Beyond 'Unloving Care'

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Meadowlark Hills

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Chandler Hall

"Patient-specific knowledge is crucially important... Each resident has preferences, whether she can communicate them easily or not."

- Susan Eaton

Beyond 'Unloving Care'

"Beyond 'Unloving Care'" is a 2000 paper by Kennedy School of Government faculty member Susan C. Eaton that describes three possible approaches to nursing home care. She bases her research on interviews and observations in 20 nursing homes in California and Pennsylvania, and describes the "regenerative" approach as most effective for elders and also most cost-effective, from the limited data we have so far. She examines the jobs of the direct care workers, and how their work is organized differently in the "custodial", the "medical" and the "regenerative" models, this last reflecting Culture Change principles. She also recommends specific Human Resource management practices that promote and support culture change. You can read her paper by clicking here. The paper is in PDF format, so you will need to have Adobe's Acrobat Reader installed on your computer to view it. This program is a standard component of most modern computers, but if you don't have it you may download it for free from Adobe's website here.

Epilogue

The following eulogy was written by Elise Nakhnikian, and is reprinted with her permission.

In the final days of 2003, the community of direct-care workers and their advocates lost a leader, friend and inspiration when Susan Eaton died of complications from leukemia on December 30. She was 46.

An academic whose work was rooted in the real world, Eaton was "a deeply committed person, a person who walked the walk," says her husband Marshall Ganz, a civil rights activist who married Eaton in 1990. "She translated her values into action in her teaching, in her research and in her public life."

Eaton developed an interest in the challenges that face low-wage workers early in life. She learned about some of those challenges firsthand while working various entry-level jobs in her youth. According to a Boston Globe tribute published after her death, her work in an assisted living facility taught her that "the quality of care in nursing homes and other places had everything to do with the way the caregivers were treated."

After graduating from college, Eaton worked as a union organizer and educator for 12 years, working with direct-care workers in nursing facilities and hospitals, among others. She then returned to school, earning a master's degree in public administration from Harvard and a Ph.D. in management from the Massachusetts Institute of Technology before becoming an assistant professor of public policy at Harvard University's Kennedy School of Government in 2000.

Eaton's interests were both broad and deep. Her areas of specialization ranged from health care management to the role of women in union leadership, yet she made a significant contribution to the effort to demonstrate the link between job quality and care quality in long-term care. "Susan was one of those remarkable academics who wanted her research to truly make a difference in the lives of others, particularly those in the workforce that need a stronger voice," says Susan Gershenfeld of the Massachusetts Aging Services Association.

Eaton served as a principal evaluator for the Extended Care Career Ladder Initiative (ECCLI) in Massachusetts, studied reasons for varying turnover rates within labor markets, and published research on long-term care facilities in California, Pennsylvania, Washington, Kansas, Wisconsin, and Massachusetts. Her work, says fellow researcher and worker advocate Mary Ann Wilner, was "original, respectful, far-reaching and yet built on incredible detail and acute listening to informants. She was able to bring very good qualitative research to policymakers in a way they could hear it and use it."

In memorializing Eaton, her long-term care colleagues - many of who were also her friends - consistently mention her gift for forging connections, not only between abstract ideas but between people. "Susan Eaton was the kind of person who felt like a close friend within five minutes of meeting her," says Debra Lipson, deputy director of the Better Jobs Better Care Program. "She had a way of showing genuine interest in people's lives and finding out what was important to them almost immediately. At the same time, she displayed a ferocious intellectual curiosity about how their experiences and views could deepen her already formidable knowledge of many issues."

Her illness did not dull her interest in others. "Watching Susan at the hospital, I saw her bringing our work to life," says Barbara Frank of the Paraprofessional Healthcare Institute. "Within a few days during her first stay in September, she knew all those caring for her - not just their names but about their lives outside of the hospital, how they felt about their work, and what their systems were for working together. She was brilliant and caring, as she tuned in to and paid attention to those caring for her."

Researcher Lois Camberg says Eaton taught her the importance of communicating academic findings to long-term care practitioners. Camberg subcontracted with Eaton under ECCLI to evaluate a small project. The goal of the project, which introduced new bathing strategies for Alzheimer's residents into four nursing homes, was to improve the experience for both residents and nursing assistants.

"When the project was completed, Susan suggested we write it up for publication," Camberg recalls. "I thought, 'What type of reputable journal would accept a manuscript based on a sample of eight?' Major research had already been published on the topic. In my academic mind frame, I saw no way of publishing these results."

Eaton gently persisted, suggesting that Camberg approach trade magazines rather than academic journals. Camberg and her collaborator finally submitted an article to Nursing Homes magazine, whose editors accepted it, calling it "groundbreaking work in a very important area."

"This experience has Susan's imprint all over it," Camberg concludes. "Rather than being focused on the prestige or necessity of publishing in peer-reviewed journals, Susan was proposing that we place it where it would be most useful. Because of Susan's commitment to the people who 'do the work,' I am now committed to finding out how to get more highly sophisticated research results to the places that will make the most difference."

This copyrighted text is reprinted with permission from Quality Jobs/Quality Care, the biweekly online newsletter of the National Clearinghouse on the Direct Care Workforce. To subscribe to the newsletter, visit the Clearinghouse website at www.directcareclearinghouse.org.