November 20, 2007 – PHI President Steven L. Dawson is the recipient of the 2007 Cindy Marano Trailblazer Award for Innovative Leadership in Sector Workforce Development. The award was presented to Dawson on November 14 by the National Network of Sector Partners, on behalf of his work at PHI.

The Trailblazer Award for Innovative Leadership is given in recognition of innovation and excellence in industry-specific workforce strategies that bridge the needs of employers and workers. A national committee of his peers – senior practitioners of sector workforce development – chose Dawson for the honor.

“It’s possible that there may have been, eventually, a sectoral workforce development field without Steve Dawson—but I doubt it would ever have been taken nearly as seriously as it is today,” says Andy Van Kleunen, the executive director of The Workforce Alliance. “Steve was among very few folks who, over a decade ago, challenged the workforce field to think not only about training workers, but also about changing jobs and industries for the benefit of both employees and employers. That wasn’t just a slogan for Steve. He knew the amount of work it would require for a sectoral initiative to demonstrate its true value as an expert within an industry. But Steve and his PHI colleagues didn’t shy away from the challenge, and the direct-care industry—workers, clients, and firms—is the better because of it. It’s the gold standard of the sectoral field.”

Also this fall, Dawson co-authored a book in collaboration with three colleagues from the Aspen Institute in the field of sectoral employment development. Sectoral Strategies for Low-Income Workers: Lessons from the field describes how sectoral programs are helping workers, regional economies, and businesses become more competitive.

November 19, 2007 – Last month, Amy Robins became PHI’s fifth state policy director, expanding the organization’s presence in Massachusetts and adding to the overall depth of PHI’s policy team.

Robins’ hire allows PHI to assume a more active role in long-term care issues affecting Massachusetts. Previously, PHI facilitated the formation of a direct-care coalition that supported the passage of the Massachusetts Extended Care Career Ladders Initiative (ECCLI), which brought educational opportunities to direct-care staff in home and residential care.

“We look forward to collaborating with PHI once more,” says Carolyn Blanks, vice president of labor and workforce development for the Massachusetts Extended Care Federation. “PHI staff were vital partners in some of our past efforts to support Massachusetts’ direct-care workforce, and I know Amy will be a great help going forward.”

More recently, PHI’s New England team has been focused on the Northern New England LEADS Institute, which worked with 12 long-term provider organizations to improve direct-care worker retention and the quality of caregiving in Vermont, New Hampshire, and Maine. Meanwhile, the passage of the Massachusetts Health Care Reform Law and the establishment of the Quality Workforce Council has positioned Massachusetts to become a leader in improving the quality of long-term care for elders and people with disabilities by committing to quality jobs for direct-care workers.

Robins comes to PHI following seven years at the Boston-based non-profit Jobs for the Future (JFF). In her role as a program director, Robins led national efforts to advance low-wage workers through education and workforce strategies. “Amy has focused her career on meeting the needs of low-wage working populations,” says JFF President and CEO Marlene Seltzer. “Her new position will allow her to apply her extensive national knowledge to the concerns of the Commonwealth. PHI and direct-care workers in Massachusetts are lucky to have her.”

Before joining JFF, Robins managed the welfare-to-work program at the Seattle-King County Workforce Development Council for three years. She has also worked in the Women’s Bureau at the U.S. Department of Labor and spent five years as a legislative aide for the U.S. Congress. Robins is a graduate of Wesleyan University and holds a Master of Public Administration from the Evans School at the University of Washington.

Robins joins a policy team at PHI that includes focused activities in Michigan, New York, Northern New England and Pennsylvania and a growing national agenda. Her understanding of working with Workforce Investment Boards and community colleges will not only help her in her work in Massachusetts but strengthen the policy team overall. Robins’ position was made possible by a grant from the Boston Foundation.

“PHI is thrilled to have a renewed presence in Massachusetts, and even more excited to have a person of Amy’s caliber leading that effort,” says Steve Edelstein, national policy director for PHI. “I know Amy will do a terrific job advancing the cause of quality jobs and quality care in the state and help raise the level of PHI’s policy work with our nation’s workforce development system on behalf of all direct-care workers.”

November 16, 2007 – “Eligibility does not guarantee coverage,” testified PHI New York Policy Director Carol Rodat at a public hearing on expanding health care coverage in New York state. “Attention must be paid to the characteristics of the uninsured population, eligibility levels, and especially enrollment procedures. The demographic, income and work hours of direct-care workers make these design elements particularly critical.”

Rodat spoke at a November 2 hearing in Manhattan, which was held by the New York State Departments of Health and Insurance at the direction of Governor Eliot Spitzer. Explaining how to make health insurance coverage affordable and accessible for direct-care workers, she focused on the state’s home care workforce. Characteristics that make these workers hard to ensure include their often part-time status and irregular hours, low income levels, high on-the-job injury rates, and high-risk demographics, she said.

New York has traditionally done a better job than most states of covering this challenging population, she noted, thanks in part to “aggressive implementation of public coverage programs, facilitated enrollment, and subsidizes for premium costs.” But rising health care costs threaten to erode that coverage, and new proposals for extending coverage must be analyzed to ensure that they meet the needs of home care aides and other low-income workers.

Rodat raised questions that must be answered as New York implements the Family Health Plus Buy-in. She also discussed other options for covering home care workers, such as the state’s Employee Health Care Enhancement Initiative, which is available for direct care workers working with developmentally disabled.

Ensuring that home care workers have health care coverage is important, “since coverage means not only health insurance coverage for the home care worker, but coverage for the thousands of elderly, frail, sick and disabled who depend on their aide to ‘cover’ their needs for that day.”

Rodat’s testimony:

• Executive summary
• Full text

November 15, 2007 - Joe Angelelli, PHI’s Pennsylvania State Director, testified before the Pennsylvania House of Representatives Aging and Older Adult Services Committee on the sale of HCR Manor Care, a large for-profit chain, to a private equity group.The Pennsylvania hearing was part of a new focus on the buying of large nursing home chains by private equity firms, which began with an extensive investigative feature in the September 23 New York Times. The article examined that trend and documented a decline in average nurse staffing levels – and care quality – under private equity ownership.

In his November 13 testimony, Angelelli noted that Manor Care nursing homes in Pennsylvania already staff below the minimum level recommended in a 2001 report to Congress and expressed concerns that staffing levels would decline even more under private equity ownership. “The critical threshold for nursing assistants identified in the report to Congress is 2.8 hours per resident day for long-stay nursing home residents. The 2.01 hours per resident day observed in Manor Care nursing homes in Pennsylvania is clearly below that threshold,” said Angelelli.

Also testifying were Kevin Hefty, Vice President for SEIU Healthcare Pennsylvania; Sarah Reese-Carter, the surviving daughter of a ManorCare resident; and David Adams, a resident of a ManorCare home in Pittsburgh.

“Manor Care may come under pressure to further cut staffing in order to service the massive $5.5 billion debt it will have once the deal is complete,” Hefty said. “SEIU estimates the increase in the interest expense alone in just the first year after the Carlyle takeover to be $400 million…. If Manor Care pays for the $400 million in higher interest payments by cutting costs evenly across the company, 177 CNAs will be cut from the company’s Pennsylvania homes. This would translate into a cut in the care each resident receives from CNAs from 2.0 hours to just 1.8 hours per day.”

Adams spoke of dedicated staff stretched so thin they could not provide adequate care, including a nursing assistant named Beth, who he said quit five days earlier because she would have been penalized for visiting her sick son in the hospital instead of working an extra shift. “If Manor Care doesn’t care for their staff, then how can they say that they truly care for their patients?” Adams asked. “I think that the type of care that you get from staff is a reflection of how they are treated on the job.”

Angelelli recommended that the Department of Health include the following in its review of Carlyle’s application and as a normal part of licensure approval:

• Assessment of facility’s level and stability of staffing
• Assessment of facility’s quality of care for residents
• Assessment of facility’s structural capacity to provide care
• Incentives to adopt human resource and management practices that promote quality of care
• Compliance and monitoring mechanisms

U.S. Senator and Presidential hopeful Hillary Clinton (D-NY) has called for a GAO study into long-term care ownership and the U.S House Committee on Ways and Means held a hearing today on the subject in Washington, D.C.

Press Release (pdf)

November 7, 2007 – Edwin Méndez-Santiago, Commissioner of the New York City Department for the Aging, has named PHI as one of two winners of the 2007 Commissioner’s Award for Innovation.

PHI is a Bronx-based nonprofit that works to ensure high-quality, cost-effective services for long-term care consumers by helping create quality jobs for direct-care workers. It develops innovative recruitment, training, supervision, and client-centered caregiving practices. It also advocates for the public policies needed to support those practices and staffs the National Clearinghouse on the Direct Care Workforce, a national on-line library of news, research, best practices, and other information to solve the direct-care staffing crisis in long-term care.

The commissioner is recognizing PHI for its work on behalf of direct-care workers who assist older New York City residents in their own homes. PHI sponsors Pathways to Independence, a New York City home care service and training network that includes:

• The SKILL Center, which uses learner-centered teaching principles to train more than 500 low-income residents a year to become home health aides;
• Independence Care System (ICS), the only partially capitated Medicaid managed-care plan in the state for people with physical disabilities, which currently serves 1,200 people; and
• Cooperative Home Care Associates (CHCA), an 1,100-worker, employee-owned home care agency in the South Bronx. CHCA is the first worker-owned home care agency ever established in the United States, and the nation’s largest worker cooperative of any kind.

PHI traces its roots back to CHCA, from which it became independent in 1992. As a nonprofit, PHI was charged with spreading the “quality care through quality jobs” principles that underlie CHCA’s business model. That model includes comprehensive training for new workers, which doubles the federally mandated 75 hours, and a supportive environment that emphasizes on-the-job training, coaching, and access to public services to allow workers to overcome obstacles to steady employment. It also includes career ladder opportunities for home health aides, who may graduate to positions as peer mentors, assistant instructors, assistant coordinators, or coordinators.

“When I’m talking to home health aides, I bring in a lot of my experience as an aide,” says Denise Clark, a CHCA coordinator who started there in 1992. “Sharing stories helps people open up to you. They trust you, they start to come to you. You knock down barriers and they stay longer.”

“They blossom like a flower,” agrees peer mentor Joann Poue, who started at CHCA 19 years ago, also as an aide. “When they start work here, the rose is closed up. The minute they find out that you worked in the field, the rose starts opening up.”

The Commissioner’s Award for Innovation is presented annually to recognize exceptional work in caregiver research, program development or service by an individual or organization. Previous honorees include United Hospital Fund, Cobble Hill Health Center, and Isabella Geriatric Center. This year’s other winner is Con Edison, which was recognized for its commitment to its employees’ caregiving needs.

PHI’s award will be presented to PHI President Steven L. Dawson by Commissioner Méndez-Santiago on Wednesday, November 7, in conjunction with the 23rd Annual Mayoral Conference on Alzheimer’s Disease, the largest municipal conference of its kind in the country.

“We thank Commissioner Méndez-Santiago for this award and for his leadership,” says Dawson. “We accept this honor on behalf of the direct-care workers throughout the city. We particularly thank the home health aides from CHCA.

“Without their dedication, skill, attention, and compassion, New Yorkers with Alzheimer’s and other chronic illnesses or disabilities and their families would face a very bleak future.”

Press Release (pdf)

October 31, 2007 – “HR 3582 offers Congress an historic opportunity to send three important economic and social signals,” said Dorie Seavey, PHI’s director of policy research, in an October 25 hearing on a proposed bill to extend minimum wage and overtime protection to home care workers. “First, that home care workers should be on an equal footing with respect to all other low-wage occupations. Second, that, within long-term care, the home care labor market should not have second-class status with respect to compensation—and, therefore, with respect to its ability to attract and retain workers. And finally, that federal lawmakers can work together to coordinate, rather than send conflicting messages about, the direction of our nation’s long-term care policy.”

The background: The federal Fair Labor Standards Act (FLSA) was enacted in 1938 to ensure a minimum standard of living for workers through the provision of a minimum wage, overtime pay and other protections. It excluded domestic workers. In 1974 the FLSA was amended to include domestic employees such as housekeepers, full-time nannies, chauffeurs, and cleaners. However, a narrow exception was retained for babysitters and for employees who provide “companionship services to individuals who because of age or disability are unable to care for themselves.” The U.S. Department of Labor interpreted that “companionship exemption” as including all direct-care workers in the home, even those employed by third parties such as home care agencies.

In 2007 the United States Supreme Court, in a case brought by New York home care attendant Evelyn Coke, upheld the DOL’s interpretation of the companionship exemption. As a result, all direct-care workers in the home—whether they provide health-related or personal assistance services—are defined as “companions” and denied FLSA protection.

The bill: In response, Senator Tom Harkin (D-IA) and Representative Lynn Woolsey (D-CA) introduced the Fair Home Health Care Act (S. 2061/H.R. 3582). This bill would reword the 1974 amendment to extend federal wage and hour protection to home care aides. If enacted, only home care workers employed on a casual basis and “live-in” aides would be exempt.

The hearing: At the October 25 hearing held by the Subcommittee on Workforce Protections of the House Committee on Education and Labor, Brooklyn-based home health aide Manuela Butler testified that, if her client were in a nursing home, she would earn overtime for the extra hours she often puts in. “But because my work helps her to stay in her home, I am deprived of overtime pay,” she said. “That’s just wrong and unfair.”

Not only is this inequitable, Seavey added, but “maintaining this imbalance between the basic compensation available to home care and nursing home workers also undermines federal policy that encourages states to ‘rebalance’ their publicly funded long-term care systems in order to provide more home- and community-based.”

Henry Claypool, the policy director of Independence Care Systems, called rebalancing “the number one civil rights issue in this country” for people with disabilities. Exempting home care workers from wage and hour protections, he said, “exacerbates the institutional bias by making direct-care jobs in nursing homes more attractive than comparable jobs in community settings.”

Exempting home care workers from FLSA protection also hurts workforce development efforts, Seavey noted, effectively undermining the status of home care work relative to other low-wage jobs. “It is basically impossible to construct any economic argument as to why other domestic or household-based service jobs such as maids, cooks, housekeepers, and gardeners should receive this basic protection but home care workers should not.”

As to cost, that would need to be carefully evaluated on a state-by-state basis, Seavey said. “While there could be significant budgetary and service delivery implications in some states that would require adjustments in federal and state funding—at least during some transitional period—it is quite possible that the costs may not be as high as some fear.”

Virtually all 800,000 home care workers now in the labor force earn at least the federal minimum wage, Seavey testified, so the only significant economic cost associated with granting FLSA protections would be overtime pay—and the vast majority of aides do not work overtime. What’s more, at least 16 states and the District of Columbia already mandate overtime pay for some home care workers. Predictions of massive dislocations of care are really inconsistent with the experience of these states, Seavey argues.

William A. Dombi, vice president for law for the National Association for Home Care & Hospice (NAHC), recommended that FSLA protections be granted only as “part of a comprehensive plan to address home care aide protections and employment,” including additional state and federal funding to pay for overtime, health care coverage, career support, background check systems, and “consistent employee protections” such as workers’ compensation, unemployment compensation, OSHA safety, and “worker qualifications.”

“We welcome NAHC’s call for a comprehensive approach to improving the quality of home care jobs, and look forward to working with them to achieve that goal,” says Steve Edelstein, national policy director for PHI. “Clearly, the best way to meet the needs of older persons and persons with disabilities is ensure that care is provided by direct-care workers who are well-trained, well-supported and have quality jobs. However, we do not believe this to be an either/or choice of a comprehensive versus a piecemeal approach.

“Ending wage and hour discrimination against home care workers is a fundamental first step—one we can take now, while we work to develop a consensus on an omnibus legislative solution.”

More on the Fair Home Health Care Act:

• The Fair Home Health Care Act
• Testimony offered at the October 25 hearing
• PHI’s Fair Home Health Care Act analysis