Steven Dawson
PHI President Steven Dawson comments on the importance of including direct care workers in the economic recovery plan.
The Obama administration’s economic recovery team is under increasing pressure to create and improve jobs for those most in need: low-income workers, particularly women. To that end, PHI and others have proposed targeted increases in Medicaid to create and strengthen the eldercare/disability services workforce–the millions of jobs held by home health aides, certified nurse aides, and personal care workers. But so far, the response from the Obama team has been a flat “no.”
That is unfortunate, because the stated purpose of the economic recovery is to get money quickly into the hands of those who will spend it fast. Since this recession will hit low-income communities faster, deeper, and longer than the rest of our nation, any economic recovery strategy must reach quickly into these communities.
The eldercare/disability direct-care workforce–more than 3 million strong–is funded primarily with public dollars. Therefore, in a quick, yet lasting, boost to the economy, these primarily female low-wage workers would spend recovery dollars immediately on essential goods and services for their families.
Instead, we’ve been told that the economic recovery will not reach direct-care workers, precisely because of that word “lasting.” The new administration wants the stimulus to be a one-time hit; it does not want any “lasting” increase in the base of federal spending.
While that is logical, it is not–as President-elect Obama urged last week–very bold. The result of this logic will guarantee that nearly half of our nation’s personal care and home care workers–whose real wages have fallen over the past seven years–will continue to live in households dependent on some form of public assistance. They will be locked into poverty-wage jobs because, once the economic recovery has washed through, the administration will be desperate to find significant public savings.
Usually, low-wage health care workers are told to wait–that their day for decent wages and benefits will come; this time, they are essentially being told to wait forever.
Remember Kathy Lee Gifford’s embarrassment when it was revealed that the clothes carrying her label were manufactured off-shore by workers making poverty wages? At first she tried to claim those manufacturers were subcontractors, and that she had no moral obligation for those workers. Public opinion soon changed her mind.
And you might also remember how presidential candidate Obama “walked a day” in the shoes of a home care worker in California last year. If he had also lived on the wage of that worker for a year, he could help his advisors understand that the federal government, as the primary funder of these jobs, has the same moral obligation to ensure that these publicly funded “subcontracted” workers do not go home at night to families living in poverty.
Perhaps the administration has already concluded that our nation will always keep these publicly funded workers in poverty–and thus fail to serve adequately the growing number of elders and people with disabilities. If so, then not targeting a portion of the likely one trillion dollar recovery package is indeed logical.
Yet if there remains a commitment to meet the administration’s obligation to create a stable eldercare/disability system, then beginning that investment now will prove a two-fold advantage: in one stroke, creating the fastest way to pump billions of dollars into low-income communities, while also making a down-payment on preparing our nation to care for its aging population.
Steven L. Dawson
President
PHI – Quality Care through Quality Jobs
HI STEVE: .Who ls your contact in the TransitionTeam?
Roy
Is this the sound of the last door slamming? How could Steven Dawson and PHI – the most articulate advocates for improving direct care jobs – who have garnered the support of institutions like the Institute of Medicine and AARP, and now, with the ultimate opportunity – to speak directly to the Obama administration – our greatest hope for intelligent and caring leadership – get a “flat no”?
But wait – we’ve been hearing “flat no” for a long time. Is the news alert a statement that we’ve lost the war for improving jobs, a revelation that the Obama administration is not what we expected or hoped for, OR is this further confirmation that Medicaid, in the form of higher reimbursement rates is not the source or the system that will improve wages and fund health insurance for workers and their employers?
I may be grasping for a thread of optimism, but I’m concluding that the “flat no” is in response to request for Medicaid dollars and not the final word on the need or prospects for improving direct care jobs. I would like to hear more about how the Obama administration will address the care gap and the need/promise of access, quality and affordability. Is there another door?
I will go to work, again today, and work a very long day with the belief that direct care workers and jobs are vital to both the individuals they support and the entire systems of long-term care, home and community-based services, health care and public health. Thank you Steven and others who are asking the questions and working so hard to find solutions and leaders. I look forward to the discussion. Elise
Given the predicted growth in the number of elder Americans and the burgeoning reliance upon direct care workers to mediate home health care plans and the cost for such, it makes total sense that the recovery plan include a boost for those workers. The US is unconsciously fortunate to have a direct service workforce, albeit an inexpensive pool of workers to care for its elder citizens. Without some acknowledgment and economic investment for this sector, the direct care workforce will quickly move from the working poor to the unemployment line.
Dear Aaron and Steve
What a helpful article and just what I needed. Akron is conducting a Community meeting tonight to provide input to the Obama Transition Team.
I just talked to the Summmit County Council folks who are convening the meeting and am emailing copies – they said they would copy for the group tonight.
I just found out about the Akron meeting last night so your info in this alert is absoutely wonderful and very timely.
I will be testifying and will use this, DCA position and other materials as reference.
Is there any way I can get clean copies of the graphics with citations and without the extra info for handouts?
I am sending your email to the Ohio Trainers Connection list serv with a hope that even at this late date, some can attend. Also sending to other listservs to get folks to find similar hearings, briefings, town meetings in their own areas, so again would be very helpful to have a printable copy with citations and how to contact for more info.
I will be in and out today but feel free to contact me if you have questions.
Jeni
Genevieve Gipson RN MEd RNC, Director
National Network of Career Nursing Assistants
cnajeni@aol.com- email
“Yes WE Can: Teamswork Makes it Happen” (C)
Not too early to begin planning for 32nd annual National Nursing Assistants Week
~June 11-18, 2009~
Jeni,
Here is a pdf with 10 relevant PHI charts. I also sent it to you via email.
I also recommend looking at the resources feature on the PHI homepage including our issue brief (pdf) and press release (pdf).
The direct care workforce are the very people who contribute significantly to reducing healthcare costs. These are the people who make it possible for the elderly and or disabled to remain at home rather than live in high cost institutional settings. The continued availability of direct care workers is essential if we are to move away from high cost institutional settings. How shameful is it that some of the very people who can make the shift possible are themselves so low paid that they cannot afford healthcare and seek state subsidy for their survival. Medicaid is not the answer.
Robert Kuttner makes a strong case in his book “Obama’s Challenge: America’s Economic Crisis and the Power of a Transformative Presidency” with his recommendation to “professionalize the human-service economy.” He writes, “Suppose the new administration announced a national policy goal of converting every human-service job to a good job that pays a living wage with good benefits and includes adequate training, professional status, and the prospect of advancement…. These,after all,are jobs caring for our parents, our children, and ourselves. …For example, instead of defining a nurse-aide as a high-turnover, low-qualification, low-pay cccupation, the job would require substantially more training. … With more training and qualifications,these workers could be entrusted with more responsibilities, and nursing home residents would get better care.” (pp.146-149) Not news to us readers of the PHI newsletter, but nonetheless a cogent argument in a broader context.
Leave it to our government. They will spend all that money bailing out the auto industry ,greedy banks ,greedy mortgage and insurance companies. But refuse to spend anything where it is long overdue on the direct care workers and nurse aides who take care of the countries disabled and elderly population. We have been so neglected and too many times brushed under the rug when it comes to getting us fair wages and benefits. I am appalled and embarassed we have have a country in which our leaders cant even get their priorities in order. Yeah right on way to go give more money to the greedy corporates to once again mismanage their funds, and dont even think about those who really need it the most. What a total slap in the face once again
I am going to remain hopeful and not despair because I beleive the future President will be open to learning alot more. i also think we need to get self advocates involved more as they can make the points like no one else. I work with folks with disabilities and my mother in law in in skilled nursing. My experiences in these two areas tells me that if this is not picked up as an important issue our society will pay a price in 10 years that will make all of us anything but proud helen
Congratulations to PHI’s President Steven Dawson for quickly and correctly calling Obama on the failure to include direct care workers in the stimulus package. Like Helen Hanes, I still remain hopeful, however. Early in November the Direct Care Alliance sent a letter to Obama’s transition team advocating for direct care workers to be included in the stimulus package as a key component to revive the economy and to start building the national infrastructure to support the economic development of the direct care workforce sector (see here: http://www.directcarealliance.org/Obama_Letter.pdf).
Obama’s pledge to increase the number of Americans who join the middle class suits the direct care workers perfectly. And, they would use stimulus funds to purchase services and products right away and thus stimulate the economy. We look forward to the new year to continue working with direct care workers and their allies to ensure that their needs do not continue to be ignored at the cost of good health, quality of life and services to millions of Americans.
It’s about time that our state and national economic development initiatives be directed to parts of the economy where real jobs, with real futures are supported at the levels they merit.
Providing subsidy for call centers, pharmaceutical companies and wall street does little to improve the current and future employment prospects of working Americans. Let’s redirect the funding we now provide corporations that enriches their profits, executives and shareholders to skilled and hardworking direct care workers.
Three types of initiatives have been proposed in the Center for American Progress’s “Blueprint for Reform” published on Oct 31, 2008 which are directly related to the investment in the direct care Workforce. This book is significant becasue it was edited by Jeanne Lambrew, Daschle’s Deputy Director for Health Reform, hence there may be some cause for optimism that these ideas are being listened to. However it seems that it would be critical to foster a stronger dialogue between the Labor/workforce types and the health reform types to make sure that they are talking with each other.
I believe that it is critical that direct care worker programs will garner political support only if they involve training and added value not just wage pass throughs.
See: http://www.americanprogress.org/issues/2008/10/pdf/health_delivery_ch1.pdf
The three points made in the first chapter are:
*Leverage the Workforce Investment Act to build the long-term care workforce.
*Strengthen training and licensing standards for geriatric care.
*Enact strategies to increase wages and benefits for direct care workers.
Reauthorize and improve the Workforce Investment Act. The Workforce Investment Act is the major federal program designed to meet the job placement and training needs of displaced and hard-to-employ workers. It has pro¬vided employment and training services for health care workers, particularly allied health workers, long-term care workers, and nurses, although exact estimates are difficult to obtain.
WIA-funded health care workforce initiatives have included training programs targeted to a specific job classification, such as certified nurse assistants, or across a range of care-giving occupations. Initiatives have developed career ladder programs that enable caregivers to obtain skills needed for higher-level health care positions, educational capacity build¬ing for workforce occupations, and scholarships to support community college classes or nursing degrees.14
Reauthorization of the Workforce Investment Act—expected in the next Congress—could provide an opportunity for leveraging WIA funding to specifically target the training, recruitment, and retention of health care workers in general, or a specific group—such as long-term care workers—in particular. This approach would fundamentally alter the existing structure of the WIA, which has attracted criticism for being too locally driven and unresponsive to larger workforce demands.
A related alternative would be to focus on the burgeoning need for direct care workers by launching a new program specifically targeting long-term care workers—in essence, a Long-term Care Worker Investment Act. This type of initiative would specifically direct federal workforce training money to long-term care worker training, job placement, and retention activities, without needing to compete for funding within the framework of WIA
Strengthen training and licensing standards for geriatric care. The Institute of Medicine’s recent report, “Retooling for an Aging America: Rebuilding the Healthcare Workforce,” highlights the need for greater “geriatric com¬petence” among all members of the health care workforce. The IOM recommends a combination of enhanced training requirements and licens¬ing standards that include competence in the care of older adults for professionals and direct care workers. More specifically, these recommenda¬tions include residency training in settings where older adults receive care, stronger state and federal minimum training standards for all direct care workers, and more stringent licensure and certification criteria for professionals and direct care workers, which would include a demonstration of competence in the care of older adults.
These recommendations, which we endorse, require a variety of stake¬holders to take action, including teaching hospitals, state licensing boards, and federal policymakers. The federal government, for its part, should amend federal standards for certified nurse assistants and home health aide training to reflect enhanced standards, specifically a minimum of 120 hours of training.
Enact strategies to increase wages and benefits for direct care workers. Payment incentives are popular strategies for improving health outcomes or providing greater access to chronic care management. Pay-for-performance programs, which reward providers for improving quality or lowering cost, have become nearly ubiquitous in health care. Payment reforms could also be used to promote an increased supply of primary care professionals, enhanced numbers of geriatric providers, and greater retention of direct care workers.
Our recommendations include enhancing Medicare payments for primary care professionals to reflect the greater proportion of patient visits devoted to cognitive activities rather than procedures, and enhanced use of wage pass-throughs, wage floors, and other Medicaid payment strategies to increase wages and benefits for direct care workers. These approaches could further additional delivery system improvements such as the development and spread of medical homes. Medical homes reconfigure the delivery of primary care to involve interdisciplinary teams, advanced information technology, care coordination, patient outreach, and other techniques designed to improve quality of and access to services.
How can bailouts of banks, auto makers and Wall Street be justified when the ceos and executives still take huge bonuses and us DIRECT CARE WORKERS, helping those in need, cannot get even a little help to improve our wages and working conditions? This is wrong, just plain wrong.
Those of us working in home-based or community-based care help keep long-term care costs down. The people we help out are where they want to be; home, instead of in a nursing home.
If things don’t improve for direct care workers, many will get out of the profession all together. Where will that leave our elders and disabled? Without a caregiver, on a long waiting list for services, or maybe without services all together. That’s not the place I want to see my grandparents or parents.
Direct Care Workers have just as important of a job as a nurse, we may not have as much schooling, but it doesnt mean our job is any less important. We are responsible for many needs of our clients and probably do far more hands on work than any nurse ever thought of but for some reason we dont seem to get compensated in any way shape or form for it . I am beginning to think we must not be to valuable to them. At least not until when one of them may need our care. I bet they would wish they would have done something more then. They will too get old one day or may have a developmentally disabled child, they may need care for. Then tell me ,who will be there for them?