Senator Herb Kohl
New legislation introduced by the U.S. Senate Special Committee on Aging looks to strengthen the direct-care workforce in preparation for an older America.
Introduced by Committee Chairman Senator Herb Kohl (D-WI), the “Retooling the Health Care Workforce for an Aging America Act of 2008” echoes recommendations from an Institute of Medicine (IOM) report released earlier this year for improving and expanding the skills and preparedness of the full range of health personnel, including direct-care workers.
It joins several other bills likely to be reintroduced early next year for consideration by the incoming Congress, including the Empowered at Home Act that seeks to increase access to home and community based services, the Caring for an Aging America Act that would expand career ladder programs for direct-care workers and other caregivers, and the Promoting Small House Nursing Homes Act.
The new legislation calls for expanding education and training opportunities in geriatrics and long-term care for licensed health professionals, direct care workers, and family caregivers by amending the Public Health Service Act, the Workforce Investment Act, the Older Americans Act, and the Social Security Act.
Dawson’s remarks (pdf) further asserted that the long-term industry must offer competitively attractive jobs to recruit and retain a stable direct-care workforce.
Key provisions of the new bill include:
- Fund the National Center for Workforce Analysis to analyze the needs of health care professionals and paraprofessionals in the long-term care sector.
- Amend the Workforce Investment Act to require state workforce investment boards (WIBs) to provide information on training and employment opportunities in geriatrics and long-term care for veterans who receive job counseling services at WIB “One Stop Centers.”
- Establish tuition stipends for direct care workers (nurse aides, home health aides and personal or home care aides) in the long-term care sector to acquire a nursing degree.
- Establish a national demonstration program in four states to develop, test and evaluate personal and home care aide competency and supplement training required by federal law.
- Integrate the needs of family caregivers into routine assessment procedures of Medicaid beneficiaries who are deemed eligible for HCBS services.
Training for direct care workers is vitally important. Older people present unique challenges in the care environment and workers need a solid background in geriatrics to understand the health needs as well as the social needs of elders. Providing direct care to a frail elder requires a broad understanding of the health challenges, social challenges and mental health challenges faced by the person being cared for in order to provide quality care. I think a national certification and licensing process is long overdue.
It is essential to note that this is one of the core issues at this present time.
The part I don’t understand about the Kohl bill is that a demonstration program is already in place as the competency and supplemental training are already inherant parts of Registered Apprenticeship programs in the Home Health Aide and numerous other occupations that directly deal with our aging population on a day to day basis. This would be a duplication of what is already in place from what I have read about it. (Establish a national demonstration program in four states to develop, test and evaluate personal and home care aide competency and supplement training required by federal law) Check out Registered Apprenticeship for this training opportunity available to all employers to offer to their staff.
I have the same question as Harry – why establish 4 demonstration projects when there seems to be already training programs around the country with extensive training programs that probably are already doing the training, etc. required by federal law. My agency, for example the IHSS Consortium in SF has an extensive basic training and specialized trainining program. PHI has a wonderful training program with an extensive compentency testing program. So I am unclear why this is Kohl’s bill.
Thank you for your comments Harry and Margaret- as one of the staff members who worked on developing this bill, I’d like to respond on behalf of Sen. Kohl.
You are both correct that a number of different state training programs for direct care workers have been developed. However, there is no national initiative underway that will develop and evaluate both competencies and a curricula for personal and home care aides – who today are not covered by any federal standards. While the competencies and curricula associated with many of the state training programs have been well-received, it would be a stretch to say there is a generally agreed upon consensus in the field regarding a standardized approach to training for direct care workers.
At the same time, there is a clear need for the health care workforce to adapt to the coming challenge of serving millions of additional older adults in their own homes or other community-based settings. Sen. Kohl believes this requires that we try to rapidly develop a larger workforce of direct care workers who are well-trained to provide services in a variety of post-acute and long-term care settings – and whose skill levels are well-defined, well-understood, and widely appreciated. That is why the “Retooling the Health Care Workforce for an Aging America Act” proposes a national demonstration that would encompass a variety of providers participating in Medicare and Medicaid.
In addition, existing CNA and home health aide requirements, which are based on federal standards, have not been reviewed or updated in over 20 years. The IOM report recommends expanding the requirements to at least 120 hours and adding additional geriatric competencies. This is another issue Sen. Kohl’s legislation seeks to address through a national demonstration.
So while there may be good examples out there of direct care worker training and other examples of more current CNA training, the standards themselves have not kept pace, and it is now time to raise the bar overall on direct care worker training. This legislation begins the process for doing that.
are there any standards for direct workers in place? who will do the training ?
None of this will have any effect on improving care for our most vulnerable adults, if workers can’t afford to work in these occupations because of the poverty wages that most direct care workers receive.
Lance, we agree. That’s why PHI has recommended a wage floor of $12 per hour to the Obama administration. Check out our recommendations at:
http://otrans.3cdn.net/e61823cf345a79af9b_8fm6i60fc.pdf
We are also very concerned about health care coverage for this workforce. If you haven’t visited our health care campaign website, go to: http://www.coverageiscritical.org.