Contact: Alex Olins
PHI Northern New England Director
Phone: (802) 655-4615
Email: aolins@PHInational.org

Rewarding Skill and Improving Care 
New initiative provides career advancement opportunities for direct-care workers in Vermont

Burlington, VT — Few issues are more important to people today than health care. Both from a personal and societal perspective, Americans are deeply concerned about what the future holds for them when it comes to health care. In many states, the growing needs of an aging “baby boomer” generation is creating an enormous shortage in qualified direct-care workers, who provide most of the “hands on” home and community-based care that elders and people living with disabilities depend upon.

Challenged by this critical need, the Vermont Department of Labor, with funding from the DOL’s Workforce Education and Training Fund, is supporting a unique education and career ladder training program for 65 Personal Care Assistants (PCAs) at four sites in northwestern Vermont:

• VNA of Chittenden and Grand Isle Counties
• Franklin County Home Health Agency
• Armistead Caregiver Services
• Home Instead Senior Care

PHI — a nationally recognized training and organizational development consulting firm focused exclusively in the eldercare/disability services industry, with a regional office in Vermont for many years— will be serving as project manager of the entire initiative. PHI will be collaborating with the Vermont Department of Labor (DOL), the Northwest Technical Center, the Community College of Vermont, Vermont Adult Learning, and all four community partner sites throughout the project.

“These educational opportunities will be the next steps in what has proven to be a valuable and mutually important collaboration,” said Churchill Hindes, VNA President and CEO. “This initiative will benefit the agencies involved, the trainees who participate in the instruction, and ultimately — and most importantly — the people who will benefit from their skills and caring.”

An Innovative Solution with Growth Opportunities

The initiative will address the state’s shortage of direct-care workers with the development of a career ladder training program to improve workforce retention and ultimately, it is hoped, increase the number of PCAs available to care for Vermont’s aging population. The program will assist incumbent workers to advance in their healthcare careers, and allow participating workers and organizations to:

• Earn while they learn. PCAs will be paid for at least 50 percent of their time while in training—a critical component of success in incumbent worker training programs for low-wage workers.
• Work toward meaningful promotions and raises: At some locations, training will enable a PCA to be promoted to PCAII. At other sites, training will enable a PCA to be certified as a Licensed Nursing Assistant (LNA), with the requisite increase in wages.
• Participate in a flexible and robust learning opportunity. Each provider will provide a customized training program for its workers.
• Encourage a more diverse group to enter healthcare professions. Non-native English speaking participants will be able to take contextualized ESOL classes at their worksite, in conjunction with their clinical skills classes.
• Improve workforce retention.

The CareWell curriculum, a 40-hour course developed by the Visiting Nurse Association (with support from the Community of Vermont Elders through their Better Jobs Better Care initiative), will be a cornerstone of the PCA training. PHI, in addition to its role as project manager, will also be providing its “Coaching Approach to Communication” training at all sites.

“One of the fastest-growing occupational areas in Vermont over the next 20 years will be in direct-care services,” said Greg Voorheis, Senior Grant Administrator for the Vermont Department of Labor. “The state’s Workforce Education and Training Fund grant to PHI creates the opportunity for multiple long-term care employers to hire well-trained direct-care workers who will be participating in the development of a career ladder in direct care.

“PHI’s leadership in this work will benefit not only long-term care employers, but many direct-care workers already in the field — or individuals who aspire to work in the field. And, most importantly, their work will improve the quality of health care provided to individuals. We look forward to sharing what we learn with others,” Voorheis concluded.

The program, which was officially launched in early June, will conclude in June of 2010.

For more information about this project, call Alexandra Olins, PHI Regional Director, Northern New England, at 802-655-4615.

An AP story summarized the draft legislation by saying it would “impose new responsibilities on individuals and employers to get coverage, end insurance company practices that deny coverage to the sick, and create a new government-sponsored plan to compete with private companies” (“Democrats try to regain health care momentum,” June 19).

An additional document released by the committees titled “What’s in the Health Reform Bill for You?” (pdf) lists “12 ways health care reform will help you and your family” — and groups them into four main categories:

• Lower Costs
• Greater Choice
• Stability & Peace of Mind
• Higher Quality

Speaking at a press conference, Rep. George Miller, Chairman of the Education and Labor Committee, said, “Today marks a historic moment in America’s urgent quest to fix our broken health insurance system.

“Our discussion draft is the first step in delivering on the fundamental change that President Obama has called for, and that families and businesses need, by building a truly American solution to reduce costs, offer real choice, and guarantee affordable, quality health care for all.”

Watch the full press conference:

As an advocate for quality long-term care, your Member of Congress needs to hear from you!

Please DO NOT CALL before Tuesday, June 23.

Details are available on the Eldercare Workforce Alliance website.

Sen. Tom Harkin (D-IA)

Fifteen U.S. Democratic senators have sent a letter to Department of Labor (DOL) Secretary Hilda Solis urging the extension of federal wage and hour laws to cover the nation’s estimated 1.5 million home health-care workers.

Background

Domestic workers were excluded from the federal Fair Labor Standards Act (FLSA) that was enacted in 1938 to ensure a minimum standard of living for workers through the provision of a minimum wage, overtime pay and other protections.

In 1974 the FLSA was amended to include domestic employees such as housekeepers, full-time nannies, chauffeurs, and cleaners. However, under a narrow exception, workers providing “companionship services to individuals who because of age or disability are unable to care for themselves” remained excluded from the law.

Two years ago, under the Bush administration, the Labor Department interpreted the law to exclude home care workers, and this decision was upheld by the Supreme Court.

The current effort

Led by Iowa Sen. Tom Harkin, the  senators claim in their letter that this Supreme Court decision leaves the door open for the Labor Department to change its interpretation under a new administration (”Lawmakers want federal rules to cover home workers,” AP, June 12).

“In the three decades since the exemption was created, the numbers of home care workers and their responsibilities have expanded dramatically as the population has aged and more and more people are choosing long-term care services in their homes rather than in institutions,” they wrote. “Home care, increasingly, has become not casual work performed by a friend or family member but a full-time regular type of employment.”

They continue, “It is critical that these professional workers, who provide essential services to our nation’s elderly and disabled, have the same right to minimum wage and overtime pay as enjoyed by other workers” (“Harkin, Senators Urge Fairness for Home Care Workers,” IowaPolitics.com, June 11).

Solis’ response

DOL Secretary Hilda Solis

Solis responded on June 12 saying that she shares the senators’ concerns. “As secretary of labor, I intend to fulfill the department’s mandate to protect America’s workers, including home health care aides, who work demanding work schedules and receive low wages,” she said (“Labor Secretary ponders oversight of home workers,” AP, June 13).

She indicated that DOL is examining whether its regulations “effectively express the statutory exemption,” but didn’t say when any decisions would be made.

A delegation of state lawmakers, representing 700 of their colleagues across the nation, delivered letters to the Obama administration and Congress on Thursday, June 18, supporting comprehensive health care reform, including a public plan option, affordability protections, and shared employer responsibility for premiums.

In a meeting with Secretary of Health and Human Services Kathleen Sebelius and White House Director of Health Care Reform Nancy Ann deParle, the lawmakers announced the formation of the White House Working Group of State Legislators for Health Reform. State Senator Jack Hatch from Iowa was named chairman of the working group. Hatch has been a strong champion of quality jobs for direct-care workers in his state, leading efforts to pass a health care demonstration project for direct-care workers.

The state lawmakers held a press conference, hosted by Iowa Senator Tom Harkin, in which they spoke to the desperate need for health care reform at the state level.

Many of the members of the delegation have led efforts in their states to expand health care coverage, but this piecemeal approach has not effectively stemmed the tide of rising costs. State budgets are crumbling under the burden of an unsustainable health care system, the legislators said, and without national reform, the situation will continue to deteriorate.

The state lawmakers offered to share their expertise and work with the White House and Congress to pass comprehensive reform this year.

Official seal of ARRA

As states struggle to balance their budgets in the face of a deep recession, there has been little good news for long-term care.

At least three states, however — North Dakota, Montana, and Oregon — are using funds from the American Recovery and Reinvestment Act (ARRA) to stabilize and enhance their direct-care workforces.

North Dakota

On May 4 the North Dakota Legislature passed a comprehensive $2.28 billion bill to fund the state’s Department of Human Services (DHS). The legislation included a provision of $41.3 million for wage increases for workers in nursing homes and basic care facilities (BCFs), as well as for Developmental Disabilities Services Providers (DDSPs) and Qualified Service Providers (QSPs). The latter are the state’s in-home care providers, both agency-based and independent, who provide personal care services to seniors and people with physical disabilities.

Money for the wage increases comes not only from the state general fund that is appropriated for Medicaid services but from the increased federal share of Medicaid payments (FMAP) under ARRA. The upshot is that on July 1 all of the above-named workers will receive raises of either $0.80 per hour or $1.00 per hour, along with an annual inflator of 6% for 2009 and 2010.

DHS  and the North Dakota Long Term care Association (NDLTCA) tell PHI that although it is the intent of the legislation to use the specified appropriations for wage and benefit increases for long-term care workers, the legislation does not specifically mandate this. But DHS is taking steps to ensure that the intent is honored.

The new legislation resulted from advocacy efforts since last September by NDLTCA in partnership with the North Dakota Association of Community Facilities (NDACP). NDLTCA expects the legislation to benefit most of state’s 18,000 long-term care workers.

Montana

Montana has assigned more than $16 million to increase wages for its 12,000 direct-care workers. The website for the Montana Department of Public Health & Human Services (DPHHS) shows how the department’s share of ARRA funds — $513 million in federal and state funds — will be allocated over the biennium to DPHHS programs.

As explained at the DPHHS web page, $16.3 million of these funds will be used “to fund a one-time direct care worker wage increase for Medicaid services in the Senior and Long Term Care Division.” The increase will apply to “direct care and ancillary service staff for the 2011 biennium only,” and will benefit “nursing facility providers, personal assistance providers, and other community based service providers.”

As for the method by which the money will actually be paid to workers, Ted Dick, political director for SEIU Healthcare 775NW, tells PHI that it won’t actually come in the form of an increase in hourly wages. “It might be paid as training funds, or possibly as a one-time only wage increase in the form of bonuses,” he says, adding that because the ARRA money is a one-time arrival, such methods “really are the most efficient way to appropriate them.”

Dick says he spoke recently with Kelly Williams, an administrator in the Senior and Long Term Care Division of DPHHS, and that although she is “still working the numbers out,” there is a plan afoot to pay two lump sums to Montana’s direct-care workers, one in July and then another in January.

Oregon

The Associated Press reported on March 28 that Oregon lawmakers were talking about using a combination of state and federal dollars to help pay for more than 300 new nursing assistants in long-term care facilities in all 36 Oregon counties.

The Oregon Department of Human Services (DHS) reports at its website that  “ARRA provides DHS and local governments an estimated $807 million of increased Medicaid funds retroactive to October 1, 2008, through December 31, 2010.”

Jim Scherzinger, Deputy Director of Oregon’s DHS, tells PHI that as of mid-June the plan to create the 300 nursing assistant jobs is still moving forward and is “definitely happening.”

For more information, see PHI’s April 2 post: Oregon to Create Nursing Homes with Stimulus Funds.

Sens. Herb Kohl (D-WI) and Maria Cantwell (D-WA)

Sens. Maria Cantwell (D-WA) and Herb Kohl (D-WI) have introduced the “Home and Community Balancing Incentives Act,” a bill that would offer enhanced federal Medicaid matching rates to states that are willing to implement home and community-based health care programs.

Specifically, the proposed legislation would:

• Improve case management to help people stay out of nursing homes
• Allow for consumer direction
• Provide a coordinated system that assists in transitioning people from nursing homes back to the community
• Create a standardized, state-wide assessment program to monitor home and community- based enrollees’ eligibility status
• Develop a services and information clearinghouse so people can have one easily learn about their home and community-based options
• Require providers to submit data on the services they provide so agencies and states can create a standardized method for tracking and charging home and community-based services
• Collect data on consumer outcomes

In a press release, Cantwell says that the federal government could save $10 billion over a five-year period by moving 5 percent of nursing home patients into home- and community-based care. The bill would also set up systems to help with the transition to HCBS and monitor its use.

“PHI welcomes federal efforts to support consumer choice,” says National Policy Director Steven Edelstein. “We are concerned, however, that we do not yet have public policies that will ensure that an adequately trained and supported workforce is available to care for consumers in their homes. PHI continues to advocate for including greater investments in the direct-care workforce in national health reform legislation.”

Cantwell and Kohl are both deeply involved in current efforts to reform the nation’s health care system. Cantwell sits on the committee headed by Sen. Ted Kennedy that is currently drafting the Senate’s national health care reform bill, and she has been designated the lead for the committee on workforce issues. Kohl chairs the Senate Committee on Aging and was responsible for introducing the “Retooling the Health Care Workforce for an Aging America” act in 2008.

After an unsuccessful effort to include provisions of his bill in the American Recovery and Reinvestment Act,  Kohl and Sen. Ron Wyden (D-OR) received a promise from Senator Max Baucus (D-MT), the chairman of the Senate Finance Committee, that the needs of the long-term care workforce would be considered in health care reform (see “Senate Floor Discussion Leads to LTC Promises,” PHI, Feb. 12).  The Finance Committee is the other Senate committee involved in drafting health reform legislation.

In the Senate

Senate Finance has released three papers outlining reform options and will soon choose among these to craft their legislation.

The Senate Health, Education, Labor, and Pensions (HELP) Committee has released a 615-page draft bill (pdf); additional components are expected to be added to address contentious issues like the creation of a public health insurance option to compete with private insurance plans, and how to finance reform. A summary of the bill’s sections (pdf) is also available.

PHI applauds Senator Ted Kennedy, HELP committee chair, for including language in the bill that will:

• Provide grants to train direct-care workers.
• Develop a National Health Care Workforce Commission whose mission it is to provide comprehensive information to Congress and the Administration about how to align federal health care workforce resources with national needs.
• Create a new national insurance plan, with voluntary payroll deductions, enabling adults who have or develop functional impairments to pay for services to help them remain independent, employed and living at home.

In the House

In the House, the three committees with jurisdiction — Ways and Means, Energy and Commerce, and Education and Labor– compiled a three-page outline (pdf) of their joint proposal.

Leaders of the three committees briefed the full House Democratic Caucus on their outline Tuesday and in a  joint statement released the same day said, “We will continue to seek input and work closely with our colleagues, outside stakeholders, and the administration and are on track to introduce legislation shortly. We anticipate committee action on health reform in the coming weeks, with legislation on the House floor prior to the August district work period.”

The House plan would:

• Reorganize the private insurance market, creating a national health insurance exchange where individuals or employers could obtain coverage.
• Require individuals to obtain insurance and employers to help pay for it.
• Create a public health insurance plan that would compete with private insurers.

States would have the option of creating their own exchanges instead of participating in the national exchange. Insurers would be prohibited from denying coverage based on preexisting conditions and could not charge higher premiums based on gender, health status, or occupation. Premiums would be higher for older people, but the increase would be limited.

The plan would cap out-of-pocket spending by patients to prevent bankruptcies due to medical costs. Some studies suggest that more than half of all personal bankruptcies are due to medical bills.

PHI reported in April that the tax, which was proposed by the Iowa Health Care Association, was expected to generate roughly $33 million, which could then be leveraged to bring in about $60 million in federal matching Medicaid dollars.

The tax will be charged against patient days, which means that although most nursing facilities will see a net revenue gain, a minority — the ones with a low percentage of Medicaid bed days – will see a net loss. Funds paid in under the new law will be deposited in a state-run Quality Assurance Trust Fund.

Opponents, such as Republican Sen. David Hartsuch, criticized the legislation as “a tax on our most vulnerable citizens,” but supporters argued for the financial benefits the tax will bring in the form of federal money flowing to most nursing homes and, also, to direct-care workers.

As explained by Democratic Sen. Joe Bolkcom, D-Iowa City, “60 percent of the new money must be used for employee salaries, wages and benefits — with more than half going specifically to direct-care workers such as certified nurse’s aides” (“Culver signs nursing home resident tax bill,” WCF Courier, May 27).

John Hale, policy director for the Iowa CareGivers Association, said, “We worked closely with legislators like Senator Bolkcom, as well as the nursing home industry, to make sure that this legislation addressed the needs of direct-care workers. The original legislation did not mention direct-care workers; the final bill obligates at least 35% of the new revenue for increases in direct-care worker compensation. It is a win for workers and for those they serve, as we firmly believe that better jobs lead to better care.”

“We’re looking at this as an opportunity to help the nursing facilities,” said Democratic Sen. Amanda Ragan. She pointed to the fact that most nursing homes will be able to draw down more money than they put in, and added that “Much of it’s going to go for direct-care workers that are working very diligently to take care of the frail and elderly” (”Benefits of Nursing Home Tax,” KIMT, May 28).

Although the governor has signed the bill, before the new law can be implemented it must be reviewed and approved by the Centers for Medicare and Medicaid Services.

Tameshia Bridges

By Tameshia Bridges, Michigan Senior Workforce Advocate

This tax year, PHI’s Michigan office launched the Earn, Keep, Save MORE outreach campaign, an effort to increase income for direct-care workers. The campaign equipped employers with information and resources they could use to educate their staff about federal and state earned income tax credits (EITC) and free tax preparation services available in the community.

The EITC provides an important opportunity for low-wage workers to build economic assets. Through the EITC, direct-care workers in Michigan can receive tax credits ranging from a few hundred dollars — to over $5000. Yet many workers don’t apply because they are unaware that they are eligible for these state and federal benefits.

Working with 14 employers in 7 counties across Michigan, PHI’s Michigan office provided information to more than 2,200 workers about the EITC and volunteer income tax assistance (VITA) services through paycheck stuffers, brochures, and posters in their workplaces.

In addition, these resources were made available through the  Earn, Keep, Save, MORE website to eldercare and disability services employers that did not work with PHI directly.

Earn, Keep, Save MORE provides an example of how employers can help link their staff to available community resources — a service that is one of the elements of a quality job.

New Passages, a provider of community-based behavioral health services, including adult foster care homes, partnered with PHI on this project.  Jamie Bragg-Lovejoy, vice president of quality, compliance, and risk management, felt Earn, Keep, Save MORE was timely for her organization. “Our chance to collaborate with PHI regarding free employee income tax preparation provided a wonderful opportunity for our organization to demonstrate our on-going efforts to enhance the employee benefit program for our direct-care workforce,” she said. “This was especially important given the economic conditions we have faced over the past year.”

In addition to educating the eldercare and disability services community about the availability of important asset-building resources, this effort also helped raise awareness within the asset-building and EITC community that the direct-care workforce, which is one of the fastest-growing employment sectors in Michigan, should be a target for education and outreach regarding the services they offer.

We look forward to continuing this work next tax season, while recognizing that getting people to use free tax services as opposed to employing a commercial preparer takes time and continued education on the benefits of these services.