December 19, 2006 - Four new policy reports from PHI offer in-depth reporting and analysis on issues of interest to state policy makers and Medicaid directors, consumer and worker advocated, long-term care providers, research, and other long-term care stakeholders.

Paying for Quality Care: State and Local Strategiesfor Improving Wages and Benefits for Personal Care Assistants

“Too little attention has been paid to the impact of low wages and benefits on the quality of care received by Medicaid personal care recipients,” says Dorie Seavey, PhD, principal author of Paying for Quality Care. “As part of quality assurance, states and the federal government need to monitor and develop standards for the compensation received by direct-care workers.”

Discussions of how to improve direct-care wages often are confined to wage pass-throughs, but Seavey and her PHI colleague and coauthor Vera Salter, PhD, identify seven strategies — including wage pass-through —that are being used to improve wages and/or benefits. Their report details pros and cons and provides local and state examples for each. It also documents the link between the quality of care and the adequacy and stability of the direct-care workforce and describes the haphazard method by which Medicaid state reimbursement rates —the principal driver of worker compensation levels —are set for home- and community-based services. The paper was commissioned and published by AARP’s Public Policy Institute.

Bridging the Gaps: State and Local Strategies for Ensuring Backup Personal Care Services

Bridging the Gaps, also written by Seavey and Salter for AARP’s Public Policy Institute, looks at what happens when a home care worker does not show up. “The problem of backup in home- and community-based services is tremendously important, and yet it’s not talked about much because it’s often hidden,” says Seavey, a labor economist and national policy analyst for PHI. When reliable backup services are not available to people with disabilities, they face emotional distress, physical harm, and loss of independence or self-determination.

This report examines state and local initiatives to ensure effective backup services for Medicaid personal care services. Three complementary strategies are considered: improving state requirements for backup services; developing effective tracking and monitoring systems; and supporting the development of backup management systems and programs such as “call-off” notification systems, specialized backup agencies, worker pools, and worker registries.

Addressing New York City’s Care Gap: Aligning Workforce Policy to Support Home- And Community-Based Care

Turning to one of the country’s largest home care workforces, Addressing New York City’s Care Gap points out that the direct-care workers who provide home- and community-based care to elders and people with disabilities in New York City account for one in seven of the city’s low-wage workers. What’s more, while the number of traditional caregivers is expected to shrink, the demand for these workers is expected to increase by 50 percent over the next ten years, making it one of the fastest-growing employment sectors in the city’s economy.

Noting that public workforce investment systems often shy away from investing in these jobs because of low wages and other job quality issues, authors Seavey, Steven L. Dawson, and Carol Rodat make a compelling case for a concerted public workforce investment strategy. They argue that “the low quality of direct-care jobs is not an ‘innate’ characteristic of this work,” but rather the very dimension that must be changed to keep up with future needs. Careful injection of workforce dollars, they add, can begin to address the need for more workers by improving job quality.

Prepared for the New York City Workforce Investment Board, the report identifies four key investment areas for upgrading the homecare profession and calls for collaboration between employers, unions, workforce development centers, and trainers to implement targeted initiatives.

Reimbursement Practices and Issues in Vermont’s Long-Term Care Programs

Vermont is often looked to as the vanguard of state rebalancing efforts because of its emphasis on consumer choice of long-term care settings and access to care. Reimbursement Practices and Issues examines the challenges raised by the state’s reimbursement and rate-setting practices in publicly funded long-term care services. The report was prepared by Seavey and PHI’s Hollis Turnham for the Long-Term Care Workforce Policy committee of the Community of Vermont Elders (COVE), a Better Jobs Better Care grantee.

Reimbursement Practices and Issues describes how rates are set across the state’s entire portfolio of long-term care settings and programs, clarifying what COVE Director Dolly Fleming calls “an extremely complex and confusing reimbursement system.” That system, the authors conclude, does not support the programmatic or fiscal goals of the state’s new Choices for Care Medicaid waiver program. Recommendations outline the ingredients of an improved reimbursement approach that would support quality care, sufficient provider capacity, and an adequate, well-trained and stable long-term care workforce. The report’s framing of data and analysis should also prove useful to policymakers in other states who wish to examine their long-term care reimbursement systems.

*Abstracts of all four papers, with links to their full text, can be found at PHI’s National Clearinghouse on the Direct Care Workforce at www.directcareclearinghouse.org.