Pennsylvania Holds Hearing on the Direct-Care Workforce

“I care for the seniors, but I care just as much for my co-workers and those who are looking to come into this profession. We need your help to invest in the direct care workforce,” hospice nurse aide Brenda Nachtway told the Pennyslvania House Aging and Older Adult Services Committee on April 2 (see video above). Nachtway, who is co-chair of the Pennsylvania Direct Care Workers Association, was one of several direct-care workers, employers, and other stakeholders to testify at a public hearing on the direct-care workforce.

Nachtway testified (pdf) that the growing care gap makes it urgent that lawmakers - especially state lawmakers - mandate and finance better training, wages, and benefits for workers. “Most direct-care workers will say that they don’t do this for the pay. At an average wage of $10 per hour that should be self-evident,” she said. “We do it because we love our jobs, we love the seniors. We are caring and compassionate people. But we also need to be valued, respected - and, yes, paid what we are worth.

“When 2 out of every 5 direct care workers don’t have health insurance, how can we be expected to return, day in and day out, to care for those seniors that need us so much?” she added.

Sandy LaCroix of SEIU Healthcare Pennsylvania noted (pdf) the problems created for long-term care consumers by high turnover rates among staff, which she traced to “a few basic, even obvious causes. At the root of the problem are poor wages and benefits, inadequate and inconsistent training, high injury rates, the difficulty of making a career in long term care, and finally, the discouragement that we feel when employers and legislators make it plain that our work and voices are not respected.”

Linda Bettinazzi, chief executive officer of the Visiting Nurse Association and VNA Extended Home Care of Indiana County, talked (pdf) about several initiatives her organization has taken on, with the help of funding from the local Area Agency on Aging, to improve direct-care worker recruitment and retention. “We have increased salaries, improved benefits, adopted a culture of mutual respect and committed to an aggressive training program,” she said. “It does work, but without additional resources our organization will have to roll back the clock.”

Health insurance is a particularly difficult benefit to maintain, she added. Paying the premiums is difficult when reimbursement rates are decreasing while employee health insurance premiums increased by 8 percent in the past year alone.

Dr. Robert Garraty, executive director of the Pennsylvania Workforce Investment Board, testified (pdf) about the Direct Care Workforce Workgroup launched in 2005 by his Pennsylvania Center for Health Careers. The workgroup’s recommendations for how to support and grow the direct care workforce include:

• Improve access to affordable health insurance;
• Set a higher minimum wage for direct-care workers;
• Make it easier for workers to get full-time hours;
• Raise the training standards for direct-care workers; and
• Improve the reimbursement system for nursing homes and home and community-based care providers, creating financial rewards or incentives for higher training standards.

In testimony (pdf) submitted on behalf of the Pennsylvania Homecare Association, Karen Kulp, President/CEO of Home Care Associates, said the government must pay home health agencies enough that they can provide appropriate wages, health insurance, and worker’s compensation.

Committee Chair Phyllis Mundy (D-Luzerne) said budget pressures make additional spending on long-term care impossible in the short term. However, she said, “I think it is important to have meetings like this to discuss what the needs are.” She also noted the irony of health care workers going without health insurance and said the state must “beef up” benefits in order to attract more people to the job.

Ask what could be done to improve the situation, the experts who testified offered the legislators a number of practical solutions, including:

• Equalize reimbursement rates for long-term care in different settings;
• Create an employer-friendly training and credentialing system for new workers;
• Fund training for incumbent workers; and
• Improve the supervisory skills of people who manage direct-care workers.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org