Vermont Association of Professional Care
Providers Survey
Survey Methods and Data
In response to recommendations contained
in Vermont’s Paraprofessional Staffing Study of March 22, 2001, the Department
of Aging and Independent Living (DAIL) contracted with the Community of Vermont
Elders (COVE), a statewide nonprofit policy and program development
organization, to coordinate a process of assessing the viability of a
professional association of direct care workers and, if feasible, assisting
members of the workforce in structuring and making operational such an
organization. A crucial component in that process was to determine the
level of interest among direct care workers for such an organization, the range
of issues that workers would have the organization address, and the capacity of
workers to sustain the organization’s work over time. This effort was
underwritten by a Real Choices Systems Change Grant received by DAIL from the
federal Centers for Medicare and Medicaid Services (CMS).
In order to measure interest in and
potential support for the association and to identify issues of concern for direct
care workers which the association might address, a survey was developed for
distribution to the workforce. Pre-test survey questions were taken from
the Paraprofessional Staffing Study as well as feedback given at six Town
Meetings that were held during the month of July 2003 in Bennington, Newport,
Brattleboro, Berlin, Rutland and Burlington. A steering committee of nine
direct care workers also reviewed the survey drafts and gave input as did staff
of DAIL and COVE.
DAIL staff coordinated additional
review of the survey instrument by staff of the Departments of Developmental
and Mental Health Services (DDMHS) and Department of Prevention, Assistance,
Transition and Health (
In late December DAIL and COVE staff
reviewed the beta-test results and discussed modifications to the survey design
and mapped out a distribution process to include direct care and support
workers employed in developmental services, attendant services, mental health
services, children’s services, home health services, adult day services, and in
consumer-directed services (paid through the fiscal intermediary Acumen).
DAIL continued its work with DDMHS and PATH staff on issues of
distribution for direct care and support workers in developmental, attendant,
mental health, children’s and consumer-directed services while COVE focused on
distribution of the survey through employer groups representing home health
care and adult day services. COVE consulted with Flint Springs
Consulting’s Joy Livingston, the author of the Paraprofessional Staffing Study,
and ultimately subcontracted with her to assist with aspects of survey design
and statistical analysis.
In late January 2004 DAIL and COVE
staff discussed input received by DAIL from DDMHS and PATH regarding survey
design and wording. In order to increase consensus about the survey and its
intent and increase the likelihood of distribution by employers, the survey was
scaled back to nine questions. Employer comfort with the survey was
essential in order to ensure distribution to direct care and support
professionals as there was no other viable means of reaching the unlicensed
workforce.
Among the concerns raised by
employers and the state agencies with which they work about distribution of the
survey to direct care and support professionals were:
1. That the
professional association to be formed as a result of the survey would become a
union with some employers feeling that
they were advocates for their workforce.
2.
That, given their other day-to-day service and operational
responsibilities, the
distribution of a survey would be burdensome
and costly.
3.
That referring to direct care and support workers as
“professional” could be confusing
and not completely accurate resulting in
uncertainty about who should participate in
the survey process.
Over the course of 5 months, the
survey was delivered to approximately 6,020 direct care and support
professionals in all of the long term care and support service
categories. Some areas such as consumer directed care, adult day services
and home health care saw broad distribution of the survey; other areas had
lower distribution despite considerable outreach by staff from COVE, DAIL, and
DDMHS.
The survey of Licensed Nursing
Assistants (LNA), as the only state-certified professionals in the workforce, was
identified by DAIL and COVE as the scientifically significant control group
within the project. It was so because access to that group was direct and
the identities of members of that group were a matter of public record.
The Vermont Department of State issues licenses and renewals to LNAs.
Accessing the identity of 2000 active LNAs was achieved through the
Department’s records. That list of active LNAs was broken down by county
and within each county names of individuals were randomly selected to create a
statistically accurate sample. By selecting survey recipients by county,
the sample was sufficient to identify any regional differences that might
exist.
In March surveys and
self-addressed postage-paid envelopes were mailed to the statewide sample of
2000 LNAs. Three hundred twenty six responses were received, representing
a return rate of 16%. That response rate establishes the group as
representing the whole.
Surveying the balance of the
workforce was attempted through employers or fiscal intermediaries. As
explained, we were not able to obtain participation by all employers within
each category of service. The surveys were distributed by employers in two main
ways:
1. Payroll
insert; or,
2. Separate from
payroll but directly to employee such as distribution at staff meetings, in
individual staff mailboxes, etc. Some employers provided addressed return
envelopes and some included postage with the survey while others collected
responses and returned them as a group to COVE. A full and final
accounting of exactly which employers distributed the survey and to what number
of direct care and support professionals could not be finally determined
because not all employers responded to requests from COVE staff for the
information. In determining response rates, the assumption was made that
any employer who did not respond to the request for the number of surveys
distributed did not distribute the instrument to any direct care and support
staff.
From March to August approximately
4,020 surveys were distributed through employers or fiscal intermediaries to
direct care and support professionals employed in a wide range of service
settings.
These results are based upon a total of
980 direct care and support professionals who responded to the survey with an
average return rate of 18%. Please note
that not all questions were answered in each survey returned to COVE.
The data should be considered with the
following points in mind:
1. The only
scientifically selected and managed category of professionals for the survey
is
Licensed Nursing Assistants (LNA). LNA was
the only category in which direct contact could
be achieved by using information from the
Department of State.
2. This survey
did not test issues within the broad category of health insurance such as level
of coverage, and out-of-pocket expenses like
deductibles and co-pays. Typically nursing
homes and home health agencies provide or
offer some level of individual health insurance
coverage and smaller employers and fiscal
intermediary payroll organizations may not.
3. Many
different types of direct care and support professionals working in the entire
spectrum of long term care and support services
was surveyed. The nature and type of
their professional responsibilities differ
greatly as do their employment settings and
expectations.
4. Fiscal
intermediaries such as Acumen and
5. All home
health agencies, adult day programs, developmental services agencies, mental
health agencies and children’s
service agencies who distributed the survey are nonprofit
organizations. Some, but not all,
nursing homes are nonprofit organizations.
Scientific Data:
LNA (Licensed Nursing
Assistants) 324 surveys returned or 16% response rate
Non Scientific Data:
Acumen
359 surveys returned or
23% response rate
Adult Day
40 surveys received
or 30% response rate
ASP
53 surveys received
or 18% response rate
(Attendant Services
Program)
Developmental Services
66 surveys received or
10% response rate
(Includes ARIS)
Children’s
Services 16
surveys received or uncertain return rate
Home Health
95
surveys received or 11% return
rate
Mental
Health 27
surveys received or 28% return
rate