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Sen. Tom Harkin

Senator Tom Harkin (D-IA) introduced a “sense of the Senate” resolution (pdf) on May 10 expressing the need for a comprehensive approach to expanding and supporting a strong home care workforce, as well as making long-term services and supports affordable and accessible to elders and people with disabilities.

Among the reasons cited for a comprehensive policy approach to meeting the nation’s caregiving needs are:

• Over the course of the next two decades, the number of Americans aged 65 and older will increase from 40 million to 70 million; 70 percent of Americans over 65 require some form of long-term services and supports.
• There are currently 12 million adults, nearly half of whom are 65 or older, who are in need of long-term services and supports due to functional limitations; this is project to grow to 27 million by 2050.
• The current direct-care workforce is well over 3 million strong — with an additional 1.8 million workers needed over the next decade to keep pace with growing demand. This workforce provides 70 to 80 percent of the hands-on care and personal assistance received by Americans who are elderly or living with disabilities or other conditions.
• The quality of home care jobs is poor with low wages, few benefits, high turnover and a high level of job stress and hazards.

The Resolution focuses on a range of policy solutions that include job creation, job quality, workforce training and advancement, pathways to citizenship, and strategies to make care affordable and accessible to consumers and their families.

These solutions are embedded in the Caring Across Generation policy platform and are part of its educational and advocacy efforts.

Caring Across Generations is a campaign to transform long term care in the U.S. for individuals who rely on these services and supports and for the workers who provide home care. PHI is a member of the campaign and serves on its Leadership Committee.

– by Carol Regan, PHI Government Affairs Director

Caring Across Generations logo

Caring Across Generations, a multi-stakeholder effort to promote quality care, is hosting a legislative town hall on Capitol Hill on May 21.

Two short panels will discuss:

• protecting current programs such as Medicaid, Medicare, and Social Security; and
• implementing future policies that will build a quality direct-care workforce to support America’s families in meeting care needs across generations.

PHI Government Relations Director Carol Regan will frame the panel discussions, which will include workers, consumers and employers.

Senator Tom Harkin (D-IA) and other members of Congress have been invited. Harkin recently introduced a Sense of the Senate Resolution that commits policymakers to addressing America’s caregiving needs, including quality direct-care jobs and accessible home- and community-based services.

Please join PHI for this important forum on creating a caring economy — and invite your member of Congress and their staff to attend.

The one-hour program takes place in Room 902 of the Hart Senate Office Building and starts at from 11 a.m.

– by Karen Kahn, PHI Director of Communications

By 2020, the direct-care workforce — nursing assistants, home health aides, and personal care aides — is projected to be the nation’s largest workforce at 5 million workers, according to a new PHI analysis available in PHI FACTS 3: America’s Direct-Care Workforce (pdf).

Home care jobs — both home health aide and personal care aide positions — are the nation’s fastest-growing jobs, projected to increase over the decade 2010-2020 at an astounding 69 and 71 percent, respectively. Nursing aide, orderly, and attendant positions are expected to increase by 20 percent. Together these jobs will add an additional 1.6 million jobs to the economy.

Comprising nearly a third (30.6 percent) of the entire U.S. health care workforce, direct-care workers far outnumber other health care practitioners, including physicians, nurses, and therapists. These workers also outnumber all those employed in allied health occupations, such as medical and dental assistants, and physical therapy assistants and aides, by nearly three to one.

Shift Toward Home and Community-Based Settings

The analysis found that there were at least 4 million direct-care workers in 2011, with the majority employed in home and community-based settings. The workers employed in these settings are expected to outnumber facility workers by more than two to one by 2020.

PHI researchers estimate that there are at least 800,000 independent providers who provide personal care services for consumers who are enrolled in public programs. These workers, who are employed directly by consumers and their families in home and community-based settings, are not tracked by the U.S. Bureau of Labor Statistics and have been heavily undercounted in government surveys, the researchers explain.

Wages and Benefits Worsen

The PHI analysis also found that the wages and benefits of direct-care workers continue to worsen.

The median wage of $10.59 in 2011 for all direct-care workers is far below $16.57, the median wage for all U.S. workers that year. Moreover, adjusted for inflation, wages for all direct-care workers have declined over the last decade.

In addition, more than one third of aides employed by home care agencies and one quarter of nursing home aides lacked health care coverage.

Poverty Increases

With wages and benefits declining, an increasing number of direct-care workers live in poor households. Since 2008, direct-care workers living in households with incomes below 200 percent of the federal poverty line have increased from 44 percent to 47 percent.

At this income level, many of these workers are eligible for — and rely on — public benefits such as Medicaid and food stamps to support their families.

To learn more about the direct-care workforce, download PHI FACTS 3: America’s Direct-Care Workforce (pdf).

– by Deane Beebe

(L-R) E.J. Dionne, Marki Flannery, PHI President Steven Dawson, Laine Romero-Alston

The Aspen Institute Workforce Strategies Initiative (Aspen WSI) convened an audience of 100 long-term-care and workforce development stakeholders in Washington, D.C., on May 3, for an expert discussion on the challenges that direct-care workers face and strategies workforce development leaders can use to improve the quality of these long-term-care industry jobs.

Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers, the thoughtful and lively discussion, was moderated by E.J. Dionne, a Brookings Institution senior fellow and Washington Post columnist, and featured:

• Steven Dawson, PHI President
• Marki Flannery, Partners in Care President, and
• Laine Romero-Alston, Ford Foundation Program Officer.

Maureen Conway, executive director of the Aspen Institute Economic Opportunities Program, framed the conversation by explaining that 40 percent of the jobs created since 2010 are low-wage jobs and direct-care occupations are the “lowest-paid jobs” with “uncertain hours.” She asked whether poor quality, direct-care jobs had “to be that way?”

Low-Wage, Not Low-Skill Jobs

Dawson explained the employment and income characteristics (pdf) of the direct-care workforce and that personal care aides and home health aides were projected to be the first and second fast-growing occupation in the nation by 2020.

He highlighted the particular challenges of home care workers, such as working in isolation and the need to have “emotional intelligence” to navigate a client’s home and the relationships within it.

“These are low-wage jobs but certainly not low-skill jobs,” Dawson said.

Valued and Respected

Flannery reported that her agency employs 9,800 home health aides — the largest licensed home care agency in the country — and described the profile of people seeking jobs as home health aides since the economic downturn.

Partners in Care has a turnover rate of 23 percent — significantly lower than the 60 percent national average, Flannery said. She attributes her agency’s high retention rate to its training partnership with PHI.

Using the PHI Coaching Approach^SM, Partners in Care’s managers, supervisors, and aides were trained in communication techniques that made the aides feel “valued and respected,” she explained, adding that the training also led to improved worker satisfaction and better patient outcomes.

Flannery also discussed the challenges of being a “high road employer” that pays aides a decent wage while reimbursement rates from public funding and private insurers go down.

Multi-Prong Strategies

Romero-Alston spoke on the importance of using “multi-prong strategies” to both “raise the floor” of direct-care jobs and “create opportunities for career pathways.” She identified a specific barrier to a good job that needed to be overcome: the exclusion of home care workers from basic labor protections such as minimum wage and overtime pay.

Romero-Alston added that the Obama Administration has “taken great strides” over the last few months to revise the so-called “companionship exemption” through a rule change proposed by the U.S. Department of Labor.

Video and Handout Available

To watch the discussion, including audience questions, an 80-minute video is available on the Aspen Institute website along with its overview (pdf) of the direct-care workforce.

“Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers” was the Aspen WSI’s second discussion this year in a series entitled, “Reinventing Low-Wage Work: Ideas That Can Work for Employees, Employers and the Economy.”

– by Deane Beebe

Iowa state capitol building

A budget bill passed by the Iowa Senate last week would support training standards and career paths for the state’s direct-care workforce.

The bill (SF 2336) sets the FY 2013 budget for the Iowa Health & Human Services Department (HHS). It would establish and fund:

• core training standards for direct-care workers,
• specialized training opportunities, and
• career advancement opportunities.

SF 2336 would also create a Board of Direct Care Professionals to oversee the implementation of these new training standards and career pathways.

The board will help “provide direct-care workers with the professional status they deserve,” said Di Findley, the executive director of the Iowa CareGivers Association.

The state House version of the HHS budget bill, which passed April 18, does not include funding for the Board of Direct Care Professionals. This and other discrepancies between the two bills will be negotiated and resolved in a future conference committee, Findley said.

Bill Draws on Council Report

In crafting the bill, state senators drew upon recommendations made by the Iowa Direct Care Worker Advisory Council. In a report (pdf) to the governor and state legislature submitted in March, the council suggested ways for the state to build a stable and qualified direct-care workforce.

The council’s recommendations “are designed to stabilize and strengthen the direct-care workforce to reduce turnover costs, improve quality, and ensure access to services,” the report says.

Established by the state legislature in 2008, the Iowa Direct Care Worker Advisory Council comprises a broadly representative coalition of stakeholders, including direct-care workers, consumers, employers, and other health professionals. The council reports to the state Iowa Department of Public Health.

“What I am most proud of is the leadership taken by direct-care workers in moving this historical piece of legislation (SF 2336) forward,” Findley said.

– by Matthew Ozga

The American Society on Aging‘s (ASA) annual conference in Washington, DC, will feature a “National Forum on Building a Workforce to Care for an Aging Society.”

The forum will be held on March 30 from 8:00 a.m.-12:30 p.m.

The program is based on the research and predictions of experts who contributed articles to the Winter 2010-11 issue of ASA’s journal, Generations. The forum will delve deeply into the policy implications, education and practice levels needed to build a workforce to care for America’s aging population.

PHI President Steven Dawson, who contributed a journal article with co-authors Nancy E. Lundebjerg and Caitlin W. Connolly of the Eldercare Workforce Alliance, is a keynote speaker.

PHI National Policy Director Steve Edelstein will present on an article contributed by Dorie Seavey, PHI national policy research director.

Pre-registration is required and space is limited. For more information, visit the ASA website.

– by Deane Beebe