A recent report from the Engelberg Center for Health Care Reform at The Brookings Institution on how to improve the efficiency and quality of care for older adults with chronic health conditions in need of long-term services and supports includes several recommendations regarding the direct-care workforce.

Achieving Better Chronic Care at Lower Costs Across the Health Care Continuum for Older Americans (pdf), released in October, identifies three main challenges to improving the delivery of care to elders:

• fragmented financing and care;
• lack of integration between medical services and social supports; and
• the need for more effective measures to evaluate long-term services and supports.

“This Brookings report is especially noteworthy for its emphasis on the foundational role that direct-care workers are positioned to play in new, more effective and more efficient care models, precisely because they are so uniquely embedded in the lives of their clients,” said PHI Director of Policy Research Dorie Seavey, Ph.D.

The authors call for new payment reform designs to “help promote holistic care, delivered by a team of professionals and caregivers, which support complex care requirements and incorporates social supports into care plans.”

The report defines social supports as both activities of daily living (ADLs) and instrumental activities of daily living (IADLs) such as “transportation, meals, bathing, and care management that can help keep individuals in their homes longer.”

Investing in the Direct-Care Workforce

“An investment in the direct-care workforce represents a key opportunity for improving integration between medical services and social supports,” the authors write. While “nearly half of the nation’s spending on long-term care services and supports” pays for these workers, this workforce is “insufficiently trained, underpaid, and underutilized.”

The report highlights the critical need for training models that better prepare the direct-care workforce — particularly training that promotes integrated care and improves chronic care and geriatric capacity. The authors explain that “new training opportunities could lead to expanded care responsibilities and reduce overall health care costs by allowing doctors to focus on targeted medical services.”

“With expanded and new roles, direct-care workers could assist with transitions from one care setting to another, prevent hospital readmissions, participate in team approaches to chronic disease management, and provide support and information to family caregivers,” Seavey said.

Health Reform Provides New Opportunities

Citing several provisions (pdf) of the Affordable Care Act that specifically pertain to the direct-care workforce, the report highlights ways in which the health reform law offers “significant opportunities to improve the delivery and quality of long-term services and supports across the care continuum.”

For example, the Personal and Home Care Aide State Training Program (PHCAST) Program is a three-year demonstration program to develop core competencies, pilot training curricula, and establish certification programs for personal and home care aides.

“As this report underscores, this workforce is a tremendously valuable — yet underutilized — asset in our health care infrastructure,” Seavey said.

An Engelberg Center for Health Care Reform conference held in early 2010 is cited as having helped inform some of the solutions offered in Achieving Better Chronic Care at Lower Costs Across the Health Care Continuum for Older Americans (pdf), which was made possible with support from The John A. Hartford Foundation and The Scan Foundation.

– by Deane Beebe