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Terry Bucher

The U.S. cannot build the home care workforce it needs to care for the aging baby-boomer generation unless home care workers are paid fairly, argues an op-ed published in the Orlando Sentinel on April 27.

The op-ed was written by Terry Bucher, the president emeritus of the Florida Professional Association of Care Givers.

In the op-ed, Bucher explains that Florida is one of 29 states that do not offer home care workers basic wage protections, such as minimum wage or time-and-a-half overtime pay. The federal Fair Labor Standards Act similarly excludes home care workers from such protections.

“Florida’s home-care workers are dedicated and diligent,” Bucher writes. “But until they are guaranteed a fair wage, Florida will simply not be able to attract enough qualified workers to meet the growing need for home-care services.”

Hope for a Federal Rule Change

In late 2011, the Obama administration proposed a federal rule change that would finally extend basic wage protections to home care workers.

Bucher notes that the Department of Labor received 26,000 public comments regarding the proposal — most of them in favor of the change.

The DOL must act to extend overtime and minimum wage protections to home care workers, Bucher writes.

She cites PHI research (pdf) in arguing that the $84 billion home care industry can easily afford to pay its workers a fair wage.

Additionally, better wages for home care workers would lower worker turnover, Bucher writes. High turnover rates are costly to home care companies and result in lower-quality care for elders and people with disabilities.

– by Matthew Ozga

Three brief stories on direct care:

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CMS Proposes Guidelines for State Balancing Incentive Payments Program

The Centers for Medicare & Medicaid Services issued a “State Medicaid Directors Letter” (pdf) on September 12 to provide guidance for establishing the State Balancing Incentive Payments Program, a provision of the Affordable Care Act.

The new program, created to serve more people in home- and community-based settings, will assist states in “transforming their long-term care systems” by:

• improving systems performance and efficiency;
• creating tools to facilitate person-centered assessment and care-planning; and
• enhancing quality measurement and oversight.

The Balancing Incentive Program offers a targeted increase in the Federal Medical Assistance Percentages (FMAP) for non-institutional long-term services and supports (LTSS) to states that undertake structural reforms to increase access to home- and community-based LTSS.

On October 7, the Friday Morning Collaborative, a coalition of national aging and disability organizations, is hosting a webinar on the Balancing Incentive Payments Program. Registration is free, but space for the webinar is limited.

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State Direct-Care Worker Associations to Hold Annual Meetings

The Arizona Direct Care Worker Association (ADCWA) is holding its 4th Annual Conference and Celebration in Tucson on October 5 to honor and educate certified nursing assistants, home care workers, and professional caregivers in the state. To learn more about the event and register, visit the ADCWA website.

The Florida Professional Association of Care Givers is sponsoring its 16th Annual Caregivers Convention entitled, “Building a Quality Direct Care Workforce for Tomorrow’s Demands!” The all-day educational meeting will take place in Altamonte Springs on October 20. A registration form and more information is available at the association’s website.

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Des Moines Register Editorializes on Better Rewards for Caregivers

The Des Moines Register published an editorial in late August arguing that to ensure an adequate supply of direct-care workers to care for aging Iowans, those workers must have better wages, health coverage, education and training, and be valued in the medical field for the critical work they perform.

The editorial also explains that worker turnover is costly to employers, Medicaid, and consumers.

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PHI Newsletter Survey

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Florida State Capitol in Tallahassee

Florida direct-care workers and nursing home residents will feel the effects of the dramatic budget cuts passed by the state legislature late last week.

The budget calls for a 6.5 percent cut to Medicaid reimbursement rates, which amounts to approximately $187 million in cuts to Medicaid-funded nursing homes.

Florida’s Republican-dominated legislature passed the budget bill in the early-morning hours of May 7.

Staffing Requirements Lowered

To offset the budget cuts, state staffing requirements for nursing homes will be lowered.

The minimum number of daily hours of care provided by certified nursing assistants (CNAs) will be lowered to 2.7 hours, from 2.9.

Overall, nursing home residents will be required to receive a minimum of 3.6 hours of daily direct care from nurses and CNAs combined, down from 3.9 hours.

In the past, Florida had “stood out as one of the few states that made a commitment to staffing its nursing homes near the level we know is necessary to provide basic care and services — 4.13 hours per resident day,” said Janet Wells, director of public policy at the National Consumer Voice for Quality Long-Term Care.

Wells continued:

It is devastating that the legislature has gone back on that commitment on the false premise that reducing staff will save the state money. Hospitalization to treat pressure sores, dehydration, broken bones, and other medical conditions related to understaffing will offset any savings gained from firing nurse aides who make $11 an hour.

Staffing Reductions and Budget Cuts Criticized

The reduction in state-mandated staffing hours means that nursing home residents will get “less assistance with their basic living activities,” thus degrading the quality of care they receive, said Terry Bucher, the director of education at the Florida Professional Association of Care Givers.

The 6.5 percent budget cut will also likely require nursing homes to cut direct-care workers’ hours — or lay them off entirely — just to stay afloat economically, Bucher added.

“Many of these direct-care workers are single heads of household; thus the [economic] ripple effect is difficult for them…in an economic time that has already left their families struggling,” she said.

Governor Expected to Sign

Gov. Rick Scott (R) is expected to sign off on the legislature’s budget within the next several weeks, observers say.

The Florida budget will also cut Medicaid support for hospitals by a larger-than-expected 12 percent, or $510 million.

– by Matthew Ozga

News that Brian Lee, the director of the Florida Long-Term Care Ombudsman Program, was forced to resign from his position on February 14 brought an outcry from ombudsmen throughout the state and from the Consumer Voice.

Several news outlets have reported that Lee was pushed out of his job shortly after he began asking nursing homes for the names of companies and individuals with ownership and operational interests in their facilities — a transparency provision in the new federal health care reform law.

Under the law, ombudsmen now have the authority to request this ownership information from Medicare- and Medicaid-funded nursing homes.

Ownership and Quality

A statement released by the Consumer Voice on February 15 explains, “The law was the subject of congressional hearings in which witnesses testified that it is often impossible to hold nursing homes accountable for quality because of complex ownership and operating structures.”

A recent Government Accountability Office report (pdf) said, “To determine the effect of ownership on nursing home quality of care, it is necessary to have complete and accurate ownership information that provides a clear understanding of the relationship of each owner to the nursing home and any other owners.”

Beginning in 2012, the Nursing Home Compare website will include a summary of nursing homes’ ownership data, according to the Consumer Voice.

“We are very concerned that the governor of Florida has yielded to industry demands to dismiss an effective advocate for residents in a state that so many elderly Americans choose as their retirement home,” said Consumer Voice Executive Director Sarah Wells. “As a national voice for long-term care residents, we strongly urge the governor to follow the law and allow the ombudsman program to operate without interference.”

Lee served as the director of Florida’s Long-Term Care Ombudsman Program for over seven years, overseeing 300 volunteers who advocated for the residents of the state’s 677 nursing homes.

Lee reportedly had a “tense” relationship with the Florida Assisted Living Association and the Florida Health Care Association, which claimed that the “ombudsman office overstepped its authority.”

“Brian was recognized by his colleagues in Florida and nationally for his commitment to protecting the rights of long-term care residents and working with residents, families, and providers to improve care,” Wells said. “The office must be independent and free of political interference to perform its statutory functions.”

– by Deane Beebe

The state of Florida has agreed to spend up to $27 million to settle a class action lawsuit brought by Medicaid recipients who argue they were forced into nursing homes. Read the full story

Wall Street Journal's Rundown of LTC Cuts

Health care stakeholders hoped this week the lame-duck session of Congress would examine a stimulus package that includes an increase to the federal medical assistance percentage (FMAP), the federal matching funds that states receive to fund their Medicaid programs.

Many states, such as New York, are threatening to cut Medicaid to make up for budget shortfalls.

According to a recent Wall Street Journal story, at least 15 states, including Alabama, Virginia and Massachusetts, are targeting funding for programs that allow low-income direct-care consumers to receive personal care in their own homes.

The story says the cutbacks are exacerbating the already long waiting lists for home-care support services in many states. With forced reductions due to state budget shortfalls, the low-income elderly and disabled may be forced into nursing homes.

Read the full story