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In a March 28 blog post, eldercare author Howard Gleckman explains what would happen to health care for elders if the Supreme Court finds the Affordable Care Act (ACA) unconstitutional.

For example, Gleckman notes that the ACA incentivizes states to expand Medicaid long-term care services for people receiving care in their home. By striking down the ACA, the Supreme Court would take away those incentives.

Gleckman also explains how a repeal of the law would impact Medicare, integrated care, and the CLASS Act.

The Supreme Court heard oral arguments this week in a case that will decide the fate of the ACA. At issue is the law’s requirement that individuals purchase health insurance or pay a penalty.

In his post, Gleckman notes that most of the ACA’s effects on eldercare “have nothing at all to do with the controversial insurance reforms in the ACA. But if the Court strikes down the entire law, all of these provisions would die.”

– by Matthew Ozga

The Eldercare Workforce Alliance (EWA) issued two policy briefs on the interrelationship between two critical issues facing our nation — the need for job creation and the rapidly increasing demand for a wide spectrum of health care providers trained to provide eldercare.

The EWA, a coalition of 28 national organizations, contends that investing in the eldercare workforce will also strengthen the nation’s economy.

One of the briefs, entitled Eldercare: How America’s Solution to the Jobs Crisis Can Lead to Better Care for Older Adults, reports that health care is expected to generate 3.2 million new jobs by 2018 due to the rapidly increasing elder population.

With 90 percent of people over age 65 having one or more chronic conditions, there is a growing need for interdisciplinary teams of health professionals who are trained to provide coordinated, person-centered care to help older adults live at home and in community-based settings for as long as possible.

Missed Opportunity for Meaningful Employment

Yet too few people are entering these professions and getting the training necessary to provide the kind of interdisciplinary team care that elders require — a “miss[ed] opportunity to provide meaningful employment for millions of Americans,” the brief explains.

“The direct-care workforce alone will require more than a million new employees to provide critical care to people with long-term care needs,” said EWA co-convener Steven Dawson, president of PHI, in an EWA press statement. “These positions should include comprehensive training, and offer livable wages.”

The EWA posits that attracting people to eldercare fields could generate jobs and “address our looming crisis in care.” The coalition recommends that efforts should be made to:

• provide quality care through quality jobs for direct-care workers;
• avoid recommendations that eliminate jobs, such as reducing Medicaid funding for long-term care;
• support Title VII and VIII training programs for geriatric professionals and direct-care workers; and
• maintain funding for implementation of health care workforce provisions of the Affordable Care Act.

In a second brief, Title VII and VIII Programs Preparing the Eldercare Workforce to Care for our Nation’s Older Adults, the EWA provides greater detail on the federal workforce development programs that are crucial to strengthening the eldercare workforce.

– by Deane Beebe

“Improving Jobs and Care: a National Sector Strategy,” a new paper by PHI President Steven Dawson, provides an overview of PHI’s work at the intersection of low-wage workforce development and eldercare and disability services.

The paper offers an in-depth look at PHI’s:

• history;
• systemic change strategies for the eldercare/disabilities services system;
• sectorial employment initiatives — the framework for PHI’s field-building strategy; and
• lessons learned along the way.

Dawson shares five lessons learned over the two decades that have shaped PHI’s core organizational strategies and tactics:

• Positioning: To influence an entire sector, the workforce practitioner must establish and maintain a careful organizational balance of being in relationship with each of the key stakeholders — offering real value to each — yet being perceived as “in the pocket” of none.
• Asset-Based Fundraising: Workforce leaders should design their initiatives from the outset with the intention of converting grant funds into assets. Current funding must simultaneously achieve the promised program impact and create something of future value.
• Building Ladders and Raising the Floor: The workforce development community must insist on policies and strategies that focus equally on both “building ladders” and “raising the floor” for the millions of low-wage jobs in the U.S. economy, confronting the existing bias toward creating ladders to “escape” poor quality jobs.
• Expertise, with an Attitude: Despite others’ expectations that an organization be either a research shop or an advocate, PHI continues to both undertake its own rigorous evaluation of work in the field and to become the most informed organization in the country, so that its expertise cannot be ignored. PHI believes that “expertise, with a point of view” is not only possible, but essential, in creating fundamental change.
• “Going to Scale” Reconsidered: In the current economy, the resources of the philanthropic community are relatively constrained, so its earlier calls to “go to scale” can no longer be backed quite so boldly with commensurate amounts of funding. Dawson suggests that perhaps an “enclave” strategy, in which philanthropy deepens and protects high-quality programs, is more appropriate during these troubled times.

Prevailing Business Model Will Not Meet Demand

Regarding the eldercare/disability service delivery system, Dawson writes that “the prevailing ‘business model’ — low investment in staff, leading to high turnover, leading to low quality of care — wastes precious resources, both capital and human.” He states that such a model will not be able to meet the ever increasing demand of elders and people with disabilities.

Instead, over the years, PHI has promoted an inverted version of the current model:

High Investment –> Low Turnover –> High Quality/Efficiency

The organization has branded its positive vision of relationship-centered care as “Quality Care through Quality Jobs,” defining the essential elements of both.

A Presumptuous Venture

Detailing the many stakeholders in low-wage workforce development and eldercare and disability services, Dawson notes the complexity of the territory in which PHI works. He describes the efforts of PHI to:

• provide real improvement in the lives of its constituents — direct-care workers, elders, and people with disabilities — that they want and deserve;
• offer practical expertise to its clients; and
• create the systematic change its funders seek.

Despite the complex terrain, Dawson writes that “For more than 25 years, the leaders associated with PHI and its affiliates worked to achieve all three — directly impacting thousands of lives and creating practical value for key stakeholders, while also changing the surrounding systems for the better. Admittedly, a presumptuous venture from the start.”

PHI Roots and Affiliations

PHI grew out of the Bronx-based Cooperative Home Care Associates (CHCA) 20 years ago. Initially CHCA’s nonprofit training arm, PHI continues to be affiliated with the agency though its mission as a national sectoral initiative has broadened substantially.

PHI is also affiliated with Home Care Associates of Philadelphia, a replication of the CHCA model that PHI worked to develop, and Independence Care System, a New York City Medicaid-funded managed long-term care program for adults with physical disabilities that PHI helped to create.

“Improving Jobs and Care, a National Sector Strategy” was made possible with support from the Hitachi Foundation.

The paper was released on May 26 at the “Building Ladders and Raising the Floor” meeting, which was organized by Jobs for the Future and PHI.

– by Deane Beebe

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

Elder abuse is a growing and largely unnoticed problem in the U.S., according to a report (pdf) by the Government Accountability Office (GAO).

The report was the focus of a March 2 hearing by the Senate Special Committee on Aging.

Elder abuse can take many forms, including physical, sexual, or psychological abuse; neglect; and financial exploitation. It has been linked to shorter life spans, depression, and other health problems.

An Under-the-Radar Problem

The most recent study on the subject found that 14.1 percent of elders had been abused in the last year. The GAO’s report, however, determined that this figure almost certainly underestimates the problem, since the vast majority of elder abuse cases go unreported.

The GAO report further states that “as the American population ages, the extent of abuse will likely grow.”

The March 2 hearing included testimony (pdf) from actor Mickey Rooney, who said that his “daily life became unbearable” due to abuse he experienced at the hand of his wife and stepson.

Rooney said that they took control of his finances without his consent, leaving him feeling “trapped, scared, used, and frustrated.”

Elder Protection Programs Face Challenges

While there are state and federal programs in place to prevent elder abuse, they “may not be able to meet the needs of the increasing number of older Americans,” the GAO report suggests.

The report identifies numerous problems with the current elder protection programs. One major issue is a lack of funding. In FY 2009, only $11.9 million in federal funding was allotted to elder justice activities; state Adult Protective Services (APS) programs received a small fraction of that money.

The report also points out that the Administration on Aging has been lax in establishing federal guidelines for collecting data on elder abuse. “Without these data, states cannot benefit from their collective experience in this area,” the report’s authors write.

Training Materials in Development

National health reform is likely to have a positive impact on the issue of elder abuse, however.

Included in the legislative package signed into law by President Obama in March 2010 is the Elder Justice Act — which, among other things, will fund the design and development of training resources addressing elder abuse.

These resources will eventually be distributed to all Medicare- and Medicaid-certified nursing homes in the U.S.

Abuse Prevention Curriculum Already Available

A free curriculum on preventing elder abuse and neglect, geared toward employees in all long-term care settings, is already available at the PHI Training and Organizational Development Services website.

“Proper education is essential to eradicating elder abuse from long-term care settings,” said Peggy Powell, PHI National Director of Curriculum and Workforce and Development. “This curriculum provides trainees with the tools necessary to recognize, report, and ultimately prevent elder abuse.”

This training was developed through a grant from the Centers for Medicare & Medicaid Services (CMS) to the Michigan Department of Community Health. Partners in its development included Michigan State University, the Michigan Office of Services to the Aging, BEAM (a wholly owned subsidiary of MPRO, Michigan’s federally designated quality improvement organization), and PHI.

– by Matthew Ozga

PHI has joined the Campaign for Better Care because direct-care workers play a critical role in the care provided to older adults with chronic health conditions.

The National Partnership for Women & Families, Community Catalyst, and the National Health Law Program kicked off the campaign this past spring to mobilize older adults, their families, and others to work for high quality, comprehensive, and coordinated care for older adults with multiple health problems.

Direct-Care Workers Coordinate Care

Direct-care workers often help to coordinate the care of their clients in addition to performing their routine caregiving responsibilities.

If you are a direct-care worker who has played this role — or know a home health aide or home or personal care aide who does — please share your story with PHI.

PHI is bringing the stories of direct-care workers who help to coordinate care, or have seen how lack of care coordination affects the person they care for, to the Campaign for Better Care to include on their website.

Some questions to consider as you share your story are:

• Are you a direct-care worker who arranges or coordinates care for an older adult with multiple chronic health conditions?
• Does your client see numerous physicians, take multiple prescription medications, or receive duplicative tests and procedures?
• Have you experienced problems coordinating the care of your client? What challenges have you faced?
• What do you think is needed to make sure that the needs of your clients with multiple health problems are met?

Share Your Story Now

Please take a moment to share your story, or pass this along to someone who you think might. PHI will share it with the Campaign.

– by Gail MacInnes