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(L-R) Dr. Melissa Scollan-Koliopoulos, UMDNJ-University Hospital; Rosa Ortiz, home health aide, Central Jersey VNA

Certified home health aides will play an integral role in efforts to prevent re-hospitalizations when a new project at the University of Medicine & Dentistry of New Jersey (UMDNJ) is launched.

The “I CARE-4-Healthcare Transition Project,” designed to prevent discharged patients from returning to the hospital within the first 30 days after they leave, will utilize a four-tiered approach to care that includes a:

• certified home health aide/patient navigator
• registered nurse
• advanced practice nurse (APN), and
• physician team.

The certified home health aide/patient navigator will be responsible for visiting patients who are in the hospital and following up after they are discharged to the community, a hospital press release explains. The APN will provide care with “physician collaboration until a patient can see a primary care physician regularly.” [Scroll down for a further explanation of home health aides' role in the program from co-director Melissa Scollan-Koliopoulos, Ed.D.]

Reduce Costs, Improve Health Outcomes

A key aspect of the project will be to help patients determine when they need to go to a hospital emergency room or when they should see a primary care physician instead, in order to reduce costs and improve health outcomes.

Educating patients about medications and overall health and wellness, as well as connecting them to resources such as health insurance, are also project goals.

Patients enrolled in the project will receive support in self-management prior to being discharged.

People are eligible to participate in the project if they do not have a regular primary care physician and if they have one or more of the following diseases:

• diabetes
• cardiovascular disease
• respiratory disease
• HIV, and
• sickle cell disease.

“Our goal is to extend the attention and care that patients receive from us beyond the four walls of UMDNJ-The University Hospital, thereby improving patient outcomes,” said David Bleich, MD, a project co-director.

The “I CARE-4-Healthcare Transition Project” will be implemented in partnership with the Visiting Nurse Association Health Group.

The project will be supported by a $300,000 grant from the Robert Wood Johnson Foundation‘s New Jersey Health Initiatives program with additional funding from the Healthcare Foundation of New Jersey.

– by Deane Beebe

Ai-jen Poo, the director of the National Domestic Workers Alliance, was selected as one of the 100 most influential people in the world by Time magazine.

Poo’s advocacy on behalf of domestic workers — including home care workers — demonstrates “the humanity of a long devalued kind of work,” wrote Gloria Steinem in a brief essay for Time. Steinem also hailed Poo’s “gift for creating worker-led groups and empathetic tactics.”

In addition to her role as the National Domestic workers Alliance director, Poo is the co-director of Caring Across Generations, a coalition of 200 organizations that includes PHI in its leadership. The coalition is undertaking a national campaign to provide quality care and dignity for aging Americans and their caregivers.

Poo has also been instrumental in the drive to achieve fair pay for home care workers.

Last December, she spoke about the necessity of paying such workers fairly at a Department of Labor press briefing (pdf), shortly after President Obama announced that his administration would pursue a rule change extending basic wage protections to home care workers.

– by Matthew Ozga

MPRO, Michigan’s Quality Improvement Organization, has produced a video on the benefits of the consistent assignment staffing model that more nursing homes are using to schedule their staff.

The video features interviews with staff and residents from three facilities in Michigan that are using consistent assignment, which helps to strengthen relationships between direct-care workers and consumers and leads to better care and less turnover.

“Without the opportunity to form close relationships and a system that protects the continuity of the relationships, person-centered care and sustainable culture transformation cannot occur,” said PHI Organizational Change Consultant Cean Eppelheimer.

“Being well-known within the community through the practice of consistent assignment is fundamental to quality person-centered eldercare and underlies the development of a more meaningful workplace,” Eppelheimer continued.

According to Advancing Excellence in America’s Nursing Homes, a national campaign aimed at improving the quality of nursing home care, consistent assignment (pdf) means that residents see the same caregivers (registered nurse, licensed practical nurse, or certified nursing assistant) almost every time they are on duty.

“Nursing homes that begin using consistent assignments might have to change the way they manage staffers,” said Mary Jane Koren, MD, chair of the Advancing Excellence in America’s Nursing Homes Campaign and vice president at the Commonwealth Fund.

“After the initial startup, they often find the new way is a better way: They often catch medical problems in the early, treatable stages,” Koren said. “In the end, nursing homes that adopt consistent assignment reduce staff turnover and work to improve other quality measures gain something priceless: They’ll have a facility that fosters strong relationships between caregivers and residents, and offers the highest standard of care.”

– by Deane Beebe

Consumers, workers, and other stakeholders in the Illinois nursing home industry are voicing their opposition to a proposed 18 percent cut to the state Medicaid program.

Details of the potentially devastating round of cuts began to emerge on April 19. According to published reports, Governor Pat Quinn (D) wants to slash Medicaid rolls by 215,000 while lowering Medicaid reimbursement rates for doctors, hospitals, and nursing homes.

Quinn’s plan would save the state $2.7 billion.

A Quick Response

Nursing home stakeholders responded immediately to the threat. The Health Care Council of Illinois (HCCI), an organization representing nursing homes, scheduled a 17-stop protest tour to speak out against the cuts. HCCI held rallies in Rockford and Chicago during the weekend of April 21-22.

If enacted, the drastic Medicaid cuts would cause thousands of elders to be kicked out of their nursing homes, according to HCCI Executive Director Pat Comstock.

“What will happen to some of these residents is that they may not be able to stay here. They may lose their home,” Comstock told WBBM, a Chicago-area television network.

Report Shows Folly of Cuts

On April 25, the Campaign for Better Care and Families USA released a joint report (pdf) documenting the economic toll Quinn’s cuts would take on Illinois.

The report finds that the proposed $2.7 billion worth of cuts to Medicaid would put more than 25,000 jobs at risk and cost the state $3.3 billion in economic activity.

Many of those imperiled jobs would be in the nursing home industry, the report says.

“Cuts could mean jobs lost for [nursing] facilities’ employees, such as aides, nurses, pharmacists, and facility maintenance and management staff,” the report states. “Inadequate staffing lessens the quality of care that facilities are able to provide.”

– by Matthew Ozga

Connecticut State Capitol building in Hartford

The Connecticut House approved a bill on April 20 that would give collective bargaining rights to a newly formed union of personal care attendants (PCAs).

The union, which formed last month, is comprised of PCAs who provide Medicaid-funded services and supports to elders and people with disabilities. The PCAs are employed by individual consumers but are paid by the state.

The bargaining-rights legislation passed the House by a vote of 84 to 57 as an amendment to a broader labor bill. If passed by the State Senate, it is expected to be signed by Governor Dannel Malloy (D), a vocal supporter of collective bargaining rights for PCAs.

Currently, the PCA union only has “meet and confer” status, meaning its members can meet with a newly formed Workforce Council to discuss ways to improve working conditions in Connecticut’s home care programs.

Bargaining Would Give Common Voice to PCAs

Collective bargaining would be a huge step forward for PCAs, supporters of the House bill say.

Marjorie Davis, a PCA from Hartford, told the Connecticut Mirror that PCAs are “a very discounted group of workers,” and that the ability to collectively bargain would represent “cohesion [through] a common voice.”

Supporters also said that collective bargaining rights are essential to help PCAs fight for better wages and adequate benefits — which, in turn, will result in better care for elders and people with disabilities in Connecticut.

“Granting workers a voice will, in the long run, improve their lives and the lives of the people they serve,” said State Representative Zeke Zalaski (D), the co-sponsor of the bargaining-rights bill, shortly before the House voted on it.

– by Matthew Ozga

An analysis of 6 million caregivers in California who provide services and supports to family members or friends found that those who are paid by Medi-Cal to assist low-income elders and people with disabilities were the most likely to be “economically insecure.”

In Hidden in Plain Sight: California’s Paid Medi-Cal Caregivers Are Vulnerable (pdf), researchers at the UCLA Center for Health Policy Research report that of the 290,000 Medi-Cal paid caregivers assisting family or friends — most of whom are likely to be employees of the In-Home Supportive Services (IHSS) program — more than half (57 percent) had incomes below or near the federal poverty level (average monthly income of $1,970).

The analysis also found that of these paid caregivers for Medi-Cal recipients:

• Nearly a third (31 percent) were uninsured;
• Nearly a third (31 percent) had food insecurity (reduced meal size or skipped meals due to lack of sufficient resources); and
• 16 percent were likely to stay in the job for less than a year, “suggesting a high client turnover.”

The researchers compared Medi-Cal paid caregivers to all paid caregivers, unpaid caregivers, and non-caregivers, finding that Medi-Cal paid caregivers fared the worst on the economic indicators.

Nearly half (49 percent) of all paid caregivers (450,000, which includes the Medi-Cal paid caregivers) in the study had poverty or near poverty incomes.

Little Pay for Hard Work

“Paid caregivers do a lot but get paid very little,” said Geoffrey Hoffman, the study’s lead author. “They play a critical and complex role caring for our aging or disabled parents, grandparents, friends, and neighbors yet can earn only a little more than minimum wage.

“When we talk about caregiving, we should be thinking not only of the supportive services we provide to older adults but also the vulnerable people providing those services,” said Hoffman, who added that proposed cuts to the IHSS program and the downsizing of the state’s Adult Day Health Care program will not only hurt consumers but “will also harm paid caregivers.”

“Of course, all of us promote the value of family members caring for one another through thick and thin,” said San Francisco IHSS Public Authority Executive Director Donna Calame, who is also a PHI board member. “What the larger public — and unfortunately many policymakers — do not understand is that paying family members the relatively low wages we do in IHSS keeps families together.

“Family members are not paid for things like cooking or cleaning the house,” Calame continued. “They are paid for doing things like bathing, dressing, or helping their loved one use the toilet. The average IHSS consumer uses about $1,500 per month. Parents caring for severely disabled children especially save the taxpayer from annual institutional costs of about $250,000-$300,000 per year. That IHSS pays family members is a humane and cost-effective use of public dollars.”

– by Deane Beebe