PHInational.org

(L-R) Massachusetts State Sen. Pat Jehlen, Personal Care Attendant Philomena Ahern

Massachusetts State Senator Pat Jehlen, chair of the Committee on Elder Affairs, introduced a bill on January 20 to establish a task force to determine the state’s preparedness for the CLASS Act by examining its direct-care workforce.

The CLASS Act, established under the health reform law, is the voluntary federal insurance plan that will help consumers purchase long-term services and supports.

“There is an enormous, predictable increase in demand for a well-trained and readily available direct-care workforce in Massachusetts, and we must be ready with the supply,” said Jehlen, who participated in a PHI-sponsored Come Care with Me Day.

The task force would be convened by the state’s Executive Office of Health and Human Services and include staff from that office, the Executive Office of Labor and Workforce Development, and government departments that provide management, delivery, or funding of direct-care services and employment.

Assessing the Data and Infrastructure

The task force would assess current direct-care workforce data and make recommendations to improve it, including:

• collecting available data sources on the number of workers, turnover and vacancies, and average wages and benefits;
• identifying gaps in data;
• planning for collecting and analyzing the workforce data on an annual basis; and
• providing recommendations on how to develop a sustainable, regular data reporting system.

The task force would also examine the infrastructure for supporting efficient long-term services and supports and mechanisms to ensure quality, and make recommendations for improvement, including an:

• analysis of current and projected workforce capacity;
• assessment of the current training and credentialing infrastructure;
• assessment of the quality of support for consumers as employers, supervisors and trainers; and
• assessment of the adequacy of the existing infrastructure for connecting consumers and workers.

In addition, the bill calls for an analysis of the impact of the state’s Community First program on workforce issues to ensure that the state’s response to CLASS also addresses the needs of this initiative.

The bill states that the task force would be required to present a report to the Massachusetts governor and legislature by June 30, 2012.

Jehlen Shadowed Direct-Care Worker

Jehlen filed the legislation just months after participating in a Come Care with Me Day, a project in which legislators shadow direct-care workers to better understand direct-care worker jobs and the critical role they play in meeting the needs of the growing number of elders and people with disabilities.

Jehlen worked beside Philomena Ahern, a homemaker and personal care attendant with Homemaker Services, at the home of Stella Murphy, a 102-year-old woman, whom Ahern helps weekly.

In an interview filmed during the Come Care with Me Day, Jehlen says, “If we want to keep people doing this work, we need to pay them enough to live on.”

More information on the Massachusetts direct-care workforce (pdf) is available on PHI’s website.

– by Deane Beebe

On January 19, while members of the House of Representatives debated and passed a bill (H.R. 2) to repeal health care reform, PHI and other advocates representing 150 national organizations (pdf) gathered elsewhere on Capitol Hill to voice ardent support for the Affordable Care Act.

Led by Families USA, the event featured speakers from the American Nurses Association, National Committee to Preserve Social Security and Medicare, United Spinal Association, and Catholic Health Association.

Particularly compelling were messages delivered by organizations representing older adults and people living with disabilities, which noted important benefits the law provides, including:

• a 50 percent discount on brand-name prescription drugs in the Medicare Part D “doughnut hole”;
• full coverage of preventive services such as diabetes tests and prostate cancer screenings for people with Medicare;
• protection from denial of health care coverage due to pre-existing conditions; and
• the elimination of annual or lifetime caps on coverage.

Kimball Gray, speaking from his wheelchair on behalf of the United Spinal Association and National Spinal Cord Injury Association, expressed support for the law’s protections for individuals with pre-existing conditions, telling those assembled, “I am a pre-existing condition.”

Move Forward, Not in Reverse

Gray called for movement forward toward more accessible and better quality health care for all, rather than reversal of what has already been achieved.

Because the repeal effort is unlikely to progress past the House, the challenge for advocates and government officials continues to be effective implementation of the Affordable Care Act.

The Direct Care Alliance has issued a new brief (pdf) on advocacy strategies, outlining what’s at stake for direct-care workers in the Affordable Care Act implementation.

– by Gail MacInnes, PHI National Policy Analyst

The U.S. Department of Health and Human Services (HHS) is planning to locate the Community Living Assistance Services and Supports (CLASS) Act Office at the U.S. Administration on Aging (AoA).

HHS Secretary Kathleen Sebelius advised the chairman of the House Appropriations Committee, Representative Harold Rogers (R- KY), of the decision to establish the new office at AoA in a letter (pdf) dated January 5.

The letter states that “to efficiently and effectively implement the provisions of Title VIII, the CLASS Act, it is necessary to have a dedicated office that has as its primary focus the implementation and management of this new and innovative program.” The CLASS Act was a provision of the Affordable Care Act, the national health reform legislation enacted last spring.

The CLASS Act Office is charged with administering the new voluntary, federal insurance plan designed to help people purchase long-term services and supports.

Personal Care Attendants Workforce Advisory Panel

The CLASS Act Office is also responsible for convening and supporting the Personal Care Attendants Workforce Advisory Panel (PCAWAP) and the CLASS Independence Council.

“We are pleased that HHS has announced the opening of the CLASS Office and that the work developing this important program will be moving forward,” said PHI Government Affairs Director Carol Regan. “We hope that an announcement of the Personal Care Attendants Workforce Advisory Panel will soon follow so that for the first time, attention is paid to this critical workforce in order to meet the demand for quality long-term services and supports.”

The PCAWAP will examine issues related to the personal care attendant workforce and make recommendations to the Secretary of HHS and Congress on this workforce. Key topics for exploration by the Panel include:

• the adequacy of the number of these workers,
• the salaries, wages, and benefits of these workers, and
• access to services provided by these workers.

– by Deane Beebe

The Alliance for Health Reform hosted a briefing on December 2 entitled “The Health Workforce Dream Team,” which included a review of the direct-care workforce and the role that direct-care workers can play in a team approach.

Bob Konrad, Ph.D, an investigator at the Cecil G. Sheps Center for Health Services Research, spoke about the variability — or, more frequently, absence — of training requirements for groups of direct-care workers among states. He also discussed the enormous growth of demand for direct-care worker services (pdf), both in the past several years and in the decade to come.

As Konrad noted, the importance of the direct-care workforce received some attention in the Affordable Care Act with the establishment of the Personal Care Workforce Advisory Panel, a component of the CLASS Act. His comments encompassed community health workers and behavioral health paraprofessionals as well as certified nursing assistants, home health aides, and personal care assistants.

Following the presentations, several participants commented on the need for nurse practitioners and nurses to work up to the limits of their scopes of practice. Konrad noted that direct-care workers, too, can play an elevated role, and that there is a need to identify and recognize needed competencies for direct-care workers to realize this potential.

The briefing was held in Washington, D.C. and attended by Congressional staff, members of the media, and stakeholders in aging issues and health care. A webcast of the “Health Workforce Dream Team” briefing, as well as source materials (pdf), including PHI publications, are available online.

– by Gail MacInnes, PHI National Policy Analyst

Assistant Secretary for Aging Kathy Greenlee unveiled the Administration on Aging’s new e-newsletter on the implementation of the Affordable Care Act and how it is impacting the aging network.

The content planned for the newsletter includes:

• information on upcoming funding and training opportunities
• relevant notices in the Federal Register
• reports from across the nation on how health care reform has been put into action

The Affordable Care Act takes “a number of steps that improve health care for people with Medicare and with Medicaid,” Greenlee wrote on November 30, when announcing the inaugural November issue (pdf).

She added that the aging network can play a critical role in making health care improvement happen.

– by Deane Beebe

The National Economic Council released a report on the recession’s impact on women, and how President Obama’s economic policies benefit them.

Since 90 percent of direct-care workers are female (pdf), the October 21 report, entitled Jobs and Economic Security for America’s Women (pdf), is pertinent to this workforce.

The report touts policies the Obama administration has already enacted, as well as proposals in the President’s Fiscal Year 2012 Budget, which demonstrate “the many ways the administration is committed to making sure the government is working for all Americans, especially American women.”

Signed into Law

Some already existing policies highlighted in the report that affect low-wage direct-care workers, and the workforce as a whole, are:

Job Training

• The Affordable Care Act, passed in March 2010, supports training (pdf) of personal and home care aides.
• The Health Care and Education Reconciliation Act establishes a new three-year program (pdf) for up to 10 community college and/or community-based training programs to provide infrastructure support for the development, evaluation, and demonstration of a competency-based curriculum to train qualified nursing assistants and home health aides.
• The Recovery Act included over $1 billion in workforce training programs at community colleges and other training providers, and the provision of education and training to dislocated workers.

Health Security for Women
The Affordable Care Act:

• Provides protections (pdf) from insurance company abuses by prohibiting lifetime caps on insurance plans, restricting annual caps on the dollar amount that insurers will spend on benefits, banning insurance plans from canceling coverage due to illness or a technical mistake on the application, and ending the practice of refusing coverage — or limiting benefits — due to a pre-existing condition (pdf), including pregnancy.
• Creates new competitive, transparent health insurance marketplaces in 2014 called “exchanges.” Additionally, insurance companies will be prohibited from gender rating, the practice of charging women more simply because they are female.
• Makes health insurance more affordable by expanding Medicaid, providing tax credits to middle income Americans to pay for coverage, requiring insurance companies to publicly disclose and justify unreasonable premium increases, and other measures.
• Promotes prevention by eliminating cost-sharing for preventive services such as breast cancer and cervical cancer screenings and bone density tests for women age 65 and older.

Obama’s Budget Proposal

The President’s Fiscal Year 2012 Budget will be sent to Congress in early February 2011. Policies that are highlighted in the National Economic Council’s report which impact low-wage direct-care workers are:

Tax Incentives
The President proposes to make permanent the expansions of two key tax credits in the Recovery Act that are set to expire at the end of this year:

• Earned Income Tax Credit, a refundable tax credit for low- and moderate-income families
• Child Tax Credit, which will be increased by up to $1,368 for low-income families as a result of the Recovery Act

Child Care Costs
The President proposes to nearly double the Child and Dependent Care Tax Credit by increasing the credit rate from 20 to 35 percent of child care expenses for families making less than $85,000 a year.

Caregiver Initiative

• To support caregivers, the President’s budget proposal includes funding for the Administration on Aging’s Caregiver Initiative (pdf), which would support more than three million more hours of respite care for caregivers.
• To help older adults stay in their homes, the President proposes spending $50 million for programs that provide adult day care, in-home services such as home care aides, and transportation services.

Supporting Paid Sick Leave
The Healthy Families Act, which the administration supports, would allow people to earn up to seven days per year of paid sick time to use for themselves or a sick family member.

Direct Care Workers Compared to All Working Women

According to the report:

• Women represent 47 percent of the American workforce. (Ninety percent of the direct-care workforce is female.)
• The annual median income for working women was $26,030. (The annual median income for direct-care workers in 2008 was $17,000.)
• The wage gap affects all women and is larger among minority women. (Minorities comprise 51 percent of direct-care workers, but just 35 percent of the U.S. population.)

– by Deane Beebe