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March 14, 2007 – Bronx, New York -Allison Wagner, an accomplished campaign coordinator with over 15 years of experience running grassroots advocacy campaigns, has been named the National Campaign Manager for PHI’s Health Care for Health Care Workers (HCHCW) campaign. The campaign seeks to expand health coverage for direct-care workers in the United States.

Nationally, two out of five direct-care workers lack health coverage of any kind. The direct-care profession (nursing assistants, home health aides, personal care attendants, etc.) is one of the fastest-growing in the American economy, primarily because the number of Americans over 65 years old is expected to double between 2000 and 2030. During that same period, the number of people traditionally available to provide this care will increase by only 7 percent, creating the potential for a large “care gap.” Additionally, low wages and few benefits force many direct-care workers to seek other ways to make a living. Studies show that health insurance is key to keeping workers in their jobs.

“Direct-care workers provide most of the hands-on care that our nation’s elders and those living with disabilities depend upon each day,” said Wagner. “The fact that so many of these workers lack health insurance compromises the long-term care system in a variety of ways, not the least of which is many workers are just one injury or illness away from financial ruin, and having to leave the workforce altogether.”

In her new position, Wagner will be responsible for developing overall campaign strategy and assisting with the implementation of state-based campaigns. “While this is a national issue,” Wagner said, “it is primarily a problem being addressed at the state and local level. By and large, the federal government has been focused elsewhere in recent years.”

Before joining PHI, Wagner served as a coalition campaign manager for anti-tobacco advocacy campaigns, as a consultant to interest groups in the areas of voter mobilization and grassroots action, and as a candidate campaign manager. Most recently, she served as a consultant to issue and candidate campaigns, providing strategic planning services, research, and voter contact expertise. A graduate of Wake Forest University and a native of Maryland, she is based in the HCHCW national campaign office in Washington, D.C.

For more information about the Health Care for Health Care Workers campaign, visit www.coverageiscritical.org

To contact Allison Wagner, email: awagner@paraprofessional.org or call 718-928-2066.

January 24, 2007 – PHI will provide technical support and training to a three-year program funded by the U.S. Department of Labor (DOL) to expand the Health Support Specialist (HSS) apprenticeship program developed by the Kansas Department of Commerce.

The DOL’s $1.6 million grant to North Central Kansas Technical College will fund the The Golden Horizons Career Works Nursing Home Apprenticeship Program, providing a career path for universal workers in nursing homes. The apprenticeship includes training in culture change.

Participating employers will be supported by a team that includes area Workforce Investment Boards and the PHI, which will work with the technical college and Golden Gate to include its peer mentoring curriculum and adult learner-centered training approaches in the HSS apprenticeship. The major employer participating in the program is Golden Gate National Senior Care, the nursing home chain formerly known as Beverly.

In the first year of the grant, Golden Gate will implement the apprenticeship in 24 facilities in Kansas and Missouri. In the second year, the program will be expanded to 37 additional sites, including 6 in Michigan.

The project is part of a new set of community-based job training grants awarded last month by the U.S. Department of Labor. In a press release announcing the grants, Assistant Secretary of Labor for Employment and Training Emily Stover DeRocco said they “recall the imperative that businesses and the workforce system team up with their region’s community colleges to ensure that workers are armed with the right skills to thrive in the 21st century economy.”

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.

May 5, 2006 – A recent issue of Health Progress, the magazine for managers of Catholic health care organizations, featured an article outlining the Paraprofessional Healthcare Institute’s Elements of a Quality Job.

The article notes that implementing these elements can, as the summary puts it, “make the difference between chronic turnover, on one hand, and employing a dedicated staff large enough to keep pace with the growing need for long-term care and services, on the other.”

Breaking the Turnover ran in the November-December issue of the magazine, whose theme was “Workplace Issues.” It describes each of the then-seven elements (PHI has since expanded them to include nine) and briefly discusses strategies for putting them into effect.

The article also includes a sidebar describing the “Four Ps,” PHI’s curriculum for teaching communication skills to direct-care workers.

Health Progress is published by the Catholic Health Association of the United States.

April 6, 2006 – PHI’s Michigan Policy Director, Hollis Turnham, has been appointed to the Michigan Long-Term Care Supports and Services Advisory Commission. The group is charged with helping Michigan improve its long-term care system in several ways, in part by improving the quality of direct-care jobs.

The commission was appointed to implement the recommendations of the Governor’s Medicaid Long-Term Care Task Force. Turnham facilitated that task force’s workforce development work group, whose Recommendation No. 8 calls for the state to “Build and sustain a competent, highly valued, competitively compensated and knowledgeable long-term care work force.”

“The task force recommendations lay out the link between quality of care and the quality of training, leadership, and compensation associated with careers in long-term care,” says Turnham. “Now the commission is charged with helping the department actualize those recommendations and our expectations for high quality.”

Turnham is one of 14 appointees to the advisory commission. She and two others – a representative of SEIU Local 79 and a representative of the Michigan Association for Homes and Services to the Aging – were appointed to represent direct-care workers. One of the other appointees represents the general public, three represent providers of Medicaid-funded long-term care supports and services, and the other seven represent primary and secondary consumers of long-term care supports and services.

“It is important to ensure that our state’s long-term care services remain the highest quality,” said Governor Jennifer M. Granholm in a February 14 news release announcing the appointments. “This commission will play a critical role in implementing recommendations from the state’s Medicaid Long-Term Care Task Force and will serve as an effective and visible advocate for improving the quality of our long-term care system.”

The commission will assist the Office of Long-Term Care Supports and Services, which is the sole developer of long-term care policy within Michigan’s Department of Community Health.

October, 15, 2004 – With Medicaid costs rising rapidly, state policymakers are understandably reluctant to increase wages for Medicaid-funded direct-care workers, even when those wages are too low to lift workers and the families they support out of poverty.This creates a dilemma not only for workers but for employers and policymakers, since low wages make it more difficult to attract enough qualified workers. Finding sufficient workers is especially challenging in the critical and growing arena of home- and community-based personal assistance services, where wages tend to be lower and full-time work harder to find than in nursing homes and other institutional settings. Furthermore, states are obligated under federal law to pay Medicaid-funded workers enough to maintain a stable workforce of sufficient size to meet the needs of Medicaid beneficiaries, as underscored in the recent Ball v. Biedess ruling (for details, go to http://www.directcareclearinghouse.org/news.jsp#az82004).

But the burden to states of raising wages is not quite as onerous as it might seem. Every dollar a state invests in wages is partially offset by savings in other areas, including increased matching federal Medicaid funds and higher personal income tax contributions by higher-earning workers.

A new online tool allows state policymakers and other long-term care stakeholders to estimate the real costs and benefits of increasing wages for Medicaid-funded personal assistance workers. Free of charge and easy to use, the Return on Investment calculator estimates the effect on a wide range of factors – including, staff turnover costs, retention rates, and the number of families who would be leaving poverty – of a proposed wage increase of any size. The tool works for all 50 states and the District of Columbia.

To access the calculator, which was created by the Paraprofessional Healthcare Institute with funding from the Centers of Medicaid and Medicare Services, go to:
http://www.directcareclearinghouse.org/roi/index.html