PHInational.org

As President Obama and Congress continue to wrestle over a budget plan to reduce the federal deficit, a small group of bipartisan senators known as the “Gang of Six” put forth a proposal which, if enacted, would cut Medicare, Medicaid, and Social Security, and repeal the Community Living Assistance Services and Supports (CLASS) Act.

The CLASS Act, a provision in the health care reform law passed in March 2010, establishes a voluntary, federal insurance plan designed to help people purchase long-term services and supports.

Details of the CLASS Act — including the monthly premiums and the cash benefit to purchase these services and supports — have yet to be worked out. However, according to the law, the Secretary of the Department of Health and Human Services (HHS) has until October 2012 to do so.

HHS Secretary Kathleen Sebelius has said that she is developing a plan that would make the voluntary, long-term insurance plan solvent, as required by the health reform law.

The sustainability of the CLASS Act has been called into question by some Republican lawmakers, prompting a March 11 hearing. Assistant Secretary for Aging Kathy Greenlee, who is the administrator of the CLASS Office, testified that the program would remain fiscally sound even when elders and people living with disabilities begin to make claims.

The CLASS Act would lower the cost of Medicaid, which pays for 62 percent of the nation’s long-term services and supports costs (pdf), say supporters of the program.

“What’s strange to me is that this started out as a cost-saver, and now it’s being targeted in the name of cost savings,” Judy Feder, a professor at the Georgetown Public Policy Institute and fellow at the Urban Institute, told Politco. “The people who are saying it will cost us money say that that’s a challenge that cannot be met, but I believe it can.”

Personal Care Attendants Workforce Advisory Panel

Less well-known is that the CLASS Office is also charged with managing a Personal Care Attendant (PCA) Workforce Advisory Panel.

While HHS has accepted nominations to the panel, which were to be announced last fall, to date there has been no such announcement.

The panel is responsible for examining the adequacy of the number of personal care aides, their wages and benefits, and access to their services, as well as advising Congress.

Personal Care Aides are projected to be the fourth fastest-growing occupation in the country between 2008 and 2018, increasing by 46 percent, according to a PHI analysis available in PHI FACTS 3: Who Are Direct Care Workers? (pdf).

– by Deane Beebe

The “Caregiver and Direct Support Workforce” was a key topic of concern on the agenda of the Community Living Initiative‘s four, day-long “Stakeholder Dialogues” and “Listening Sessions,” according to the US Department of Health and Human Services‘ (HHS) April 2011 summary of the 2010 sessions.

The Community Living Initiative was established by HHS to identify and promote ways to improve access to housing, community supports, and independent living arrangements for people living with disabilities and older adults.

“We heard from consumers in more than one session about the low pay and lack of support that their direct-care workers received,” said Henry Claypool, director of the HHS Office on Disability.

“Developing strategies to enhance the pay and better support the direct-care workforce is central in efforts to improve the quality of the services provided to those that rely on Medicaid for long-term services and supports,” Claypool said.

All of the session participants — state and local officials, consumers, service providers, advocates, and other stakeholders — agreed that there were not enough qualified workers to provide care to people with disabilities in the community.

Multiple Workforce Concerns

Other issues raised in the stakeholder dialogues and listening sessions regarding the caregiver and direct-support workforce, were:

• There is no formal training program, or a role description, for paid direct-support providers in many places.
• Many workers who provide care in the community lack insurance.
• Many workers lack the supports necessary to grow and thrive as professionals.
• Paid caregivers may take direction from a referring or service-providing agency as much as from the consumer, and lack understanding of the different roles of the individual, family, and formal support service system.

Also of concern was whether direct caregivers who are losing jobs in large institutions that are closing would be able to transition to providing in-home care.

The participants also reported that family members and informal caregivers are unaware of their official role as a direct-support provider and consequently do not get the training and support that would help them in this role.

Recommendations

The participants made the following suggestions to the “Federal Listening Panel” regarding the caregiver and direct-support workforce:

• Permit direct payment to direct-support providers via Medicaid waivers.
• Create a professional campaign to recruit direct-support providers, similar to the option of enlisting in the military.
• Create a database that consumers can use to locate and hire direct-support providers.
• Raise wages and provide benefits to attract and retain a dependable caregiver workforce.

The other topics of concern addressed by the participants were:

• coordination and collaboration among agencies
• housing, and
• access to services

Depending on the issue, addressing the problem would require either a regulatory process or enactment of legislation, according to the HHS summary, which also provides examples of “Successful Community Living Strategies.”

The Community Living Initiative sessions were held in San Diego, California; Raleigh, North Carolina; Fairfax County, Virginia; and Boston, Massachusetts.

– by Deane Beebe

Western Missouri District Court, Kansas City, MO

Supportive services workers who care for people with Medicaid in community-based residential care settings are not exempt from federal minimum wage and overtime requirements, confirmed a U.S. district court in Western Missouri. Read the full story

National experts on health, consumer, and aging issues have joined to form the Long-Term Quality Alliance (LTQA) to ensure that people who need long-term services and supports receive high-quality care. Read the full story

Henry Claypool

The Health and Human Services Coordinating Council on Community Living is off to a good start, said Henry Claypool, director of the HHS Office on Disability. Read the full story