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Dozens of workforce development experts, policymakers, providers, funders, researchers, and advocates gathered in Washington, D.C., on May 26 for an in-depth examination of innovations in practice and policy for bolstering the direct-care workforce in the eldercare and disability services sector.

“Building Ladders and Raising the Floor,” which was organized by Jobs for the Future (JFF) and PHI, aimed to engage all stakeholders in dialogue to identify strategies and opportunities for both creating career advancement opportunities and improving the quality of direct-care jobs.

PHI President Steven Dawson noted that in the last 20 years, the workforce development field has invested a great deal in creating ladders to good jobs for direct-care workers, but far less in strategies to raise the floor of entry-level jobs.

Dawson highlighted the impact that the direct-care workforce has on elders and disabilities, saying, “The direct-care worker is the face, hands, and voice of long-term care for literally millions of elders and people with disabilities. The quality of this job undeniably determines the quality of their care.”

Two direct-care workers — Darlene Scott of Porter Hills Green House and Ancil Alexander of Cooperative Home Care Associates (CHCA), a PHI affiliate — shared their love for their work and desire to stay on the front line while receiving better training, compensation, support, and good supervision.

Best practices, such as those implemented at Porter Hills and CHCA, offer direct-care workers more time, control, authority, and pay, and encourage access to and sharing of information.

Stakeholders Express Concerns, Suggest Strategies

Participants included a wide variety of stakeholders concerned about the direct-care workforce.

“An elder and disability services sector strategy aimed at building the direct-care workforce is essential,” said Olga Merchan, director of workforce strategy for YouthBuild USA. “A common strategy will help YouthBuild and other workforce programs to achieve placement goals, ensure higher retention in employment and training opportunities, and position participants for higher wages.”

The keynote speaker, Gerri Fialla, deputy assistant secretary, employment and training administration, U.S. Department of Labor (DOL), detailed DOL’s commitment to investing in the direct-care workforce and to partnering with other federal agencies to do so. In an environment of budget cutting, she emphasized strategies to “do more with less.”

PHI National Policy Director Steve Edelstein noted how one state was handling the budget crunch:

Responding to the need for budget cuts in New York, stakeholders recently hammered out an agreement on unprecedented reforms of the Medicaid program. Without a doubt, budgets at both the federal and state level are challenging, but I hope that, working together, we can use these challenges as an opportunity for improvements and reform.

Participants at the event began a conversation about how to meet the challenge. Henry Claypool, director, Office on Disability, U.S. Department of Health and Human Services, offered one strategy for meeting the challenge: engagement with the 15 states that received grants from the Federal Coordinated Health Care Office at the Centers for Medicare and Medicaid Services to improve coordination of services for individuals who are dually eligible for Medicare and Medicaid.

Participants discussed this and other partnerships and strategies for growing and strengthening the direct-care workforce.

– by Gail MacInnes, PHI National Policy Analyst

Rick Surpin

PHI Founder and Board Chair Rick Surpin was praised in INSEAD Knowledge on April 15 for creating successful, innovative business models that meet social needs. Read the full story

President Barack Obama has launched  “The Year of Community Living,” an effort to assist Americans with disabilities, instructing HHS Secretary Kathleen Sebelius and HUD Secretary Shaun Donovan to “work together to identify ways to improve access to housing, community supports, and independent living arrangements.”

The announcement was made on the tenth anniversary of the Olmstead case in which the Supreme Court ruled that the unjustified institutional isolation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act.

HHS Secretary Kathleen Sebelius

An announcement from Sebelius issued the same day indicated that she was taking various actions at HHS in support of the new initiative, including the creation of a new HHS Coordinating Council “to put in place solutions that address barriers to community living for individuals with disabilities and to give people more control over their lives and the supports they need.”

She also said she would direct additional funding toward the HHS Aging and Disability Resource Center Programs (ADRCs), which are a collaborative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS), and intended to provide a “one-stop shop for consumers for long-term care information, assistance, and access to services.”

HUD Secretary Shaun Donovan

HUD announced, in turn, that it was making available $30 million in voucher assistance to provide housing support for 4,000 non-elderly disabled families, including 1,000 vouchers that are targeted specifically at people who are transitioning out of nursing homes and other institutions. Notably, these 1,000 vouchers directly satisfy an ongoing demand from ADAPT.

Some individuals and organizations expressed a tempered optimism regarding the new initiative.

Chris Hildebrant, Director of Advocacy for the Center for Disability Rights, opined in a June 23 blog post that while the initiative contains many positive points, it still fails to eliminate the institutional bias in America’s long-term services and supports.

Denika Boardman, systems change coordinator for Central Coast Center for Independent Living in California, called the initiative a “positive development” in a July 2 column for The Californian, but said that “many people with disabilities have little to celebrate on this anniversary” of the Olmstead decision, since California’s catastrophic budget crisis is resulting in cuts to “nearly every community support service people with disabilities need to live independently.”

But President Obama expressed resolute optimism even as he acknowledged the long delay in achieving full independence for individuals with disabilities.

“The Olmstead ruling was a critical step forward for our nation, articulating one of the most fundamental rights of Americans with disabilities: Having the choice to live independently,” he said. “I am proud to launch this initiative to reaffirm my Administration’s commitment to vigorous enforcement of civil rights for Americans with disabilities and to ensuring the fullest inclusion of all people in the life of our nation.”