Join us for the New York Care Congress on Sunday, June 3, 2012 at Pace University, One Pace Plaza [ map ].

Care Congresses are town-hall dialogues to bring together everyday people in a new movement to create quality, dignified care for all. The program includes:

• Sharing care stories: sharing testimonies and vision for change between seniors, people with disabilities, family caregivers, home care workers, domestic workers, children and families of care workers and people who need care;
• Giving voice to change: taking action together on important state and local campaigns; and
• Growing a movement at home: sharing the vision of transforming care in America and building the Caring Across Generations movement in New York.

Free food, interpretation, and childcare will be provided.

To RSVP, visit bit.ly/NYCareCongress and for more information about Caring Across Generations, please contact Melanie Willingham-Jaggers at Melanie@ALIGNny.org or 212.701.9478.

• The Earn, Keep, Save MORE website, hosted by PHI, provides information on which states offer EITC and other credits, and Michigan-specific information.
• The It All Adds Up Toolkit provides Iowa-specific information and is housed on the Iowa CareGivers Association site.

Long-term care employers are encouraged to use the sites to download materials — paycheck stuffers, fact sheets, and posters — to help their employees make this a rewarding tax season.

– by Deane Beebe

Here are the changes that were made regarding the Training Sites:

• Training programs will no longer be associated with a specific site, but rather with a designated home care agency or hospice that sponsors the training;
• Home care agencies that are currently operating multiple training programs (sites) would be allowed to combine the programs and operate out of one site under the direction of a coordinating nurse instructor;
• The training program must designate at least one approved nurse instructor to be responsible for the coordination of training activities and oversight to ensure that training and supervision of practical training is consistent across sites; and,
• All training programs must meet minimum location, equipment and space requirements.

Trainees must now receive written documentation of their rights that meet minimum criteria specified by the Guide, and must receive a copy of their completed Home Health Aide Trainee Evaluation Forms that are appended to the Guide.

Changes were also made to the Nurse Instructor requirements:

• A nurse wishing to train home health aides must now submit a signed application to the DOH, and additional supporting documentation is required for an instructor wishing to teach in a language other than English; and,
• All training must take place under the direction of an approved nurse instructor;
• All supervisors of practical training must be approved nurse instructors listed in the Home Care Registry.

Training and Testing Materials are also addressed in the Guide with new requirements:

• The training must be conducted by using lesson plans based on the content in the DOH Home Care Curriculum (HCC) and Health Related Tasks Curriculum (HRTC), both of which are available on the DOH website;
• All training programs are required to use a published text that is consistent with the content of the HCC and the HRTC, and the training programs are required to use written tests from texts published for the purposes of training home health aides.  Test questions must come from a “bank” of questions and trainee evaluation forms must be used to document competency of required skills.

Training in a Foreign Language will only be allowed if the approved nurse instructor meets certain proficiency requirements, and a text and written tests in the language are required.

Training programs must also actively participate in the sponsoring organization’s Quality Assurance or Quality Improvement program.  Quality assessment and improvement activities must now be conducted on a quarterly basis and include a written annual evaluation of the training program.

The Guide includes several forms to be used:  the Home Health Aide Trainee Evaluation Form; a list of the procedures that must be demonstrated proficiently, an equipment list, a list of required documents for survey purposes, a Home Health Aide Training Program Monitoring Tool, Trainee Rights, and a Schedule of Classes form to be used every six months when training programs report anticipated classes. 

PHI staff participated in the DOH workgroup, and believes the changes are an improvement in the regulatory framework of the home health aide training program.  For further background on the training of home care aides in New York, see the NYSDOH guide (pdf) on the Training program.

The report, Self-Determination and the MI Choice Medicaid Waiver Program (pdf), is based on a survey of 624 direct-care workers in the MI Choice Program. It offers recommendations and strategies to strengthen the SD program for workers and participants.

“The survey findings should stoke what should be a growing discussion of the intersection of the paid direct-care workforce and family caregivers,” said PHI Director of Midwest Policy Hollis Turnham.

“Self-direction models across the country rely on family caregivers as well as friends and neighbors to become paid direct-care workers,” Turnham said. “As self-direction grows as a delivery option, we need to acknowledge and learn more about that intersection of individual roles and public funding — both about the challenges and the opportunities.”

The survey of workers in the SD program was designed to:

• Collect baseline demographic information;
• Understand the workers’ motivations, job satisfaction, and training needs; and
• Identify strategies to strengthen and support recruitment and retention.

The report compares the findings from three types of SD workers — family, friends, and strangers — and explains that while they are “indistinguishable” in many aspects, “there are some remarkable differences among the groups.” For example, more friends and neighbors were found to be working with an individual with a disability rather than elders.

The Findings

The survey findings are summarized as follows:

Satisfaction: While SD workers are, overall, satisfied with their jobs and find the work rewarding, they indicated low satisfaction with their wages and the number of hours they work. SD workers earn wages that are among the lowest of all direct-care workers in the state, and have higher rates of uninsurance.

The SD workers — especially the SD workers who are family and friends — reported that they provided services for which they were not paid, which is an indication that the SD model is built on the informal unpaid support that these caregivers provide.

Relationships between Workers and Participants: Common assumptions about family members and friends working in the SD MI Choice Option are not reflected in the findings. In fact:

• A significant number of paid family members do want training. Almost half of the workers expressed an interest in training in specific clinical topics and communications skills.
• A majority of the family members (57 percent) do not live with the participant they support.

Recruiting and Retaining SD Workers: The MI Choice program — like every long-term care services and supports program — is challenged to find and retain qualified, competent workers. Only half of the workers indicated they intend to continue working for the participants for whom they currently provide support, which points to a “potentially high level” of turnover among these workers.

Recommendations

Based on the findings, PHI has made the following recommendations for the MI Choice program:

• Develop mechanisms to ensure that workers have the opportunity to receive training on topics that are relevant and of interest to them.
• Provide training opportunities and resources for participants to be effective employers in the MI Choice SD Option.
• Offer more and continuing work to current workers to build and sustain a workforce willing to serve SD participants.
• Explore opportunities to maximize outreach and enrollment in Medicaid and subsidized health plans under the Affordable Care Act (ACA) to secure health care for uninsured and underinsured workers.
• Identify mechanisms and opportunities for SD workers to recognize and address workload imbalances and concerns.

The project was made possible through a technical assistance award from the National Direct Service Workforce Resource Center to the Michigan Department of Community Health and, with additional funding from the Centers for Medicare and Medicaid Services State Profile Tool Grant to the Michigan Office on Services to the Aging.

– by Deane Beebe

PHI’s letter to the DOL opposing the delay appears below.

Learn more at www.companionshipexemption.com.

Secretary Hilda Solis
U.S. Department of Labor, Room S-3502
200 Constitution Avenue NW.
Washington, DC 20210

Dear Secretary Solis:

I am writing to urge the Department to adhere to its original 60-day comment period for the NPRM (RIN) 1235-AA05, which would narrow the current companionship exemption under the Fair labor Standards Act and extend federal minimum wage and overtime protections to home care workers . We understand that there are some organizations, particularly those opposed to this proposed change, that are urging action to extend the comment period beyond February 27, 2012.

With over 2000 comments submitted to date, we do not believe an extension is needed. You announced that the Department was looking into this issue in 2009 – over two years ago – and it was included in the Spring regulatory agenda in 2010. Furthermore, those requesting the extension have been aware of this issue for at least six years. Along with proponents of the change, opponents gave public testimony at a hearing in October 2007 on the Fair Home Health Care Act – a bill that, if passed, would have similarly narrowed the exemption.

The companionship exemption was included as part of President Obama’s “We Can’t Wait’ agenda, and we wholeheartedly agree. Home care workers have been waiting almost 40 years to receive these basic labor protections. We urge you to close the comment period at the end of this month so the Department can review the comments and proceed with finalizing its policy.

Sincerely,

Carol Regan
PHI Director of Government Affairs

SB 693 will create Michigan’s Exchange, the MiHealth Marketplace.  Although there are some concerning things in the version that was passed, we are very pleased that consumers will have be in the majority on the Marketplace Board.  It now moves on to the full Senate for a vote.

The ACA requires states to create an Exchange, the a new marketplace where individuals and small businesses will be able to find out information about health insurance plans and access tax credit subsidies to reduce the cost of health insurance.  Health insurance plans on the Exchange will have to meet specific quality and cost requirements and won’t be able to use health status to determine premims. This video explains what is in the ACA and what exactly an Exchange does.

By passing legislation to create the Exchange,  Michigan will be to apply for federal grants to pay for the development of the Exchange.  If the state does not create its own Exchange, it will have to participate in the federal Exchange.

PHI provided testimony (pdf) in the House and the Senate in support of Michigan creating our own Exchange and letting legislators know how the MiHealth Marketplace will help many direct-care workers and long-term care employers across the state.   We have also been very active with the Michigan Consumers for Healthcare in talking with legislators urging their support for moving forward with implementation.  Last month, PHI-Michigan participated in a press conference with MCH to outline our priorities in what a Michigan Exchange should look like, including the following:

• Consumer representation on the Exchange Board and not allowing the insurance industry to have a voting seat on the Board.
• Move beyond the “Orbitz for Healthcare” model by providing other ways for workers to get information about their health care options, including allowing community organizations to act as Navigators.
• Seamless enrollment in Medicaid to allow workers to move between Medicaid and private insurance to do so without gaps in coverage.

Even with the victory in the Committee, we still have long road ahead to creating a Michigan Exchange.  Many  legislators are opposed to the Exchange or even implementing the ACA  in Michigan.  It is important for them to hear from you about how the it will help make quality health coverage more accessible and affordable.  If you would like to get involved or contact your legislature, please contact Tameshia Bridges at tbridges@phintional.org.

The Alzheimer’s Association, New York City Chapter (AlzNYC), is offering a free monthly newsletter, ADvancing Care, to people who work in nursing homes and other residential care settings as well as to the families and friends of those who reside there.

To subscribe and read the current and past issues, visit the AlzNYC website.

New York City Council Speaker Christine Quinn

New York City Council Speaker Christine Quinn outlined her vision for how the city can both create jobs and build long-term economic security in an October 18 speech.

Among the initiatives intended to help recent immigrants and low-income workers improve their job prospects is an expansion of training for home care workers to help them get jobs in the growing health care sector.

The City Council is working with PHI and 1199 SEIU to train an additional 200 New Yorkers per year in home health care and to also address stabilization efforts across the home care sector.

“PHI thanks Speaker Quinn and the City Council for investing in the home care workforce to ensure quality jobs for low-income workers and better care for elders and people with living with disabilities in New York City,” said PHI President Steven Dawson.

Increase in Demand for Home Care Workforce

Quinn says that the following recent state changes are expected to have a large impact on the home care workforce, making it an ideal time to support this vital industry:

• As the population ages, there will be an increased demand for health professionals who care for disabled or home-bound individuals.
• New York State has mandated that all home care workers serving Medicaid recipients within geographic areas that have local living wage laws be paid a living wage (to be phased in beginning in 2012).
• New Yorkers who need more than 120 days of home and community-based long term care services — mostly dual eligibles — will be required to enroll in Managed Long Term Care (MLTC) plans beginning in April 2012, pending federal approval. Most MLTC plans will likely employ home health aides to ensure compliance with federal regulations and because these workers can perform health-related tasks.

“An enormous amount of upgrade training will be necessary to ensure that tens of thousands of personal care aides do not become unemployed due to these changes,” Quinn said.

Initiative Specifics

The City Council’s partnership with PHI will fund a RN-certified trainer to make it possible for PHI and its affiliate, Cooperative Home Care Associates (CHCA), to train new home health aides and help transition personal care aides who might not otherwise retain their jobs.

CHCA guarantees a job to any trainee who successfully completes the entry-level training.

Through the City Council’s partnership with 1199 SEIU, the 1199 SEIU Bill Michelson Home Care Education Fund will provide additional training and education services to support all home care workers — including individuals from CHCA — to achieve higher levels of education and employment by providing extensive ESL training, preparation for college enrollment, and other skill-building initiatives.

“By partnering with 1199 SEIU and PHI, the City Council is supporting a field that will see increased growth due to demographic shifts, and an agency that is committed to improving the quality of the profession and the stabilization of this field,” Quinn said.

Both the Massachusetts House and Senate have passed surplus reserve bills that would provide some direct-care workers in the state with a one-time wage supplement if the state has reserve tax revenues of at least $20.6 billion by January 15, 2012.

Eligible direct-care workers and human service workers who earn less than $40,000 a year would benefit from the legislation, which earmarks $10 million for a Direct-Care Worker’s Salary Reserve.

The wage supplement was included in the surplus reserve bills because the direct-care workers who will likely be eligible have not received a wage raise in three years, explained PHI Massachusetts Policy Director Amy Robins.

While the language in the bill does not provide much detail, Lisa Gurgone, executive director of the Massachusetts Council for Home Care Aide Services, said that the language tracked previous legislation that made clear which workers would be eligible for the salary reserve wage supplement.

The direct-care workers who were eligible in 2009 were:

• homemakers and personal care homemakers who provide long-term services and supports to clients enrolled in the Massachusetts Home Care Program administered through the state’s Executive Office of Elder Affairs and the Massachusetts Rehabilitation Commission;
• direct-care workers who are employed by social service agencies that contract with Commonwealth’s Executive Office of Health and Human Services; and
• home health aides who work as homemakers and personal care homemakers for agencies that have contracts with Aging Services Access Points, which provide case management services and long-term services and supports to elders.

Direct-care workers who are employed in settings such as nursing homes, certified home health agencies, and assisted living facilities that are paid “class-rates” (set by the state’s Health and Human Services Division of Health Care Finance and Policy) would most likely not be eligible for the bonus.

In fiscal year 2009, direct-care workers received a one-time salary reserve bonus, but the subsequent state budgets lacked adequate funding for a salary reserve.

According to the Associated Press, 30,000 direct-care workers would be eligible for the salary reserve bonus should the bill be signed into law.

It is anticipated that Massachusetts Governor Deval Patrick will sign the supplemental budget proposal, but he could still veto the Direct-Care Worker’s Salary Reserve provision.

– by Deane Beebe