Newsday Op-Ed

Newsday published an op-ed (pdf) co-written by PHI President Steven Dawson and Direct Care Alliance Executive Director Leonila Vega to pay tribute to the “American heroine” Evelyn Coke on the one-year anniversary of her death.

Coke, a home care worker, fought the Fair Labor Standards Act’s “companionship exemption.”

“In honor of Coke and the millions of home care workers nationwide, Secretary of Labor Hilda Solis should immediately provide all home care workers with the minimum wage and overtime protections promised to American workers under the Fair Labor Standards Act,” wrote Dawson and Vega.

New York Times Blog Posts

The New York Times reports in its New Old Age Blog on the relationship between quality care in nursing homes and high turnover of nurses’ aides.

Reporter Dale Russakoff shares her personal experience with finding a nursing home for her mother 10 years ago. She writes that what has changed since then is that “the federal government and the states have all identified the turnover rate as a crisis in long-term care.”

PHI Director of Curriculum and Workforce Development Peggy Powell confirms Russakoff’s observations and is quoted as saying, “Cycling in aides who don’t know you is very disorienting and upsetting, and the resident is the one who suffers on the quality end.”

In another New York Times blog post, Nancy Folbre, an economics professor at the University of Massachusetts Amherst, argues for creating more jobs by providing increased federal support for home care services and cites two reports to make her case.

More Media Coverage

More news on the direct-care workforce, including a letter (pdf) to the editor published in the Boston Globe on how Massachusetts health care reform left direct-care workers behind, can be found at the PHI Newsroom.

– by Deane Beebe

The first case study profiles the Edgewood Centre, a family-owned long-term care facility in Portsmouth, New Hampshire.

Like all of the facilities chosen for PHI case studies, Edgewood embodies PHI’s “quality care through quality jobs” tagline by maintaining a broad range of supports for its direct-care staff.

Strong Practices, Strong Outcomes

The Edgewood case study explains how the facility — with PHI’s assistance — introduced several programs to improve the quality of their direct-care workers’ jobs.

For example, Edgewood’s overall approach to communication has changed as it has adopted the PHI Coaching Approach^SM. Edgewood has also implemented the practice of consistent assignment, which benefits residents just as much as it does workers.

The Edgewood case study includes data proving that those practices work: Staff turnover and callouts by employees have both decreased over the last few years, while staff satisfaction is extremely high.

Such quantitative data will be an ongoing feature of The Business of Caregiving case studies.

“While it is often challenging to track outcome data, the organizations profiled all have some solid evidence of success in their workforce development efforts,” said Marcia Mayfield, PHI director of evaluation.

Multimedia Components

The Business of Caregiving has several multimedia components to accompany the case studies, including podcasts and picture galleries, all of which will be posted to PHI’s Training & Organizational Development Services website.

PHI will release more case studies in the coming months.

The case study series was funded by the Hitachi Foundation. Hitachi was also instrumental in funding PHI’s ongoing series of best practices in long-term care.

– by Matthew Ozga

The SECTORS Act (H.R. 1855) would provide grants to establish or expand “sector partnerships” to identify and provide training that meets the sectoral needs of a region’s economy.

Sector — or industry — partnerships are comprised of an industry’s stakeholders, including employers, unions, education and training providers, and local workforce and education administrators.

These partnerships develop plans to grow — or save — an industry, “with a particular focus on building new workforce pipelines where skilled worker shortages exist and transforming the ways existing workers are utilized, retrained, and compensated,” according to the National Skills Coalition (formerly The Workforce Alliance).

PHI Model for Sector Strategy Approach

“The SECTORS Act would, for the first time, establish congressionally authorized funding in support of the kind of sector/ industry-based strategies that have been proven to work for both workers and employers across a range of industries,” said Andy Van Kleunen, executive director of the National Skills Coalition, which helped to develop the bill.

“PHI’s efforts in the direct-care sector, in which it brings together employers and workers to develop strategies for both workforce training and improved working conditions and supervision, has been one of the pioneering models for this sector-based approach,” Van Kleunen said.

Implementation and Renewal Grants

Under the SECTORS Act, eligible sector partnerships could apply for implementation grants of up to $2.5 million for three years and $1.5 million renewal grants for an additional three years. The Department of Labor would administer the grants.

The House bill was introduced by Reps. Dave Loebsack (D-IA) and Todd Platt (R-PA). The lead co-sponsors of the Senate version (S. 777) are Sens. Sherrod Brown (D-OH), Patty Murray (D-WA) and Olympia Snowe (R-ME).

The Senate has not yet taken up the bill for a vote.

“If SECTORS is passed by the Senate, it would create new opportunities to organize local partnerships of employers, unions, training providers and other experts in the direct-care arena, so they could develop workforce strategies similar to PHI’s across a range of local direct-care settings, and leverage new public dollars to help train and retain local direct-care workers for the long-term,” Van Kleunen said.

PHI is among the 168 organizations, including 75 employers, that endorsed the legislation (pdf).

More information on the SECTORS Act is available on the National Skills Coalition’s website.

– by Deane Beebe

NCCNHR is now The National Consumer Voice for Quality Long-Term Care — a modification of its tagline — or the “Consumer Voice” for short.

The Consumer Voice has broadened its federal advocacy efforts to include addressing policy issues regarding at-home care and assisted living. The organization has been a force for improving the standard of care in nursing homes since its inception in 1975 as the National Citizens’ Coalition for Nursing Home Reform.

Among the ways that the Consumer Voice says it will carry out its revised mission — to represent the consumer voice at the national level as an advocate for quality long-term care, services, and supports — is to “promote the critical role of direct-care workers and best practices in quality-care delivery.”

The Critical Role of the Direct-Care Workforce

Recognizing the value of direct-care workers to the care team and how these workers impact quality of care is not new to the organization.

“No matter what laws and regulations are in place, no matter who or where the care is provided — the experience of the consumer is determined by his or her interactions with the direct-care worker,” said Consumer Voice Executive Director Sarah F. Wells.

“I am confident that consumers and workers partnering together can advance quality in all care settings,” she continued. “This is an exciting time for The National Consumer Voice for Quality Long-Term Care and the people we represent.”

New Policy Agenda

The organization’s new policy agenda includes:

• the reauthorization of the Older Americans Act;
• implementation of long-term care provisions in the health care reform law, including nursing-home transparency, elder justice, and criminal background checks on workers;
• development of policy on non-nursing-home settings, including assisted living;
• promoting a high-quality and effective long-term care workforce;
• strengthening oversight and enforcement; and
• promoting long-term care quality initiatives.

The Consumer Voice’s expansion of priorities was the outcome of a seven-month strategic planning process (pdf) that was funded by The Atlantic Philanthropies and announced on June 14. The process brought together consumers, members, past and current leaders, donors, grant makers, long-term care experts, staff, and other stakeholders.

– by Deane Beebe

Health Reform Facts 1 details several federal grant opportunities for states, community colleges, and individual employers that could have a major impact on training and education for the direct-care workforce.

The fact sheet also describes two new workforce commissions that will convene in the coming months. Once formed, the commissions will address many issues facing the direct-care workforce, such as wages, benefits, recruitment, and retention.

To receive additional Health Reform Fact Sheets as they are released, subscribe to PHI’s Health Care for Health Care Workers email alerts.

– by Matthew Ozga

“Aiming Higher: Removing Barriers to Education, Training and Jobs for Low-Income Women” (pdf) also proposes several policy changes to the Workforce Investment Act (WIA), Temporary Assistance for Needy Families (TANF), and other federal programs, all aimed at increasing opportunities for low-income women.

Although direct-care workers are not specifically mentioned in the report, they would clearly stand to benefit from the programs and the policy suggestions.

The direct-care workforce (pdf) is 90 percent female, and the median yearly income of all direct-care workers is just $17,000. More than four in ten direct-care workers rely on public benefits for basic services.

“Home health aides and personal care aides are the third and fourth fastest-growing occupations (pdf) in the country and are far too often overlooked when it comes to investments in entry-level training — let alone career ladders,” said Carol Regan, PHI government affairs director. “This report highlights the need for WIA to be changed to address this workforce.”

Proposed Policy Changes

The report recommends that federal policymakers should work to help low-income women find jobs more easily. Some of the specific recommendations include:

• WIA should be modified to strengthen the career paths available to low-income workers by expanding education and job training systems.
• Low-income workers should be made more aware of the specific benefits offered by TANF.
• Congress should pass the Local Jobs for America Act, which would authorize the distribution of $100 billion over two years, targeted at maintaining vibrant job markets in local economies.

The report notes that, by strengthening job opportunities for low-income female workers — a group especially vulnerable to the current economic recession — federal policymakers would be strengthening the entire U.S. economy from its foundation up.

Programs Promote Good Jobs

The report profiles nine local programs that aid low-income women in their drive to secure and maintain meaningful, stable, and high-quality jobs.

One program, Memphis Hope, helps former public-housing residents in Memphis, Tennessee, find jobs. Memphis Hope cooperates with local businesses and has a very high success rate of matching women with rewarding job opportunities.

Other programs profiled in the report promote work experience and on-the-job training, address stereotypes that plague low-income women, and educate women on the work supports available to them.

About the Campaign

The Women’s Economic Security Campaign is a project of four women’s funds scattered throughout the U.S.: the Chicago Foundation for Women, the Washington Area Women’s Foundation, the Women’s Foundation for a Greater Memphis, and the Women’s Foundation of California.

Representatives from those women’s funds spoke about the “Aiming Higher” report in a two-part video interview at Spotlight on Poverty and Opportunity. Part one explains the challenges low-income women are facing during the recession, while part two explains some of the practices described in the report.

– by Matthew Ozga

The legislation now moves to the Senate, where lawmakers could add the FMAP extension back into its version of the bill next week.

State budgets are in dire straits. States desperately need enhanced federal Medicaid funding to ensure their ability to meet the health care needs of their low-income citizens and families.

The FMAP extension would continue through June 30, 2011, the enhanced match provided through the American Recovery and Reinvestment Act. Without this fiscal relief, state policymakers will be forced to make substantial Medicaid cuts, including cuts to provider payment rates and health benefits for low-income residents.

This is likely to be the last opportunity this year to extend the enhanced FMAP rates, which are absolutely critical for job creation and economic growth.

FMAP’s and the Direct-Care Workforce

Many long-term care employers depend on Medicaid funds to provide services to elders and persons with disabilities. These funds pay direct-care workers’ wages, and often also help low-income direct-care workers provide health coverage for their families.

With home and community-based services already at risk in many states, additional cuts could be devastating to businesses, workers, and consumers.

More than half (30) of the states have assumed the continuation of the enhanced FMAP in their budgets. Without this funding, they may have to adopt even deeper cuts to already bare-bones state budgets.

PHI has sent a letter to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi urging them to consider changing The American Jobs, Closing Tax Loopholes and Preventing Outsourcing Act, so that the FMAP extension is included.

To support the FMAP extension, contact your senators.

– by Carol Regan, PHI Director of Government Affairs

The article notes that the predominately female direct-care workforce is aging along with the rest of the population. By 2018, as much as 30 percent of the direct-care workforce will be age 55 or older.

The aging workforce is a cause for concern, because older workers alone cannot meet the growing demand for services. Younger workers — both female and male — will need to be recruited to the field of direct care to address the support and service needs of growing numbers of elders and people with disabilities.

Dawson proposes several ways to ensure a strong, capable direct-care workforce in the future, including better training and “a fresh look at the job design of home care workers.”

In an introduction (pdf), Editor-in-Chief Thomas C. Ricketts and Managing Editor Christine Nielsen write that the issue aims to “present a broad range of views and opinions, with the ultimate goal of drawing some much-needed attention to the important issues within the field of long-term care.”

The issue is entitled “Long-Term Care: Are We Ready to Meet Expected Needs and Demand?” Several of the articles mention the expected care gap that will emerge as the baby-boomer generation reaches retirement age.

“It’s exciting to see a state-focused health care journal dedicate an entire issue to the question of essentially whether the state is prepared to care for the emerging long-term care needs of its citizens, and to underscore, in several articles, the critical importance of building and supporting the direct-care workforce,” said PHI Director of Policy Research Dorie Seavey.

“In addition, valuable information is presented about two leading initiatives in North Carolina to advance the direct-care workforce that should be of interest to all states,” Seavey said.

WIN A STEP UP and NC NOVA

One of the workforce-related articles, “Strengthening the Direct-Care Workforce in North Carolina,” describes the state’s efforts to create quality care through quality direct-care jobs since the early 1990s.

Aided by money provided through the Better Jobs Better Care program and technical assistance from PHI, North Carolina enacted two programs aimed at making direct-care positions more attractive to job-seekers.

The WIN A STEP UP program provides bonuses and wage increases to direct-care workers who complete a certain amount of training. It has been recognized by the U.S. Department of Health and Human Services (HHS) as a proven method of reducing worker turnover.

Meanwhile, the North Carolina New Organizational Vision Award (NC NOVA) was established to recognize care facilities that work especially hard to maintain a strong, well-trained staff of direct-care workers.

Addressing Turnover and Staffing Shortages

The second Journal article that addresses the direct-care workforce is titled “Assuring the Adequacy of Staffing of Long-Term Care, Strengthening the Caregiving Workforce, and Making Long-Term Care a Career Destination of Choice: From Mission Impossible to Mission Critical?”

Yearly turnover of the certified nursing assistant (CNA) workforce in North Carolina is estimated to exceed 100 percent, the article notes.

It lists three “key challenges” that must be addressed to reverse that trend, including the challenge of providing greater incentives (wages, benefits) to attract and retain a consistent, well-trained long-term care workforce.

– by Matthew Ozga

On Friday, May 7, a notice (pdf) was published in the Federal Register soliciting letters of nomination for this 15-member commission. Letters of nomination are due by June 30, 2010.

The NHCWC is one of the many provisions to take effect during the first year of the health reform law’s passage; appointments are to be made no later than September 30, 2010.

Appointing the Commission

The 15-member commission will be appointed by the Government Accountability Office’s Comptroller General of the U.S.

By law, the Commission will include individuals who are nationally recognized in health care labor market analysis including workforce, health financing and economics, health facility management, heath plans and integrated delivery systems, workforce education and training, health care philanthropy, and providers of health care services.

The law requires one representative from:

• Health care workforce and health professionals
• Employers
• Third-party payers
• Individuals skilled in interpretation of health care services and economics research
• Representatives of consumers
• Labor unions
• State or local workforce investment boards
• Educational institutions

The remaining seven members may include additional representatives from the above categories and others deemed appropriate by the Comptroller General.

Defining ‘Direct-Care Worker’

PHI worked hard to get language included in this section of the law that for the first time codifies the definition of direct-care worker in the Public Health Services Act:

DIRECT CARE WORKER. — The term ‘direct care worker’ has the meaning given that term in the 2010 Standard Occupational Classifications of the Department of Labor for Home Health Aides [31-1011], Psychiatric Aides [31-1013], Nursing Assistants [31-1014], and Personal Care Aides [39-9021].

The inclusion of this language means that the direct-care workforce will be included in the Commission’s responsibilities.

Duties of the Commission

The work of the Commission will be critical in:

• collecting and analyzing workforce data;
• projecting the demand for workers;
• determining education and training capacity and infrastructure, and projecting the demand;
• reviewing the implications of new and existing federal policies that affect the health care workforce (including those supported through the Workforce Investment Act); and
• determining the workforce needs of special populations.

Advocates of eldercare/disability services and quality jobs should insist that the Commission include representation from experts in this workforce that now numbers over 3.2 million workers and will reach 4 million by 2016.

– by Carol Regan, PHI Government Affairs Director