Paid Feeding Assistants

How are paid feeding assistants (PFAs) faring in nursing homes? Does quality of care and resident safety suffer when PFAs, with just eight hours of formal training, help out at mealtimes? Are these single-task workers replacing higher-paid certified nurse aides (CNAs)? Are they being asked to perform tasks for which they lack proper training?

Results from a recent federally commissioned study suggest that PFAs are welcome additions to the nursing home staff. In interviews with researchers, administrators and management staff from seven nursing homes in three states were so pleased with the work of the PFAs in their facilities that they planned to train more of these workers. Similarly, nearly all of the 54 CNAs interviewed for the study reported that the PFAs were helpful and that they had no concerns about the work of these assistants.

The results of the study, the first of its kind, refute the concerns that initially greeted the federal PFA regulation. That regulation, issued in September 2003, allowed nursing homes for the first time to hire single task workers to provide feeding assistance to

This study used a standardized observation tool to assess feeding assistance quality. A modified version of the tool is available from the UCLA Borun Center website. The tool enables nursing homes to evaluate feeding assistance by scoring six quality indicators.

The intent was to boost staffing, and with it, quality of care, during mealtimes, when many nursing homes reported being short-staffed. Some resident and staff advocacy groups, however, feared the new regulation would compromise care quality as PFAs took over the work, and possibly the jobs of more highly trained and more expensive CNAs.

The new research findings, reported in the April, 2007, issue of The Gerontologist, are considered preliminary due to limitations in the studyÆs design; the researchers, from the Center for Quality Aging at Vanderbilt University and Abt Associates, Inc., a research consulting firm based in Massachusetts, used a convenience sample of nursing homes, as opposed to a random sample, so participating facilities may have been biased in ways that favor the use of PFAs. That said, the results are strong enough that they should help allay concerns about PFAs.

The researchers found that the quality of feeding assistance provided by PFAs was comparable to that delivered by CNAs. There were no reported changes in staffing levels following implementation of the PFA program, which suggests that PFAs were not replacing other line workers. And most other staff members not only supported the use of PFAs, but expressed enthusiasm about the program.

The study also shed light on the kinds of workers who fill PFA positions and what this new job entails. Five of the participating facilities trained as PFAs only non-nursing staff from their own facilities, including social workers, administrators, housekeepers, and dieticians. The other two facilities recruited from within as well as from the community. In four facilities, PFA training was voluntary; one required that all laundry and housekeeping staff complete the training; and the remaining two facilities wrote PFA training into selected job descriptions, such as housekeeping.

About half of the 39 PFAs interviewed for the study reported that they always helped the same residents at each meal. On average, each PFA assisted two residents per meal. All said they were comfortable with their mealtime assignments. Most PFAs helped with mealtime tasks other than feeding assistance, including transporting residents to the dining room, picking up meal trays, and delivering between-meal snacks to residents. A small minority of PFAs, all of whom he ld other, non-nursing jobs within the facility, assisted residents with non-meal-related tasks, such as walking, getting into or out of bed, and using the toilet.

The study findings are not the last word on the PFA program already the researchers are at work on a follow-up that will monitor two new PFA programs for a six-month period in two nursing homes but what they reveal about it is promising. In the facilities that use them, PFAs are proving to be assets, enabling nursing homes to provide quality care to more residents during busy mealtimes.

Thanks to Healthcare Excel for this informative article.