability assessment developed forcounseling and career exploration. It measures nine job-relevant abilities, including administration guidance andsoftware. Its reports provide not only scores, but instructions onunderstanding and using the scores with 0*NET information.Participants receive a computer-generated score report. Thereport provides customized information that the individual canuse to explore careers.

Remedial and Some persons who desire caregiver careers may have difficultylliteracy skills passing the licensing tests because of literacy or academic

deficiencies. Educators, employee organizations, and employersshould develop remedial and tutoring programs to facilitate entryinto the caregiver occupations for persons who show potential andinterest. Assessment programs can identify skills and abilities thatneed to be strengthened before the caregiver can proceed throughtraining and licensing with confidence in a positive result.

Core Retention in caregiver occupations could be improved with acompetencies combination of career ladders and career paths. Workers will beand career drawn to caregiver occupations if they see paths to advancementpaths within the health and human services industry.

Health care educators, industry segments, and employeerepresentatives need to work together to develop competencyclusters that enable workers to target advancement opportunitieswithin health care and obtain certification in the neededcompetencies. Articulation between health care segments andeducational institutions can reduce the number of redundantcourses required as workers acquire more skills or shift their focus

Recommendations for Recruitment and Retention

22-3 1 6

Core within health careers. All training should be articulated to eliminatecompetencies unnecessary duplication and ensure standard competencies. Theand career National Skills Standards Board process would be a useful vehiclepaths to develop skill standards and establish health career pathways.(continued)

Once skill standards are in place, training becomes tailored to theindividuals and bridging skill gaps rather than requiring people torepeat courses for skills they have already mastered. For example,in order to shorten the CNA training time required for experiencednurse aides, tailor training programs for:O Nurse aides with less than four months' experience in any

settingO Nurse aides with no experienceO Nurse aides with several years acute care hospital experience

Financial Caregiver occupations will never attract those who are motivated byincentives "big bucks," though salaries will inevitably rise because of supply-

demand realities. There are financial incentives aside fromimproved wages that could bolster recruitment and retention:

Finder Fees Employees receive a fee for each person they referwho is hired. The fee could be paid in installments: One-third athiring, one-third at probation or certification, and one-third at oneyear of service.

Retention Bonus Caregiver employers can offer "retentionbonuses" to employees who stay longer than 6 months, one year,etc. This practice is common in the retail sales establishments atChristmas-time. These bonuses range from $50 to $150.1

Paid Leave Even a small amount of paid time off for employeeswould be a big plus in the board and care segment of the industrywhere it is nearly non-existent.

Employee Ownership Use profit sharing or some form ofemployee ownership to increase employee longevity and quality ofservice. As "owners" of the organization, caregivers will haveenhanced interest in the image, quality, and efficiency of theworkplace.

BLS Daily Report, Nov. 3, 2000


Workplace Investigate redesign of caregiver occupations and workplace toreengineering include more opportunities for the motivating factors: achievement,

recognition, responsibility, and advancement. Employers mightwant to reengineer the workplace so frontline workers canparticipate in care-giving decisions.

For further Initiate an "Americorps" for caregivers. Hire workers for a one-orstudy two-year contract. At the end of their "service," they are given

vouchers for LVN, RN, or other medical specialty training programand many choices of locations.

Similarly, high school students could receive exposure to caregiveroccupations through community service classes for academiccredit.

Summary There is no one, or easy, answer to the question, how to makecaregiver occupations a "good" job in the eyes of job and careerseekers. The most important part of the answer lies in targetingpeople who would see caregiver occupations as an opportunity todo good; i.e., persons with a high Relationships work value. Part ofthe solution is to improve the wages, benefits, and workingconditions. Another facet of the solutions mix is collaborationbetween health care segments, employee organizations, andeducators to establish skill standards and career paths.

The Quest for Caregivers was written from the point of view ofpersons selecting a job or career and the factors they shouldconsider in making that choice (see Exhibit 3.1). For someseekers, caregiver occupations would have more minuses thanpluses. For others, a caregiver occupation could add up to arewarding career choice. Find those people and reward them!

22-5Recommendations for Recruitment and Retention

108

APPENDICES

A. California Demographics

qz. California Population by Age/Sex, Year 2000 Exhibit A.1

0 Percent Change from 2000 to 2020 Exhibit A.2

B. Bureau of Labor Statistics Training Levels

C. Benefits for Competing and Caregiver Occupations

D. Occupational Information Network (0*NET)

o Glossary of Skills, Know ledges, and Abilities with Scale Exhibit D.1Benchmarks

0 Trunk Strength Levels Exhibit D.2

0 Extent Flexibility Levels Exhibit D.3

0 Static Strength Levels Exhibit D.4

0 Stamina Levels Exhibit D.5

Explosive Strength Levels Exhibit D.6

0 Scale Types and Benchmarks Exhibit D.7

Comparison of Potentially Stressful Characteristics for Exhibit D.8Caregiver and Competing Occupations

0 Values and Needs for Competing Occupations Exhibit D.9

0 Values and Needs for Caregiver Occupations Exhibit D.10

E. Holland Interest Types

F. Resources for Career Exploration

Appendices

109

APPENDIX A: California Demographics

EXHOBIIT A 1 California Population by Age/Sex, Year 2000

Age Group

MalesI I

Females

10 8 4 2 0 2

Percent

EXHOBOT A.2 Percent Change from 2000 to 2020

4 6 8 10

80

70

60

t. 50a)2 40a)D- 30

20

10

0

71.4

_ 11.5

24 - 54 Age Group 65 plus

Women only All seniors

Source: California Department of Finance Projections Report, 1998.

85+

80-84

75-79

70-74

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

110APPENDIX A

Exhibit A.1 & A.2

AIPPIENIOAX 11: Bureau of Labor Statistics Training Levels

TraininLevel

Bureau of Labor Statistics (BLS)Training Definition

The Bureau of Labor Statistics (BLS) training levels uses a classification P 4.6 .Ssystem that provides a national measurement of how much training or ro PI 112 u

.ca 0-, .0experience an occupation requires for most workers to become proficient. gE EBLS has identified 11 training levels ranging from short-term on the job =z z 5training (Level 11), to first professional degree (level 1), for a physician.

First professional degree is the minimum preparation required for entry into 7 1.7several professions, including law, medicine, dentistry, and the clergy.Completion of this academic program usually requires at least 2 years of full-time academic study beyond a bachelor's degree.Examples of occupations in this category: law, medicine, dentistry, and theclergy.

2 Doctoral degree usually requires at least 3 years of full-time academic work 6 1

beyond the bachelor's degree. Completion of this program is required forentry into 6 occupations in academia and the physical, biological, and socialsciences.Examples of occupations in this category: positions in academia and thephysical, biological, and social sciences.

3 Master's degree programs usually require 1 or 2 years of full-time study 10 1.4beyond the bachelor's degree.Examples of occupations in this category: urban planner, managementanalyst, and librarian.

4 Work experience in an occupation requiring a bachelor's or higher 14 8.1degree is comprised of managerial occupations that require experience in arelated non-managerial occupation.Examples of occupations in this category: engineers who advance toengineering manager. It is very difficult to become a personnel, training, orlabor relations manager without first gaining experience as a specialist in oneof these fields.Bachelor's degree requiring at least 4 but not more than 5 years of full-time 64 13.9academic work after high school.Examples of occupations in this category: mechanical engineer, pharmacist,recreational therapist, teacher, and landscape architect.Associate's degree usually requires at least 2 years of full-time academic 16work after high school.Examples of occupations in this category: Most occupations in this categoryare health related, such as registered nurse, respiratory therapist, andradiologic technologist. Also included are science and mathematicstechnicians and paralegals.

7 Vocational training is provided in postsecondary vocational school or bytaking job-related college courses that do not result in a degree. Someprograms take less than a year to complete and lead to a certificate ordiploma. Others last longer than a year but less than 4 years.Examples of occupations in this category: Occupations in this categoryinclude some that only require completion of the training program, such astravel agent, and those in which people who complete the program must passa licensing exam before they can go to work, such as barber andcosmetologist.

APPENDIX BPage 1 of 2


TrainingLevel

10

Bureau of Labor Statistics (BLS)Training Definition

Skills developed through work experience in a related occupationincluding occupations in which skills may be developed from hobbies or otheractivities besides current or past employment or from service in the ArmedForces.Examples of occupations in this category: cost estimators, who need priorwork experience in one of the construction trades; police detectives, who areselected based on their experience as police patrol officers; and lawn servicemanagers, who may be hired based on their experience as groundkeepers.

Long-term on-the-job training includes occupations that generally requiremore than 12 months of on-the-job training or combined work experience andformal classroom instruction before workers develop the skills needed foraverage job performance.Examples of occupations in this category: electrician, bricklayer, andmachinist. Also included in this type of training are intensive occupation-specific employer-sponsored programs that workers must successfullycomplete before they can begin work. These include fire and policeacademies and schools for air traffic controllers and flight attendants. In otheroccupationsinsurance sales and securities sales, for exampletraineestake formal courses, often provided at the job site, to prepare for the requiredlicensing exams. Individuals undergoing training are generally considered tobe employed in the occupation. This group of occupations also includesmusicians, athletes, actors, and other entertainers, occupations that requirenatural ability that must be developed over several years.

Moderate length on-the-job training includes occupations in which workerscan achieve average job performance after 1 to 12 months of combined on-the-job experience and informal training. This can include observingexperienced workers. Individuals undergoing training are generallyconsidered to be employed in the occupation. This training relies on traineeswatching experienced workers and asking questions. Trainees are givenprogressively more difficult assignments as they demonstrate their mastery oflower level skills.Examples of occupations in this category: dental assistants, drywall installersand finishers, operating engineers, and machine operators.

1 Short-term on-the-job training provides average job performance in just afew days or weeks by working with and observing experience employees and

1 by asking questions.1 Examples of occupations in this category: cashier, bank teller, messenger,1 highway maintenance worker, and veterinary assistant.

13 .0co c

t 11 43 2 Co

Eo g E2

zoi zM39 1 9.9

1 13.7

1191 1

16.2

Source: Darrel Patrick Wash, "A New Way to Classify Occupations by Education and Training," OccupationalOutlook Quarterly, Winter 1995-96, p. 29 Note: data are national level figures

BEST COPY AVAILABLE

112APPENDIX B

Page 2 of 2

APPENIDDX C: Benefits for Competing and Caregiver Occupations

OCCUPATION TITLE

0cTo

L

(,)E,

a

a).0cwi I!..-zca _E

co

>

a)>ata)1

iT)

4-ceEw... c15 CCrs E.

a)0cc Es2 =5 ..E

a)0cas

=cnc0.-1

)2cc02c..)

lal

0Adjustment Clerks (Customer ServiceRepresentatives) 83% 77% 80% 74% 64% 62% 70% 5% 40%Cashiers 66% 56% 62% 54% 44% 43% 43% 25% 1.5%Child Care Workers 55% 42% 61% 58% 28% 27% 24% 35% 15%Combined Food Preparation and ServiceWorkers 58% 56% 53% 49% 45% 43% 41% 25% 8%Correctional Officers & Jailers 100% 100% 100% 100% 100% 100% 80% 39% 37%Counter Clerks & Retail Clerks 52% 34% 53% 38% 29% 22% 26% 5% 19%Dental Assistants 60% 56% 85% 68% 51% 11% 18% 4% 19%Emergency Medical Techs 89% 87% 81% 68% 68% 71% 62% 1% 5%Fitness Trainers & Aerobics Instructors* 38% 20% 35% 25% 23% 13% 16% 5% 0%Food Preparation Workers 56% 50% 51% 45% 41% 41% 45% 28% 23%General Office Clerks 79% 63% 80% 68% 55% 44% 85% 4% 27%Medical Assistants 71% 43% 77% 73% 56% 31% 32% 3% 37%Receptionists & Information Clerks 62% 58% 59% 58% 54% 52% 52% 44% 22%Retail Salespersons 75% 61% 70% 59% 50% 44% 50% 20% 12%Security Guards 54% 47% 54% 38% 34% 33% 39% 2% 22%Shipping, Receiving, & Traffic Clerks 60% 57% 57% 53% 62% 53% -56% 47% 26%Social & Human Service Assistants 82% 67% 81% 76% 44% 50% 48% 7% 22%Teacher Assistants 62% 64% 61% 67% 50% 53% 40% 10% 21%Waiters and Waitresses 43% 35% 34% 21% 15% 19% 21% 1% 21%

Average, Competing Occupations 65% 56% 65% 57% 48% 43% 44% 16% 21%

Nursing Aides, Orderlies, andAttendants 77% 69% 78% 69% 48% 47% 51% 7% 12%Personal and Home Care Aides 44% 30% 44% 39% 28% 19% 17% 6% 6%Home Health Aides 55% 48% 53% 46% 37% 35% 35% 7% 17%

Source: Employment Development Department, Labor Market Information Division, California Cooperative OccupationalInformation System (CCOIS), Occupational Outlook Reports, 1997, 1998, and 1999

Note: The California Cooperative Occupational Information System (CCOIS) is a.partnership of theEmployment Development Department (EDD), local public employment and training providers, educators,economic developers, planners, and employers. The goal of the partnership is to improve the matchbetween employers' labor needs and the skills of job seekers. The CCOIS accomplishes this by providingspecific, localized and current information for use in making better training and labor market decisions.Each year, the CCOIS conducts surveys of hundreds of occupations throughout the state. Each localagency contracting with the State conducts surveys on 15 to 25 occupations that it considers to have thegreatest interest to the local community.

Data are representative of those counties where the occupation was surveyed rather than the wholestate. The number of counties surveyed for each occupation varied from a low of three to a high of thirty-two out of the fifty-eight counties in California.

* Fitness Trainers & Aerobics Instructors is included in a broad group called Athletic Trainers.

APPENDIX C

113The Quest for Caregivers

APPENDDX 10: Occupational Information Network (0*NET)

What is O*NET?

0*NET is part of the US Department of Labor/Employment and TrainingAdministration's workforce development strategy to build and display critical informationfor job seekers and employers in a user-friendly manner. 0*NET is designed to serveas an occupational/labor market information resource for public and private sector useand development.

0*NET is designed to be the nation's most comprehensive resource of occupationalinformation, with a database system that includes 400+ descriptors about eachoccupation. This in-depth data is a Web-based application that provides user-friendlyaccess to the 0*NET database of occupational information. 0*NET On Line is accessedat http://online.onetcenter.org/ and can be used to:

o develop effective job descriptions quickly and easily,o expand the pool of quality candidates for open positions,o define employee and/or job-specific success factors,o align organizational development with workplace needs,o refine recruitment and training goals, ando design competitive compensation and promotion systems.

Development of O*NET DataTechnical reports are available which describe the development of 0*NET data. Thesereports may be accessed and downloaded at http://www.onetcenter.org/rd/index.html

The exhibits in section D are derived from the 0*NET database.

APPENDIX D

114

EXI-DO DT DI Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

Note that this glossary contains only those skills, knowledges, and abilities that were among the ten mostimportant to either the caregiver or competing occupations. See the 0*NET On Line athttp://online.onetcenter.orq/main.html for a comprehensive list of skills, knowledges, and abilities.

DefinNOoolActive Listening: Listening to what 1other people are saying and askingquestions as appropriate

Arm-Hand Steadiness: The abilityto keep the hand and arm steadywhile making an arm movement or

, while holding the arm and hand inone position.

Biology: Knowledge of plant andanimal living tissue, cells,organisms, and entities, includingtheir functions, interdependencies,and interactions with each other andthe environment.

Sods100 1

85 1 0

57 128 1 0

0 1 0

100 1 0

9058 1 0

2114

Benchmagt Samples

Presiding as judge in a complex legal disagreementAnswering inquiries regarding credit referencesTaking a customer's orderNot relevant

Requires extreme steadiness to move the arm and handor to hold them in position.Cutting facets in diamondsThreading a needleLighting a candleRequires only a little steadiness to move the arm andhand or to hold them in one position.

0 Not relevant

100 0 Requires knowledge of advanced biologicalphysiological, and ecological systems, their interactions,and management

97 0 Isolating and identifying a microscopic virus77 0 Investigating the effects of pollution on marine plants and

animals.Dissecting a frogFeeding domestic animalsRequires knowledge of basic biological, physiological,and ecological principlesNot relevantRequires knowledge of complex chemicals, theirproperties, composition, structure, and possibleinteractionsDeveloping a safe commercial cleanerUsing proper concentration of chlorine to purify waterUsing a common household bug sprayRequires knowledge of common-place chemicals andtheir use

0 Not relevant

42 0

1714

0F--

Chemistry: Knowledge of thecomposition, structure, andproperties of substances and of thechemical processes andtransformations that they undergo.This includes uses of chemicals andtheir interactions, danger signs,production techniques, and disposalmethods.

Clerical: Knowledge ofadministrative and clericalprocedures and systems such asword processing systems, filing andrecords management systems,stenography and transcription,forms design principles, and otheroffice procedures and terminology,

100 0

90572114

0

1

0

1 01

0

100 1 0 Requires knowledge of advanced clerical, stenographic,and word processing procedures and recordsmanagement systems.

74 0 Organizing storage system for company forms44 0 Typing 30 words per minute31 0 Filing letters alphabetically14 0 Requires knowledge of simple clerical and filing.0

0 Not relevant

APPENDIX DExhibit D.1Page 1 of 7

15 The Quest for Caregivers

EXD DT D.1 Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

Defin Mon Scalia

Communications & Media:Knowledge of media production,communication, and disseminationtechniques and methods includingalternative easy to inform andentertain via written, oral, and visualmedia.

Coordination: Adjusting actions inrelation to others' actions

Customer & Personal Service:Knowledge of principles andprocesses for providing customerand personal services includingneeds assessment techniques,quality service standards,alternative delivery systems, andcustomer satisfaction evaluationtechniques.

Education & Training: Knowledge ofinstructional methods and trainingtechniques including curriculum designprinciples, learning theory, group andindividual teaching techniques, designof individual development plans, andtest design principles.

100 o

91 o

74 0

54 0

14 0

0 o

10085 0

57 0

28 0

0 0

100 0

92 o

71 0

57 o

28 0

14 0

0 0

8471

602714

01

Benchmark SampllesRequires knowledge of complex multiplecommunications methods and media to inform andentertain different and \jaded audiencesWriting a novelBeing a radio disk jockeyWriting a thank you noteRequires knowledge of how to use simplecommunications methods and media to inform orentertain a limited audienceNot relevant

Working as director of a consulting project calling forinteraction with multiple subcontractorsWorking with others to put a new roof on a house.Scheduling appointments for a medical clinicNot relevantRequires knowledge of complex customer and personalservice principles and processes for identifying andmeeting complex demands of multiple clients withdiverse needs.Responding to citizen's request for assistance after amajor natural disasterCatering a large wedding.Working as a day care aide supervising ten children.Running a hospital cleaning serviceProviding air flight arrival times over the phone.Processing customer dry-cleaning drop-offRequires knowledge of basic customer and personalservice processes for meeting demands of single clientswith simple needsNot relevantRequires in-depth knowledge of numerous relevant factsand multiple instructional techniques to teach experts ina given field

O Designing a training program for new employeesO Teaching a high general science courseO Leading a quality improvement seminar

Showing someone how to bowlO Requires knowledge of single instructional approaches to

teach simple tasks to studentsO Not relevant

BESTCOPY AVAILABLE

116APPENDIX D

Exhibit D.1Page 2 of 7

EXHD DI D.1 Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

DefInMon

English Language: Knowledge ofthe structure and content of the Englishlanguage including the meaning andspelling of words, rules of composition,and grammar

Information Gathering: Knowinghow to find information andidentifying essential information.

Information Ordering: The abilityto correctly follow a given rule or setof rules in order to arrange things oractions in a certain order. Thethings or actions can includenumbers, letters, words, pictures,procedures, sentences, andmathematical or logical operations.

1 Judgment & Decision Making:I Weighing the relative costs and

benefits of a potential action.

Manual Dexterity:The ability to quickly make

I coordinated movements of oneI hand, a hand together with its arm,I or two hands to grasp, manipulate,I or assemble objects.

Mathematics: Using mathematicsI to solve problems

Scaleloo

826050 0

21 014

0

10085 0

57 0

28 0

0

100 0

88 0

68 0

341 0

18 014 1

0 I

10085 0

57 0

28 0

0 0

100 0

98 0

58 0

17 0

14 0

0

10085

57

280

Benchmark Sart* s0 Requires fluent knowledge of advanced English in

vocabulary, complex grammatical rules, and pronunciationTeaching a college English classEditing a feature article in a local newspaperReading a complicated historical novelWriting a thank-you noteRequires elementary knowledge of English vocabulary,grammar, and pronunciationNot relevant

Analyzing industry indices and competitors' annual reportsto determine feasibility of expansionConducting an employee opinion surveyLooking up procedures in a manualNot relevant

Requires putting in order a large amount of informationusing two or more complex rulesAssembling a nuclear warheadMixing chemicals according to a specific sequence sothey do not become toxicFollowing the correct steps to change a tirePutting things in numerical orderRequires putting in order a small amount of informationaccording to a simple ruleNot relevant

Deciding whether a manufacturing company should investin new robotics technologyEvaluating a loan application for degree of riskDeciding how scheduling a break will affect work flowNot relevantRequires very fast coordinated use of one hand, a handand arms, or two hands to grasp, place, move, orassemble objectsPerforming open-heart surgery using surgical instrumentsPackaging oranges in crates as quickly as possible.Screwing a light bulb into a lamp socketRequires some speed and coordination to grasp, place,move, or assemble objects with one hand, a hand andarm, or two handsNot relevant

O Developing a mathematical model to stimulate andresolve an engineering problem

0 Calculating the square footage of a new home underconstruction

O Counting the amount of change to be given to a customerO Not relevant


117The Quest for Caregivers

EXG-HIBDT Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

Dennnon ScesMathematics: Knowledge ofnumbers, their operations, andinterrelationships includingarithmetic, algebra, geometry,calculus, statistics, and theirapplications

Medicine and Dentistry:Knowledge of the information andtechniques needed to diagnose andtreat injuries, diseases, anddeformities. This includessymptoms, treatment alternatives,drug properties and interactions,and preventive health-caremeasures.

Memorization: The ability toremember information such aswords, numbers, pictures, andprocedures

Benchmavk Serin_pOes100 0 Requires knowledge of advanced mathematical concepts

and operations such as calculus, non-linear algebra, and. statistics

85 0 Deriving a complex mathematical equation60 1 0 Analyzing data to determine areas with the highest sales.15 i 0 Adding tWo numbers14 . Requires knowledge of basic mathematical operations

such as multiplication, addition, and subtraction} 0 Not relevant

100 0 Requires in-depth knowledge of human anatomy andphysiology and methods for diagnosing and treatingcomplicated medical symptoms or problemsPerforming open-heart surgeryDiagnosing appendicitis from a patient's symptomsFilling a tooth cavityTaking a person's blood pressure

O Using a small bandageO Requires general knowledge of the human body and

methods for treating simple medical symptom and

0 problemsO Not relevantO Requires remembering a large amount of complex

material over a long period of time84 0 Reciting the Gettysburg Address after studying it for 15

minutes0. Reciting the first names of the five people you just metO Remembering the number on your bus to be sure you get

back on the right oneO . Requires remembering a small amount of simple.material

for a short period of timeO Not relevant

987864381514

o

0

100

5717

14

0

Monitoring: Assessing how well 100

one is doing when learning or doing 85 0

something57

Reviewing corporate productivity and developing a plan toincrease productivity .

Monitoring a meeting's progress and revising the agendato ensure that important topics are discussed

28 . Proofreading and correcting a letter0 0 Not relevant .

Near Vision: The ability to see 100 0 Requires fine visual distinctions at a close rangedetails of objects a t a close range 88 0 Detecting minor defects in a diamond(within a few feet of the observer) 68 0 Reading the fine print of a legal document

40 0 Reading dials on the car dashboard14 a

. Requires gross visual distinctions at a close range

.

. 0 0 Not relevant: Number Facility: The ability to 100 0 Requires fast and accurate calculations using manyi add, subtract, multiply, or divide different operations, with complex numbers

; quickly and accurately 92 0 Manually calculating the flight path of an aircraft, takinginto account speed, fuel, wind, and altitude

s

65 0 Computing the interest payment that should be generatedfrom an investment

ii

, 41 0 Balancing a checkbooki 17 0 Adding 2 and 7: 14s

0 Requires simple calculation when more than enoughs time is availables

0 0 Not relevant.

BEST COPY AVAILABLE

118APPENDIX D

Exhibit D.1Page 4 of 7

LEXHI IT D.1 Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

Definition Scaler Oral Comprehension: The ability 100 0

to listen to and understandinformation and ideas presented

78through spoken words and54

sentences 25140

Oral Expression: The ability to 100

communicate information and ideasin speaking so others willunderstand

Problem Identification:Identifying the nature of problems.

Problem Sensitivity: The ability totell when something is wrong or islikely to go wrong. It does notinvolve solving the problem, onlyrecognizing there is a problem.

91

5425140

10085

5728

0

100

80

55

18140

Benchmark SamplesRequires understanding complex or detailed spokensentences that contain unusual words and phrases

O Understanding a lecture on advanced physicsO Understanding a coach's oral instructions for a sportO Understanding a television commercialO Requires understanding short or simple spoken

sentences that contain common words and phraseso Not relevanto Requires speaking in a clear and well organized way to

communicate complicated ideas to others9 Explaining advanced principles of genetics to college

freshmenGiving directions to a lost motorist

O Canceling newspaper delivery by phoneO Requires speaking to communicate simple ideas to othersO Not relevant

9 Analyzing corporate finances to develop a restructuringplan

O Identifying and resolving customer complaintsComparing invoices of incoming articles to ensure theymeet required specifications

O Not relevantRequires recognizing very unusual or complex problemsand identifying all elements of the problemRecognizing an illness at an early stage of disease whenthere are only a few symptomsRecognizing from the mood of prisoners that a prison riotis likely to occurRecognizing that an unplugged lamp won't workRequires recognizing common or simple problemsNot relevant

Psychology: Knowledge of humanbehavior and performance, mentalprocesses, psychological researchmethods, and the assessment andtreatment of behavioral andaffective disorders

100

9178543225140

Public Safety and Security: 100

Knowledge of weaponry, publicsafety, and security operations,rules, regulations, precautions,prevention, and the protection ofpeople, data, property

887157351514

0

Requires knowledge of complex human behavior,advanced methods of psychological research, evaluation,and treatment

o Treating a person with a severe mental illnessDeveloping a job performance appraisal systemUnderstanding the impact of alcohol on human responsesSoothing a sad friendMonitoring several children on a playgroundRequires knowledge of basic concepts of human behavior I

Not relevantRequires knowledge of advanced safety rules andprocedures, security needs and operations, and use ofcomplicated weapons systemsCommanding a military operationSecuring a crime sceneInspecting a building site for safety violationsLoading and shooting a weaponUsing a seatbeltRequires knowledge of basic safety rules andprocedures, security operations, and use of simpleweaponsNot relevant

APPENDIX DExhibit D.1Page 5 of 7 119


EXCIDIBOT Di Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

Den Mon &de Benchmallt SampOesReading Comprehension: 100Th

85 1 0

documents. 57 I 0

28 0

0 0

Service Orientation: 100 1

ActiVely looking for ways to help 85 1 0

people 57 0

28 0

0

Social Perceptivenets: 100

Being aware of others' reactions 85 0

and understanding why they react57the way they do

0

Understanding written sentencesand paragraphs in work related

280 0

Speaking: Talking to others to 100

effectively convey information 85 0

57 0

280 1 0

Speech Clarity: The ability to 100 1 0

speak clearly so that it is 82 0

understandable to a listener 50 0

20 0

14 0

0_ 0

Speech Recognition: Requires 100 0

hearing and understanding complexspeech that is unclear or distorted 82

57 0

0

2114

0

Static Strength: The ability to 100 0

exert maximum muscle force to lift,push, pull, or carry objects 90

55 0

0

17 0

140

Reading a scientific journal article describing surgicalproceduresReading a memo from management describing newpersonnel policiesReading step-by-step instructions for completing a formNot relevant

Directing relief agency operations in a disaster areaMaking flight reservations for customers, using airlinereservation system.Asking customers if they would like cups of coffeeNot relevant

Counseling depressive patients during a crisis period..

Being aware of how a co-worker's promotion will affect awork groupNoticing that customers are angry because they havebeen waiting too longNot relevant

Arguing a legal case before the supreme courtInterviewing applicants to obtain personal and workhistoryGreeting tourists and explaining tourist attractionsNot relevantRequires speaking many complex words in clear fashionGiving a lecture to a large audienceMaking announcements over the loud speaker at a sportseventCalling the numbers in a bingo gameRequires speaking a few simple words in a clear fashionNot relevantRequires hearing and understanding complex speech thatis unclear or distortedUnderstanding a speech presented by someone with astrong foreign accentIdentifying a former customer's voice over the telephoneRecognizing the voice of a coworkerRequires hearing and understanding simple speechunder normal conditionsNot relevantRequires use of all the muscle force possible to lift, carry,push, or pull a very heavy objectLifting 75-pound bags of cement onto a truckPulling a 40-pound sack of fertilizer across the lawnPushing an empty shopping cartRequires use of a little muscle force to lift, carry, push, orpull a light objectNot relevant


EMI° DT D.1 Glossary of Skills, Know ledges, and Abilities with Scale Benchmarks

DelDnD.RDon Sze DeTelecommunications: Knowledgeof transmission, broadcasting,switching, control, and operation oftelecommunications systems

Therapy and Counseling:Knowledge of information andtechniques needed to rehabilitatephysical and mental ailments and toprovide career guidance includingalternative treatments, rehabilitationequipment and its proper use, andmethods to evaluate treatmentseffects

100 I

97

6145311714

100

85

602714

0

Writing: Communicating effectively with 100others in writing as indicated by the 85needs of the audience 57

280 0

Written Comprehension: The 100 0

ability to read and understandinformation and ideas presented inwriting

Benchmark SampOesO Requires knowledge of complex high-tech, digital

transmission and switching telecommunication systemsO Developing a new, world-wide telecommunications

networkFinding the cause of static on a lirie

O Operating a television cameraO Installing a satellite TV dishO Dialing a phoneO Requires knowledge of simple telecommunications

equipment and their useO Not relevantO Requires knowledge of counseling and therapy for

treating complicated or difficult mental, emotional, orphysical conditions or situations

O Counseling an abused child. Designing a physicaltherapy program to rehabilitate stroke victims

O Providing job counseling to the unemployedO Putting ice on a sprained ankleO Requires knowledge of basic counseling and therapy for

treating simple mental, emotional, and physical conditionsor situationsNot relevant

O Writing a novel for publication.O Writing a memo to staff outlining new directives.

Taking a telephone messageNot relevantRequires understanding complex or detailed writtensentences that contain unusual words and phrasesUnderstanding an instruction book on repairing a missileguidance systemUnderstanding an apartment lease

O Understanding signs on the highwayO Requires understanding short or simple written sentences

that contain common words and phrasesNot relevant

O Requires clear and well organized use of words andsentences to communicate complicated ideas to others inwriting

O Writing an advanced economics textbookO Writing a job recommendation for a subordinateO Writing a note to remind someone to.take something out

of the freezer to thawO Requires use of words and sentences to communicate

simple ideas to others in writingO Not relevant

Written Expression: The ability tocommunicate information and ideasin writing so others will understand

92

602414

100

925417

14

0

BESTCOPYAVAILABLE



EXG-10BDT D.2 Trunk Strength Levels

Trunk Strength Levels

Trunk Strength is the ability to use the abdominal and lower back muscles tosupport part of the body continuously over time without fatiguing


Adjustment Clerks

Personal and Home Care Aides

Dental Assistants


Child Care Workers


Home Health Aides


Emergency Medical Technicians and Paramedics


Shipping, Receiving, & Traffic Clerks

Retail Salespersons

Cashiers

Combined Food Prep & Service Workers

Medical Assistants

Teacher Assistants

Nursing Aides, Orderlies, and Attendants

Waiters and Waitresses


Security Guards


1

0 10 20 30 40 50 60 70 80 90 100

Trunk Strength LevelsScale 0-100

Benchmarks100 Requires use of all the abdominal and lower back muscle force possible to hold up or move part of

the body for a long period of time.93 Doing 100 it ups57 Shoveling snow for a half-hour to clear a walkway21 Sitting up in an office chair14 Requires use of a little abdominal and lower back muscle force to hold up or move part of the body

for a short time

BEST COPY AVAILABLE

122APPENDIX D

Exhibit D.2

EXD-OD DT D.3 7 Extent Flexibility Levels

Extent Flexibility Levels

Extent Flexibility is the ability to bend, stretch, twist, or reach out with the body, arms, or legs.




Child Care Workers

Home Health Aides

Dental Assistants






Cashiers

Medical Assistants

Teacher Assistants

Security Guards

Salesperson, Retail







wil

I

1

1

1

I I

1

I

I

I

1

I

,

,

1

I

1 I

,

I

I

I

I I

I I

0 10 20 30 40 50 60 70 80

Flexibility LevelsExtent Scale 0-100

Benchmarks100 Requires a high degree of bending, stretching, twisting, or reaching out into unusual

positions.83 Working under a car dashboard to repair the heater.50 Reaching for a box on a high warehouse shelf.26 Reaching for a microphone in a patrol car.14 Requires a low degree of bending, stretching, twisting, or reaching out.

APPENDIX DExhibit D.3

123

90 100


EXHDBOT D.4 Static Strength Levels

Static Strength Levels

Static strength is the ability to exert maximum muscle forceto lift, push, pull, or carry objects

Adjustment Clerks

Dental Assistants




Cashiers

Child Care Workers



Retail Salespersons

Teacher Assistants



Medical Assistants



Home Health Aides



Security Guards



MI

I

1

1

I

I

I

I

i

1

I

1

1,

1

I

I

I

i

1

1

1

1

1

I 1 I

1

I

I) 1

0 10 20 30 40 50 60 70 80 90 100

Static Strength LevelsScale 0-100

Benchmarks100 Requires use of all the abdominal and lower back muscle force possible to hold up or

move part of the body for a long period of time.93 Doing 100 sit-ups.57 Shoveling snow for a half-hour to clear a walkway.21 Sitting up in an office chair.14 Requires use of a little abdominal and lower back muscle force to hold up or move part of

the body for a short time.

124BEST COPY AVAILABLE


co0.

0

EXHI OT D.5 Stamina Levels

Stamina Levels

Stamina is the ability to exert one's self physically over long periods of timewithout getting winded or out of breath

Dental Assistants





Cashiers


Medical Assistants



Retail Salespersons

Child Care Workers


Home Health Aides

Teacher Assistants






Security Guards


1

1

1

,

Ell

I

1

1

i

1

1

I1

1

1

1

i,

1

,

i

0 10 20 30 40 50 60 70

Stamina LevelsScale 0-100

80 90 100

Benchmarks100 Requires physical activity of the whole body over a long time, with great strain on the heart and lungs.86 Running a 10-mile race.57 Climbing six flights of stairs.17 Walking a quarter of a mile to deliver a letter.14 Requires physical activity of the whole body over a short time, with little strain on the heart and lungs.

APPENDIX DExhibit D.5 125


o.

0

EXDIRENT D.6 Explosive Strength Levels

Explosive Strength Levels

Explosive Strength is the ability to use short bursts of muscle forceto propel oneself (as in jumping or sprinting), or to throw an object



Child Care Workers

Dental Assistants


Cashiers



Home Health Aides


Retail Salespersons

Teacher Assistants


Medical Assistants






Security Guards



Benchmarks100 Requires bursts of all the muscle force possible to propel one's own body weight or

objects.93 Propelling (throwing) a shot-put in a track meet.79 Running up a flight of stairs with fire equipment.57 Jumping onto a 3-foot high platform.31 Hitting a nail with a hammer.14 Requires bursts of a little muscle force to move one's own body weight or objects.

II

=-Nom

I

I

1

1

J

1

I

I

I

0 10 20 30 40 50 60 70 80

Explosive Strength LevelsScale 0-100

90 100


126

EXD-DD DT D.7 Scale Types and Benchmarks

Scale Type Value menchmark LabelsAmounts of Contact 100 i Very Extensive Contact--Constant contact with

others is required.50 Moderate ContactSome contact with others is

required; about half of work time spent in contactwith others.

0 Very Little ContactAlmost no contact with others isrequired.

How Serious? 100 Extremely SeriousSubstantial costs, loss ofreputation, damage to physical plant, or seriousinjury or death to self, other workers, or the public.

50 Moderately SeriousSome loss of time, money, ordamage to equipment.

0 Mildly SeriousMinimal loss of time or effort orminor inconvenience to customers.

Deal with Physically Aggressive 100 AlwaysPeople 75 Often

50 Sometimes25 Almost Never

.I0 .Never (or does not apply)

Degree of Injury 100 Injury resulting in total impairment or death.80 Injury resulting in permanent partial impairment.60 Injury resulting in loss of more than one work day.40 Injury resulting in loss of up to one work day.20 Injury requiring first aid.

[-- 0 No treatment required.I Responsible for Health & Safety 100 Very Substantial ResponsibilityOthers' health and

safety depends almost entirely on actions of worker.57 Moderate ResponsibilityMust be careful to avoid

injury to others.14 Very Limited ResponsibilityHas little responsibility

for others' health and safety.0 NoneNo responsibility for the health and safety of

others.Importance 100 Extremely important

80 Very important60 Important40 Somewhat20 Minimally important0 _Does not apply

Likelihood of Injury 100 Very high possibility85 High possibility71 Fairly high possibility57 Some possibility42 Limited possibility28 Very limited possibility14 ! Almost no possibility0 I No possibility

Source: Trefoil, Occupational Viewer 2000, 0*NET in it

APPENDIX DExhibit D.7 127


EXHIBIT D.8 Comparison of Potentially Stressful Characteristics for Caregiver andCompeting Occupations

Characteristic DefinitionsTS el ei,

oca,.0 ta

x is.:.46xf, o 4

a)Eme

02ta :I-a P.

i....c ,......,,c16 o o o c 0c El a 5 a a2 EM (DEZ

.". 0

I Consequences of Error. How serious would the resultI usually be if the worker made a mistake that was not readily'correctable?i;Deal with Physically Aggressive People. How frequentlyIdoes this job require the worker to deal with physical'aggression of violent individuals?:

;Diseases/Infections. How often does this job expose the;worker to diseases/infections?,

1

;Diseases/Infections. If injury due to exposure to;disease/infection were likely to occur while performing this,

;job, how serious wouki be the likeiy.outcome?;Diseases/Infections. What is the likelihood the workerI

;would be injured as the result of being exposed toidiseases/infections while performing this job?

;!Importance of Being Sure All Is Done. How important is itIto be sure that all the details of this job are performed andI

;everything is done completely?1

1Job-Required Social Interaction. How much does this job'require the worker to be in contact (face-to-face, byItelephone, or otherwise) with others in order to perform it?

'Responsibility for Health and Safety of Others. How!responsible is the worker for others' health and safety on this;job?

HowSerious

Frequency

Frequency

I Degree ofInjury

Likelihoodof Injury

nmportance

Amount ofContact

Responsiblefor Health &

Safety

47 67

1

1 01 29i

50 88

321 57

;

291 48I

.

;841 801

1

r901 89I

1

571 R9I

I

'37

15

26

25

20

80

93

49

50

18

.......

55

38

32

75

...

91

58

42

17

16

11

i69

.........

35

I

Source: Trefoil, Occupational viewer 2000, 0*NET in it* Scale 0-100. See Exhibit D.7

BEST COPY AVAILABLE

128APPENDIX D

Exhibit D.8

Sta

ndar

dize

d W

ork

Val

ues

Cor

resp

ondi

ng N

eeds

*1*2

*3*4

**7

*8*9

*10

*11

*12

*13

*14

*15

*16

*17

*18

*19

Mea

n

RE

LAT

ION

SH

IPS

5855

7058

5459

6778

6856

5851

6169

5658

5072

6861

Soc

ial S

ervi

ce50

4494

3444

5372

9778

3841

5078

6950

5613

6666

58

Mor

al V

alue

s63

5959

8456

6369

5963

7272

6950

7566

5084

7269

65

Co-

wor

kers

6363

5656

6363

5978

6359

6334

5663

5369

5363

6960

SU

PP

OR

T61

5846

4866

5753

5153

4858

5461

5561

6557

6155

56

Sup

ervi

sion

, Hum

an R

elat

ions

6959

4450

7259

,56

5659

5066

5966

6359

6963

6953

60

Com

pany

Pol

icie

s &

Pra

ctic

es63

5656

5072

5356

5372

4753

5663

5969

5659

6647

58

Sup

ervi

sion

, Tec

hnic

al53

5938

4453

5947

4428

4756

4756

4456

6950

6369

52

WO

RK

ING

CO

ND

ITIO

NS

5545

5240

4949

5547

5340

5544

5254

5454

4749

4149

Sec

urity

6359

6347

8150

6969

6647

5356

5666

5650

5359

4157

Act

ivity

6656

6959

6644

5350

6959

6944

5953

6656

5666

5957

Var

iety

4422

5328

4141

5069

5931

5031

5953

4456

2847

2244

-

Inde

pend

ence

3853

3450

3456

3419

2844

5353

4131

4153

5331

3142

Wor

king

Con

ditio

ns72

4756

3434

6966

2853

3466

4459

5966

6950

6947

54

Com

pens

atio

n47

3134

2238

3856

4744

2541

3438

5950

4144

4444

41

AC

HIE

VE

ME

NT

5222

478

5236

5383

7214

4442

5353

4552

2861

2344

Ach

ieve

men

t53

2553

956

3856

8878

1647

4756

5644

5628

5925

46

Abi

lity

Util

izat

ion

5019

416

4734

5078

6613

4138

5050

4747

2847

2241

RE

CO

GN

ITIO

N47

2738

1746

3444

4363

1945

3550

4436

4732

4816

38

Soc

ial S

tatu

s47

2238

644

3450

6366

1644

3447

5338

4128

539

38

Adv

ance

men

t53

4734

4447

5047

3147

3463

2850

4138

6347

3822

44

Aut

horit

y50

1944

959

1628

3481

925

5056

3138

2822

4413

33

Rec

ogni

tion

3819

389

3434

5044

5916

4728

4750

3156

3144

2236

IND

EP

EN

DE

NC

E48

1848

1431

2925

4977

1136

3650

2132

4830

3825

34

Aut

onom

y44

2853

1919

3831

4469

1341

4453

2838

5341

2828

37

Cre

ativ

ity44

1344

631

2222

3884

631

1947

1628

4416

2813

28

Res

pons

ibili

ty56

1347

1644

2822

6678

1638

4750

1931

4734

3134

37

Com

bine

d M

ean

5439

5031

5044

.50

5962

3149

4455

4947

5441

5538

47

*1A

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t Cle

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(Cus

tom

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ervi

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epre

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*8E

mer

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edic

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echn

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ns &

Par

amed

ics

*14

Rec

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nist

s &

Info

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ion

Cle

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*2C

ashi

ers

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itnes

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rain

ers

& A

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ics

Inst

ruct

ors

*15

Ret

ail S

ales

pers

ons

.3C

hild

Car

e W

orke

rs*1

0F

ood

Pre

para

tion

Wor

kers

*16

Sec

urity

Gua

rds

*4C

ombi

ned

Foo

d P

repa

ratio

n &

Ser

vice

Wor

kers

*11

Gen

eral

Offi

ce C

lerk

s*1

7S

hipp

ing,

Rec

eivi

ng &

Tra

ffic

Cle

rks

.5C

orre

ctio

nal O

ffice

rs &

Jai

lers

*12

Hum

an &

Soc

ial

Ass

ista

nts

*18

Tea

cher

Ass

ista

nts

*6C

ount

er C

lerk

s &

Ren

tal C

lerk

s*1

3M

edic

al A

ssis

tant

s*1

9W

aite

rs &

Wai

tres

ses

*7D

enta

l Ass

ista

nts

Sou

rce:

Tre

foil,

Occ

upat

iona

l Vie

wer

200

0 w

ith O

*NE

T in

it

Ext

ent S

cale

0-1

00

ST

AN

DA

RD

IZE

D W

OR

K V

ALU

ES

Cor

resp

ondi

ng N

eeds

Hom

e H

ealth

Aid

esN

ursi

ng A

ides

,O

rder

lies

& A

ttend

ants

Per

sona

l I H

ome

Car

eid

esV

alue

Mea

nR

ELA

TIO

NS

HIP

S61

7564

67S

ocia

l Ser

vice

9484

100

93M

oral

Val

ues

6972

5967

Co-

wor

kers

2269

3141

SU

PP

OR

T34

5552

47S

uper

visi

on, H

uman

Rel

atio

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5953

49C

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ny P

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and

Pra

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5356

48S

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visi

on, T

echn

ical

3453

4745

WO

RK

ING

CO

ND

ITIO

NS

5148

6849

Sec

urity

5366

5658

Act

ivity

5063

4753

Var

iety

5350

5352

Inde

pend

ence

5341

5650

Wor

king

Con

ditio

ns50

3844

44C

ompe

nsat

ion

4434

3437

AC

HIE

VE

ME

NT

4244

45A

chie

vem

ent

5344

5350

Abi

lity

Util

izat

ion

3134

3834

RE

CO

GN

ITIO

N31

2739

32S

ocia

l Sta

tus

4434

4140

Adv

ance

men

t25

2831

28A

utho

rity

2225

4731

Rec

ogni

tion

3422

3831

IND

EP

EN

DE

NC

E32

1167

30A

uton

omy

4416

5639

Cre

ativ

ity25

1338

25R

espo

nsib

ility

286

4727

Com

bine

d M

ean

4343

4945

Sou

rce:

Tre

foil,

Occ

upat

iona

l Vie

wer

200

0 w

ith 0

*NE

T in

it

Ext

ent S

cale

0-1

00

APIPENIDOX 1E: Holland Interest Types

Along with values, interests contribute to work satisfaction. Interests generally refer to the like or dislike ofactivities. The interest component of Department of Labor's Occupational Information Network (0*NET)draws on the research of John L. Holland whose interest assessment theory and related assessmenttools are widely used in schools, colleges, and one stop centers. Holland's theory proposes that peoplefunction best and find job fulfillment in work environments that are in harmony with their personalities.

Occupational Classificationa=.0

a)M

wg.73a)=u)

>c

6..)

T't<

To

cn

a)c.a0.

c111

70co

w

o0

Symbol

Adjustment Clerks (Customer ServiceRepresentatives)

Cashiers

Child Care Workers..

Combined Food Preparation and ServiceWorkers

Correctional Officers & Jailers_1


Dental Assistants

Emergency Medical Technicians andParamedics

Fitness Trainers & Aerobics Instructors_1



Medical Assistants

Receptionists and Information Clerks

Retail Salespersons

Security Guards ,



Teacher Assistants


Mean of Competing Occupations

22

50

33

89

83

50

67

67

67

39

50

22

44

44

61

28

39

50

52

33

17

28

11

7

17

33

56

33

11

17

39

17

22i

22

22

22

33

17

25

17

17

44

22

17

17

17

33

33

17

1 I22

17

28

17

11,-L.

441

44

28

24

61

33

94

28

67

39

83

89T

83

2Y

28

83

67

56

83

22

94

94

83

64

67 89 CES

--I--56 83 CER

28 28 SAR

394- 39 RCE

4 44 RSE_,..._

67 83 CER

50L 44 SRE

33 39 SRI

56 39 SRE

394 RCE

3 94 CRE_L

33 67 SCR

72 83 CESi

89 39 ESR

67 50 SEC

39 CRE

3-9.4 61 SCA

33 56 SCR

67 50 SEC

50 59 SCR

Home Health Aides



Mean of Caregiver Occupations

61

72

61

65

171

28

17

21

221 89

22 89

17 83

20 871

22 33 SRC

50 33 SRE

33 28 SRE

35F 31E SRE

Extent Scale 0-100

Source: Trefoil, Occupational Viewer 2000 with O*NET in it

APPENDIX E

131


APPENDDX F: Resources for Career Exploration

Occupational exploration resources available on the lnternet:

America's Career Info Net - Developed by the Department of Labor (DOL),America's Career Info Net provides a wealth of information under the categoriesof Career Exploration, General Outlook, Wages and Trends, State Profile, andResource Library

CaCTIS (California Career & Training Information System- CaCTIS linkscounty-based information about the following: Job requirements, trainingprogram locations, wages, and job openings.

California Career Planning Guide A step by step guide to finding a good jobthat matches the individual's skills, abilities, and interests.

California Occupational Guides describe 350 individual occupations or groupsof related occupations in detail with statewide wage and trend information.

California Professional & Business License Handbook 1999 contains a list ofoccupations licensed by the State of California along with licensing requirements,license fees, and.the name and address of the licensing authority.

California Training and Education Providers (CTEP) CTEP offers informationon local schools and colleges including name, address, phone numbers, faxnumbers, and the educational and training programs offered. Links to transit andmap web sites to provide transportation information to training seekers.

Career Guide to Industries provides information on available careers byindustry, including the nature of the industry, working conditions, employment,occupations in the industry, training and advancement, earnings and benefits,and employment outlook.

Career Opportunities is an industry-based exploration of careers in thefollowing industries: Information Technology, Manufacturing, Hospitality,Tourism, and Recreation, Arts, Media & Entertainment, and Health Services.Available for statewide and 12 School-to-Career regions

Employment and Wages by Occupation lists the most current wages for eachoccupation: entry-level hourly, mean hourly, mean annual, and hourly at the25th, th--bU (median), and 75th percentiles. Regional, county, and statewide dataare available.

Occupational Outlook Handbook, published by DOL. Profiles occupations withnational trend and wage information.

Occupational Outlook Quarterly (00Q,), another DOL publication, featuresarticles on occupations, trends, education and training, occupations andindustries, choosing and changing jobs, college graduates, workers without abachelor's degree.

Occupational Outlook Reports provide information about occupations selectedby each of the local California Cooperative Occupational Information System(CCOIS) partners.

ONET On Line offers in depth skills, tasks, and related occupational information.ONET replaces the Dictionary of Occupational Titles and contains crosswalks toother occupational classification systems.

http://www.acinet.orq/acinet/

http://www.cactis.ca.gov/

http://www.soicc.ca.qov/#CCPG

http://www.calmis.ca.gov/htmIfile/subtect/GUIDE.htm

http://commerce.ca.gov/doc/business/small/management/pub/license/

http://www.soicc.ca.gov/ctep/

http://stats.b1s.gov/cqhome.htm

http://www.calmis.ca.gov/htmlfile/subtect/CareerOps.htm

http://www.calmis.ca.qov/file/occup$/OES$.htm

http://stats.b1s.gov/ocohome.htm

http://stats.b1s.gov/opub/ooq/ooahome.htm

http://www.calmis.ca.qov/htmlfile/ccois/oor.htm

http://online.onetcenter.org/main.html

APPENDIX F

132

MbHography

Assembly Bill 2876 Chapter 7, Section 11022c, 1-10

Bolles, Richard N., What Color Is Your Parachute?, Ten Speed Press, Berkeley, CA,2000.

Built to Work, A Common Framework for Skills Standards, National Skill StandardsBoard, Washington, DC, 2000. Retrieved from www.nssb.org

The Center for the Health Professions, The Hidden Health Care Workforce, A. Reportof the California Twenty-first Century Workforce Project, University ofCalifornia, San Francisco, 1999.

The Changing Nature of Work, National Research Council, National Academy Press,1999. Retrieved from www.nap.edu/html/occup analysis/index.html

California Nursing Homes, Federal and State Oversight Inadequate to ProtectResidents in Homes With Serious Care Violations, GAO, Testimony Beforethe Special Committee on Aging, U.S. Senate, July 28, 1998.

California's Professional & Business License Handbook, California Trade andCommerce Agency and Employment Development Department, Labor MarketInformation Division, Sacramento, 1999.

California Projections of Employment 1998-2008, Employment DevelopmentDepartment, Labor Market Information Division, Sacramento, 2000.

Caring Till It Hurts, Service Employees International Union (SEIU), 1997.

Coffman, Janet, MPP, and Joanne Spetz, "Maintaining an Adequate Supply of RNsin California," Image: Journal of Nursing Scholarship, Volume 31, Number 4,Fourth Quarter, 1999.

, Nursing Workforce Challenges in California, The Center for the HealthProfessions, University of California, San Francisco, April 2000.

A Crisis for Caregivers: Health Insurance Out of Reach for Nursing Home Workers,A Special Report from SEIU, North America's Largest Healthcare Union,1998.

Bibliography

133

Direct-care Health Workers: The Unnecessary Crisis in Long-Term Care,Paraprofessional Healthcare Institute, New York, 2000.

Division of Occupational Safety and Health, Guidelines for Security and Safety ofHealth Care and Community Service Workers, "Nonfatal Assaults in theWorkplace," March 10, 1998. Retrieved fromhttp://www.dir.ca.gov/dosh/dosh publications/hcworker.html

Employment Projections by Occupation, Employment Development Department,Labor Market Information Division, Sacramento, 2000.Retrieved from: http://www.calmis.ca.gov/htmlfile/subject/occproj.htm

Ettinger, Judith M. [Ed.], Improved Career Decision Making in a Changing World,Garrett Park Press, Garrett Park, MD, 1991.

Fleishman, Edwin A. et al, "Know ledges" in Norman J. Peterson et al Volume I:Report, Development of Prototype Occupational Information Network(0*NET) Content Model, Utah Department of Employment Security, 1995.

Gottfredson, Gary D.and John L. Holland, Dictionary of Holland Occupational Codes,Psychological Assessment Resources, Inc., 3rd ed. Odessa, Florida, 1996.

Harrington, Charlene, Ph.D., R.N., et al, "Experts Recommend Minimum NurseStaffing Standards for Nursing Facilities in the United States," TheGerontologist, Vol. 40, No. 1, 2000.

, et al, "Nursing Home Staffing and Its Relationship to Deficiencies," Journal ofGerontology, Vol. 55B, No. 5, 2000.

, et al, Nursing Facilities, Staffing, Residents and Facility Deficiencies, 1992Through 1998, Department of Social and Behavioral Sciences, University ofCalifornia, San Francisco, January 2000.

Henly Julia R., "Mismatch in the Low-Wage Labor Market: Job Search Perspective,"in The Low-Wage Labor Market: Challenges and Opportunities for EconomicSelf-Sufficiency, The Urban Institute, Washington, D.C., 1999.Retrieved from: htto://aspe.hhs.gov/hsp/IwIm99/henly.htm

Holland, J.L., Making of vocational choices: A theory of vocational personalities andwork environments, (3rd ed.), Psychological Assessment Resources, Inc.,Odessa, FL, 1997.

In Search of Skills Standards for 2000 & Beyond, Employment DevelopmentDepartment, Labor Market Information Division, Sacramento, 1996.

The Quest for Caregivers134

Landy, Frank J. and Don A. Trumbo, Psychology of Work Behavior, The DorseyPress, Homewood, IL, 1976.

"Occupational Injuries and Illnesses and Work-related Fatalities Technical Note,"Compensation and Working Conditions, Bureau of Labor Statistics, Summer2000.Retrived from: http://stats.bls.gov/oshhome.htm

OES Employment and Wages by Occupations, 1999, Employment DevelopmentDepartment, Labor Market Information Division, Sacramento

0*NET (Occupational Information Network), Department of Labor, 1998 Retrievedfrom http://online.onetcenter.org

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135

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