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Three brief stories on direct care:

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Standards Lowered for Some Hawaii Caregivers

Hawaii has reduced its qualification requirements for part-time caregivers working in community-based adult foster homes.

As a result of legislation signed by Governor Neil Abercrombie (D) in July, nurse aides who provide less than five hours of care daily (or less than 28 hours weekly) in adult foster homes no longer have to be certified.

To become certified, nurse aides must take a state-administered test every two years to demonstrate continued mastery of their skills. Uncertified nurse aides are trained but not tested.

Advocates for the elderly say that the degraded qualifications could lead to worse quality of care in adult foster homes.

The lowered qualifications apply only to adult foster homes with three residents, the maximum allowable in Hawaii’s Community Care Foster Family Homes program.

The changes to the qualifications are set to expire in June 2013, at which point lawmakers will decide whether to extend them permanently.

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Boston College Receives HHS Grant to Improve Home- and Community-Based Care Competencies

The Department of Health and Human Services (HHS) has awarded $2.25 million to Boston College’s Graduate School of Social Work to bolster consumer direction in home- and community-based care settings.

The grant will fund a three-year program called Accelerating Participant Direction Philosophy and Models in the Aging Network.

The program’s overarching goals are to identify the skills necessary to jobs that help people obtain home- and community-based services, and to enhance providers’ ability to ensure consumer direction.

Announcing the grant on July 26, HHS Assistant Secretary for Aging Kathy Greenlee said that the grant is “an investment that will help strengthen our commitment toward providing home- and community-based services…based on both the needs and preferences of the consumer.”

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PHI Board Member Calame Honored in San Francisco

San Francisco Mayor Edwin Lee (D) proclaimed July 21, 2011, to be “Donna Calame Day” in honor of the executive director of the San Francisco In-Home Supportive Services (IHSS) Public Authority.

Calame, a PHI board member, was honored for her career-long dedication to helping people with disabilities exercise their right to “the widest range of choices possible for [living] outside of institutional settings with appropriate assistance,” according to the city’s proclamation.

Since 1996, the San Francisco IHSS Public Authority has served as the employer of record for the city’s home care workers, fighting for better wages, benefits, and supports.

– by Matthew Ozga

Massachusetts State House in Boston

PHI Massachusetts lent its support to two bills at a July 19 hearing on home and community health care provider policies, held by the Joint Committee on Public Health.

“An Act Relating to Training for Certified Nurses’ Aides and Direct-Care Workers,” Senate Bill 1121, calls for a review of current training standards for home health aides and certified nurse aides (CNAs) in the state.

“An Act Relative to Home Health Aides,” Senate Bill 1138, would expand the current role of home health aides (HHAs) in the state and, with appropriate training and oversight, allow them to administer some medications.

Facilitating a Career Lattice

Passage of the training standards bill would be well-timed: Massachusetts is one of six states to receive a Personal and Home Care Aide State Training (PHCAST) demonstration grant from the Department of Health and Human Services.

“The PHCAST demonstration grant will position Massachusetts as a leader on training standards for personal care attendants and personal care aides nationally — and also lay the foundation for a portable credential in the state,” said PHI Massachusetts State Director Amy Robins in her hearing testimony.

“A close examination of training standards for CNAs and HHAs could help facilitate the creation of a clearly articulated and intentional career lattice among direct-care occupations. This would allow workers to advance to new positions and move across settings — keys to cultivating, recruiting, and retaining the direct-care workforce Massachusetts will need in the coming years,” Robins’ testimony (pdf) concluded.

Medication Administration

Senate Bill 1138 provides a very attainable advancement opportunity for HHAs who are interested in medication administration.

“The experience of others demonstrates that this can be done safely and effectively — and that this strategy also helps ensure the best value for our health care spending, with all working to the top of their training and licensing,” Robins’ testimony (pdf) said.

The bill “would send a clear signal that the state recognizes the importance of this vital workforce and the need to do more to improve these jobs and create meaningful advancement opportunities,” her testimony continued.

There are nearly 100,000 direct-care workers in Massachusetts. Direct-care jobs are the second largest occupational grouping in the state and are expected to grow by 22 percent by 2016, dramatically outpacing the growth of other jobs.

Home and community-based direct-care jobs are among the state’s lowest-paying jobs, paying wages that fall below the state’s low-wage threshold.

“Quite simply, the state must do more to cultivate a high-quality, well-trained and stable workforce,” Robins says. “These two bills are important steps in the right direction.”

For more information on the direct-care workforce in Massachusetts, see State Facts: Massachusetts’ Direct-Care Workforce (pdf).

– by the PHI Policy team

(L-R) CNA Kelly Stokes, Iowa State Senator Jeff Danielson

Iowa State Senator Jeff Danielson (D) experienced firsthand the daily routine of a direct-care worker when he participated in a recent “Come Care with Me” event.

During the event, which was organized by the Iowa Caregivers Association and supported by PHI, Danielson trailed Kelly Stokes, a certified nursing assistant (CNA) at Harmony House, a long-term care facility in Waterloo, Iowa.

Video of the Come Care with Me event is available at the Iowa Caregivers Association’s website.

“Backbreaking Work”

Danielson said the Come Care with Me event was an “invaluable” experience, and that he learned a lot about direct-care workers during his day spent trailing Stokes.

For example, he said was surprised at the sheer physical toll Stokes’s job inflicts upon her, day in and day out.

“Direct-care workers [do] backbreaking work,” said Danielson, who also works as a firefighter.

“But they’re too invisible to us,” he continued. Policymakers “need to know [what's] going on, and the public needs to be aware of that.

“We need to make sure that they are paid well [and] that they have benefits, so they can take care of their families too — just like they take care of families here,” Danielson concluded.

Pitching In

Stokes said that she enjoyed the experience as well.

“I was glad that I was able to share with someone like the senator because of the position that he has, and I was glad that he was able to pitch in and do hands-on [care],” she said.

“As a firefighter, I sometimes get called a hero,” Danielson said, “but when you see the direct-care workers here, you know that they’re the everyday heroes.”

More information about Come Care with Me, a national PHI campaign, is available online.

Come Care with Me events are a project of the PHI Health Care for Health Care Workers campaign, which is made possible with support from the Nathan Cummings Foundation.

– by Matthew Ozga

The quality-improvement intervention INTERACT II (Interventions to Reduce Acute Care Transfers) can reduce hospitalization rates among nursing home residents, according to a report published in the Journal of the American Geriatrics Society.

The study found that nursing homes that diligently employed INTERACT tools reduced the hospitalization rates of their residents by 24 percent.

Hospitalization can be emotionally and psychologically traumatic for nursing home residents, and stressful for their family members. A “substantial proportion” of such hospitalizations may be avoidable, the researchers write.

Hospitalizations are also costly. The researchers estimated that, in a 100-bed nursing home, a 24 percent reduction in hospitalizations can save Medicare approximately $125,000 a year.

Role for CNAs

The INTERACT II intervention tools comprise “clinical and educational tools and strategies” that can be used daily in long-term care facilities, according to the INTERACT website.

Among the tools used in the INTERACT II program is “Stop and Watch” (pdf), a checklist that allows certified nursing assistants (CNAs) to easily alert nurses to changes in residents’ behavior — changes which could lead to hospitalization if left unchecked.

The INTERACT program was developed initially by the Georgia Medical Care Foundation with funding from the Centers for Medicare and Medicaid Services (CMS). INTERACT II is the second, more refined, iteration of the intervention, which was developed by the authors of the study with input from direct-care providers.

Study Shows Reductions in Hospitalization

The researchers evaluated the effectiveness of INTERACT II in 25 nursing homes spread across three states — New York, Massachusetts, and Florida — over a six-month period.

Of the 25 facilities, 17 were judged to be “moderately or highly engaged” in the INTERACT II program. Those facilities saw a 24 percent reduction in their hospitalization rate.

The other eight facilities were characterized as “minimally” engaged in INTERACT II. They reduced their hospitalization rate by six percent.

The researchers concluded that these results “strongly suggest” that INTERACT II is effective in helping nursing home residents stay out of the hospital.

The study was funded by the Commonwealth Fund.

– by Matthew Ozga

The 34th Annual National Nursing Assistants Week is set to take place from June 16-23.

The annual event recognizes and celebrates nursing assistants for the daily care they provide in nursing homes, home care, and other long-term care settings.

The week will kick off with National Career Nursing Assistants Day on June 16.

This year’s theme is “New Roles, New Goals.”

“This is a time in our health care history unlike any other, said M. Jeannie Flossie, LNHA, Altercare of Ohio, Inc. “Nursing assistants are working more independently than ever and their input, actions, and contributions are more crucial to continuity of care than ever before.”

The National Network of Career Nursing Assistants (NNCNA) has developed a “PR Kit and Planning Guide 2011” and other materials to help employers organize the week’s activities and events, including:

• Asking the town’s mayor to proclaim Nursing Assistants Week (download the proclamation [pdf]);
• Inviting public officials and community leaders to attend an event;
• Promoting Nursing Assistants Week events in the media; and
• Generating individual and group blueprints for nursing assistants’ new roles and new goals.

NNCNA is also sponsoring the 34th Annual Nursing Assistant Convention and Recognition Program (pdf) in Ohio on June 22. The convention will feature a presentation by Mary Woodyard, coordinator, Nurse Aide Training Programs at the Ohio Department of Health. Also on the agenda are:

• Person-Centered Care: Culture Change — Implications for Nursing Assistants
• MDS for Nursing Assistants
• Ending Rehospitalizations
• The Safe Lifting Fair

Nursing assistants are also encouraged to submit (pdf) essays, songs, skits, and posters on this year’s theme. Prizes will be awarded at the convention in Ohio.

NNCNA also sponsors the Twenty Year Club, a nationwide honorary member organization for experienced nursing assistants who provide direct care in nursing homes, homes, hospitals, hospices, or other long-term care services.

For more information about National Nursing Assistants Week and the Twenty Year Club, contact the NNCNA at cnajeni@aol.com and visit the NNCNA website.

– by Deane Beebe

Cindy Ramer

Two brief stories on direct care:

Iowa DCW Speaks at Health Reform Conference

Iowa direct-care worker Cindy Ramer spoke about her experiences living without health insurance during a press conference honoring the one-year anniversary of health reform in Des Moines last month.

Ramer’s employer does provide health insurance; however, the coverage is so expensive that Ramer cannot afford it. Ramer incurred massive debt trying to pay for her diabetic husband’s health care costs. She eventually had to declare bankruptcy.

“I’m not asking for a handout; I’m just asking for something I can afford,” Ramer said.

Ramer said that she is hopeful that the Affordable Care Act will help her obtain subsidized health coverage via insurance exchanges.

U.S. Surgeon General Regina Benjamin also spoke at the press conference.

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Journal Issues Call for CNA Stories

Narrative Inquiry in Bioethics is encouraging certified nursing assistants (CNAs) to submit written first-person accounts of their experiences in long-term care.

The journal, published by Johns Hopkins Press, is devoting an entire issue to CNAs and their personal stories — the challenges, concerns, and rewards they face each day while caring for others.

CNAs interested in sharing their stories should send an e-mail to narrativebioethics@gmail.com. More information can be found on the Johns Hopkins website (pdf).

– by Matthew Ozga