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July 26, 2007 – A powerful new resource from PHI’s Health Care for Health Care Workers campaign, www.coverageiscritical.org has something for everyone with a stake in improving the quality of care in our nation’s long-term care system.

People receiving long-term care services and their friends and family members can learn about why health care coverage for direct-care workers is so important and how it affects the quality of care they depend on.

Providers can find out about what managers of nursing homes, assisted living facilities, home care and home health agencies, and other long-term care organizations are doing to provide affordable coverage for their employees – and whether there’s a campaign in their area that they can participate in.

Direct-care workers can keep up with the latest news from the campaign and find out if there’s a campaign in their state to get involved in.

Policymakers can read up on the five ways of expanding coverage and link to examples of each. They can also download the text of current and proposed laws that have been drafted to expand health care coverage across the country.

Members of the media can read press releases, testimonials from people affected by the issue, and news from the campaign. They can also contact key campaign staff and download fact sheets and print-quality graphs and other artwork.

Anyone who cares about this issue and wants to make a difference can visit our Get Involved section to:

• Share your story;
• Sign our petition;
• Download our advocacy tool kit;
• Sign up for regular e-mail updates;
• Volunteer to help spread the word; or
• Make a tax-deductible contribution.

Come see what Health Care for Health Care Workers can do for you – and what you can do to help direct-care workers get the health care coverage they deserve.

July 3, 2007 – “The eldercare field, to a very large degree, now knows how to recruit and retain paraprofessional workers,” Steven L. Dawson, president of the Paraprofessional Healthcare Institute (PHI), told the Institute of Medicine (IOM) Committee on the Future Health Care Workforce for Older Americans. “There is no mystery here: If tomorrow we paid these individuals a livable income, offered them health insurance, trained them better, supervised and supported them—listened to them—we would solve this unnecessary ‘workforce crisis’ in a matter of months.”

So why the shortage of the home health aides, certified nurse aides, and personal care attendants who provide at least 80 percent of our paid long-term care services? The problem, says Dawson, is that we’re used to seeking out “best practices,” when what is needed is systems change.

The IOM committee is gathering expert testimony and conducting research for a consensus study on the optimal health care workforce for older Americans in an aging society. Its report, which will include sections on how best to educate, recruit, and retain workers, is due next March. Dawson was invited to speak at a June 28 meeting of the 15-member group in San Francisco.

The real barriers to recruiting and retaining a stable and adequate direct-care workforce, Dawson told the committee, are lack of implementation capacity and lack of political will. Dawson cited:

• A dearth of trainers who know how to deliver adult-centered learning;
• Limited numbers of nurse supervisors who know how to guide and support paraprofessional workers; and,
• An absence of administrators who know how to create a work environment that is truly person-centered—for both consumers and workers.

Noting a lack of motivation on the part of policymakers to solve the workforce problem, Dawson suggested that there may be multiple reasons for this failure of political will: “Policy makers may falsely believe that there still exists an endless supply of women willing to work for low pay and few benefits. Or it might be due to the fact that 70 percent of long-term care is paid for by third-party government programs, and we know that those third-party payors are not only under great pressure to control costs, but that structurally they also respond very slowly, if at all, to market forces. Personally, I believe a central cause is that policy makers are usually of a different race, class and gender from the low-income workers who typically provide this care, and therefore these workers are, simply, invisible.”

Dawson told the committee about nine Essential Elements of a Quality Job that PHI has identified, through its work in the field and its analysis of existing research. A 15-page insert in Dawson’s presentation details the strong evidence-based research establishing the impact of these nine elements on paraprofessional workers and the people they assist.

Dawson also laid out a set of recommendations to address the lack of implementation capacity and political motivation, including:

• Call for a public investment in the training of those who shape the quality of paraprofessional jobs, including educators, supervisors, and administrators
• Call for investments in state-based training systems to prepare paraprofessionals for both home- and facility-based care settings, create career ladders for paraprofessional, and support statewide requirements and core competencies
• Acknowledge the full value and importance of the paraprofessional workforce for elder services.
• Support the use of national job quality/workforce indicators such as turnover rates, staffing levels, wages, and benefits to create incentives for adequate and safe staffing, better education and training, and greater workforce stability.
• Call for a full and realistic public investment in the long-term care workforce, adequate to support the nine Elements of a Quality Job.

To read Dawson’s presentation and recommendations, go to http://www.paraprofessional.org/publications/Dawson_IOM_6-28-07.pdf.

June 19, 2007 – Vera Salter, PhD, Director of the National Clearinghouse on the Direct Care Workforce since its founding in 2000, left her full-time position at the end of May.

Salter built the Clearinghouse into the premier national information resource supporting the movement to improve the quality of long-term care through the creation of quality jobs for frontline workers. The Clearinghouse website currently receives as many as 40,000 visits per month.

President Steven Dawson of PHI, the parent organization of the Clearinghouse, praised Salter’s efforts: “The National Clearinghouse has become a trusted source of information and analysis for the full range of stakeholders across the field. Its library, state activities pages, best practice profiles, and worker voices provide a wealth of information to all those working to improve the quality of jobs for direct-care workers. Vera has been the driving force behind this excellent resource.”

“Vera has been a valued contributor to the PAS Center,” says Teresa Scherzer, PhD, MSW, of the Center for Personal Assistance Services at the University of California, San Francisco. “Her collaboration with the Center has contributed to the knowledge and dissemination of state- and community-based efforts to improving working conditions of personal care workers. Moreover, her warmth, humor, and positive spirit infuses her collegial relationships and makes her a valued colleague and friend.” The Clearinghouse contributes information to the PAS Center website.

Salter is now working as an empowerment coach and consultant. She will remain involved in the direct-care workforce movement as a member of the board of the Direct Care Alliance.

In the wake of Salter’s departure, PHI is reorganizing its communication department. PHI’s Director of Communications Karen Kahn will serve as the temporary director of the Clearinghouse until PHI hires an Online Communications Specialist to oversee an even more robust PHI web presence. PHI currently maintains three separate websites — www.directcareclearinghouse.org, www.coverageiscritical.org, and www.paraprofessional.org —all of which will soon be accessible through a single web portal. PHI will launch the new website, which will provide users with more advanced search and interactive capacities, in 2008.

June 8, 2007 – Joe Angelelli, PhD, is joining the Paraprofessional Healthcare Institute (PHI) as its Pennsylvania State Director. Angelelli will assume his new position on July 2.

“We are thrilled that Joe will be joining PHI,” says National Policy Director Steven Edelstein. “He is a passionate long-term care reformer who brings with him a great depth of knowledge and experience, both as a researcher and as a coalition-builder.”

Angelelli comes to PHI from the Pioneer Network, where he had served as Director of Networking and Development since 2005. “Joe brought energy, passion and expertise not only to the Pioneer Network but to the entire culture change movement,” said Bonnie Kantor, executive director of the Pioneer Network. “His new position is an exciting one, which will allow him to build on the work he did here.”

Before joining the Pioneer Network, Angelelli was an assistant professor in the Community Health and Health Policy and Administration departments of Brown University and Pennsylvania State University. He has conducted research on health care issues in long-term care and other settings and written numerous articles for peer-reviewed journals about nursing homes and the culture of aging in the United States. He earned his PhD in gerontology and public policy at the University of Southern California.

“I know Joe will do an incredible job in bringing people of the commonwealth together to improve the quality of direct care jobs and quality of care for long-term care consumers,” says Edelstein.

June 6, 2007 – Montana has approved a new way of providing health care coverage for health care workers. As of January 2009, the state will increase its Medicaid payments to agencies that deliver in-home care so they can purchase health insurance for a significant number of their direct-care employees.

“We applaud Montana’s ground-breaking legislation,” says Carol Regan, director of PHI’s Health Care for Health Care Workers (HCHCW) initiative. “This is part of a growing national trend that will benefit everyone who needs long-term care services — and the family members who care for them.”

The direct-care workforce in long-term care (nursing assistants, home health aides, personal care attendants, etc.) is one of the fastest-growing in the American economy. Key to keeping up with increased demand is lowering the profession’s alarmingly high turnover rates, and studies show that health insurance helps keep workers in their jobs. Yet approximately two out of every five direct-care workers lack health care coverage.

The Montana effort, called Healthcare for Montanans Who Provide Healthcare, allows employers to offer health insurance to personal care attendants and private duty nurses. The state’s budget for the coming biennium includes an additional $2.6 million to raise payments to employers who participate in Medicaid in-home care. Federal matching funds will bring the total to about $5 million a year. To receive the extra money, employers must agree in writing to spend it on health insurance for their direct-care employees, which must meet a set of quality criteria established by the state. The plan is expect to cover 1,000 currently uninsured workers. The bill was signed into law on June 1.

A separate piece of legislation also passed this year. Senate Bill 206 requires Montana’s Medicaid agencies to look into funding insurance in a similar fashion for nursing homes, developmental disability community service agencies, and other long-term care organizations.

“To me what we are doing here is a great example of how private business and government can and should work closely together to get something done and make a positive difference in people’s lives,” says Bill Woody, president of Consumer Direct Personal Care and Nightingale Nursing. “I am thrilled that the Montana Legislature has recognized the dedication of our employees, the valuable work done by in-home caregivers and the critical role that the ability to offer affordable health insurance plays in enabling businesses such as ours to recruit, hire and retain qualified workers.” Woody’s in-home care agency developed the concept paper that gave birth to the Montana insurance initiative and spearheaded the effort to secure funding from the legislature.

“Montana has taken a significant step towards ensuring the availability of a high-quality long-term care workforce now and in the future,” Woody says. “At the same time, we will all clearly reap positive social and economic benefits because more of our fellow citizens have health insurance.”

Woody, who also owns and operates in-home care agencies in Arizona, Alaska, Nevada, and New Mexico, believes other states should consider replicating or adapting Montana’s approach. “The issues that make this initiative important — the emerging crisis in the long-term care workforce and general lack of affordable health insurance — are not unique to us,” he says. “It seems to me we are all grappling with the same problems and challenges. Why not learn from each other?”

HCHCW is already working with several other states and employers who are finding new ways to cover direct-care workers. For example:

• In Maine, HCHCW is supporting LD 1687, which would make it easier for direct-care workers and their employers to enroll in state-subsidized health insurance.
• In Pennsylvania, HCHCW is supporting Prescription for Pennsylvania, a comprehensive bill that would expand health coverage to low-income families and workers – including many in direct-care – employed by small businesses.
• In Michigan, HCHCW is working with a large nursing home company to make health insurance affordable and accessible for direct-care staff.

“We’re excited about the progress being made in Montana and elsewhere,” says Regan. “We look forward to working with more states as they expand health coverage to the uninsured or restructure their long-term care systems.”

May 24, 2007 – As part of its Health Care for Health Care Workers initiative in Pennsylvania, PHI is helping to shine a spotlight on the needs of the commonwealth’s direct-care workers.

On May 4, PHI held a briefing for Allegheny County legislators on how the Prescription for Pennsylvania, a new statewide legislative plan to reform health care, would benefit direct-care workers. That same day, the Pittsburgh Post-Gazette ran an editorial by Tracy Lawless, head of the Pennsylvania HCHCW initiative, about the need for affordable health insurance for direct-care workers. Lawless, who had spoken at a May 3 press conference in support of the proposed law, also did a radio interview on Metro Networks News after the hearing. Lawless also helped organize a May 23 rally in support of the bill.

PHI is part of a coalition of Pittsburgh-area groups, including Consumer Health Coalition and Mon Valley Unemployed Committee, who support the legislation. The coalition called the press conference to address the media covering the second day of hearings by the House Insurance Committee. They spoke about the need for affordable, quality health care for all Pennsylvanians.

The coalition also sent a letter to state legislators urging them to support the legislation. “The Prescription for Pennsylvania would reduce health care costs and, we believe, slow the growth in insurance premiums that continues to force more employers to drop coverage and swell the ranks of the uninsured,” the letter says.

The state’s new plan would subsidize workers who earn less than 300 percent of the federal poverty level, which would make most direct-care workers eligible for subsidies, since the average wage for a direct-care worker in Pennsylvania is $9 an hour.

Speakers at PHI’s legislative briefing included a direct-care worker, a consumer, and a home care employer, who talked to legislators about challenges facing the direct-care workforce and the need for long-term care reform, including better health care coverage for caregivers. In attendance were local state elected officials, representatives from the Governor’s office, and several state and federal legislative staff.

“With the nation’s third-oldest population and the fastest-growing segment of people over 80, long-term care must be a top priority for the Commonwealth,” said Rep. Todd Eachus, Majority Policy Chairman and co-host of the event, in a PHI press release. “Quality care starts with direct-care workers, and lawmakers need to know the facts about what these professionals face every day.”

About 700 people attended the rally to promote health care coverage for low-wage workers, according to an article in the Pittsburgh Post-Gazette. The article quoted Lawless as saying that employers are reluctant to provide insurance because of the high cost, but paying for coverage could save money in the long run by cutting down on the cost of recruitment and training as retention rates improved.

In her op-ed, Rx for Pennsylvania: Health-care workers need health-care coverage,

Lawless wrote: “What happens when direct-care workers lack health coverage? Many are forced to seek better-paying jobs with health benefits so they can care for themselves and their families. Who suffers? Pennsylvanians who need long-term care.”