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Home health aides in New Jersey held a rally on April 25 to voice their opposition to wage cuts proposed by their employer.

The aides, who provide in-home care for elders and people with disabilities, work for Personal-Touch Home Health Services, a large, for-profit home care company with locations in 13 states.

Personal-Touch is currently in contract negotiations with its 350 home health aides, who are represented by 1199 SEIU. During negotiations, Personal-Touch proposed instituting a sliding scale of rate-based cuts that would reduce many workers’ wages by as much as 30 cents an hour.

Dozens of Personal-Touch aides attended the rally, which was held outside the company’s Roselle Park branch, one of four Personal-Touch locations in New Jersey.

Lawmakers Join Rally

At the rally, the workers were joined by several members of the New Jersey General Assembly, who spoke in support of the aides.

Assemblyman Gary Schaer (D) told the gathered workers that his mother has received care from a home health aide for the last four years.

“That home health aide has been the difference to her between life and death,” he said. “Although you might think you are few in numbers, there are a whole lot of us standing right beside you.”

Assemblyman Joseph Cryan said that Personal-Touch must demonstrate that it values its workers by paying them fairly.

“For the lives you touch, you deserve a whole lot more than a pay cut,” Cryan said. “You deserve a pay raise, because what you do matters to people each and every day. When corporations make millions, they can spare 30 cents a head every hour.”

Additionally, 38 New Jersey lawmakers — including U.S. Senators Frank Lautenberg (D) and Robert Menendez (D) — signed a letter to Personal-Touch urging the company not to cut its workers’ wages.

– by Matthew Ozga

(L-R) Dr. Melissa Scollan-Koliopoulos, UMDNJ-University Hospital; Rosa Ortiz, home health aide, Central Jersey VNA

Certified home health aides will play an integral role in efforts to prevent re-hospitalizations when a new project at the University of Medicine & Dentistry of New Jersey (UMDNJ) is launched.

The “I CARE-4-Healthcare Transition Project,” designed to prevent discharged patients from returning to the hospital within the first 30 days after they leave, will utilize a four-tiered approach to care that includes a:

• certified home health aide/patient navigator
• registered nurse
• advanced practice nurse (APN), and
• physician team.

The certified home health aide/patient navigator will be responsible for visiting patients who are in the hospital and following up after they are discharged to the community, a hospital press release explains. The APN will provide care with “physician collaboration until a patient can see a primary care physician regularly.” [Scroll down for a further explanation of home health aides' role in the program from co-director Melissa Scollan-Koliopoulos, Ed.D.]

Reduce Costs, Improve Health Outcomes

A key aspect of the project will be to help patients determine when they need to go to a hospital emergency room or when they should see a primary care physician instead, in order to reduce costs and improve health outcomes.

Educating patients about medications and overall health and wellness, as well as connecting them to resources such as health insurance, are also project goals.

Patients enrolled in the project will receive support in self-management prior to being discharged.

People are eligible to participate in the project if they do not have a regular primary care physician and if they have one or more of the following diseases:

• diabetes
• cardiovascular disease
• respiratory disease
• HIV, and
• sickle cell disease.

“Our goal is to extend the attention and care that patients receive from us beyond the four walls of UMDNJ-The University Hospital, thereby improving patient outcomes,” said David Bleich, MD, a project co-director.

The “I CARE-4-Healthcare Transition Project” will be implemented in partnership with the Visiting Nurse Association Health Group.

The project will be supported by a $300,000 grant from the Robert Wood Johnson Foundation‘s New Jersey Health Initiatives program with additional funding from the Healthcare Foundation of New Jersey.

– by Deane Beebe

Connecticut Gov. Dannel Malloy (D)

Connecticut Governor Dannel Malloy (D) has proposed that home health aides and agency-based personal care attendants (PCAs) in the state should be trained to administer medication to consumers.

Currently, only nurses are permitted to administer medication to consumers receiving care in the home. Nurse visits cost an average of $54 each last fiscal year, for a total cost to the state of nearly $130 million.

The Malloy administration says that the plan would save the state more than $28 million a year, once fully implemented.

It would also help thousands of elders and people with disabilities to remain in their homes — rather than enter nursing homes or other long-term care facilities — by ensuring that the cost of home care is as low as possible, administration officials say.

Nurses and many home care agencies say they oppose the idea, arguing that medication is more safely administered by highly trained nurses.

Malloy’s plan comes as part of a set of proposed adjustments to the state budget, which will go to the legislature for approval.

Details of Plan

Malloy’s plan would allow home health aides to administer oral medicine, topical medications, and eye drops, so long as they are trained and certified to do so.

The plan would also permit agency-based PCAs to administer medication. Currently, only independent PCAs who have been trained by their clients can legally give out medicine.

“Allowing home health aides and agency-based PCAs to administer medication is a positive step for Connecticut’s home care industry,” said PHI National Director of Curriculum and Workforce Development Peggy Powell.

“However, it is extremely important that these direct-care workers are properly trained in handling and administering medication in order to keep their clients as safe as possible,” Powell added.

Additionally, the Malloy administration’s proposal would reduce by 10 percent the rates paid to nurses administering medication. It would also allow certain medicine-related assisted technologies — such as medication reminders and automatic pill dispensers — to be covered under Medicaid.

– by Matthew Ozga

The estimated 2.5 million people employed as home health and personal care aides provide crucial long-term care to elders and people with disabilities, yet their jobs are inadequately supported and compensated, according to a comprehensive new PHI analysis of the workforce.

The just-published 120-page report — entitled Caring in America — A Comprehensive Analysis of the Nation’s Fastest-Growing Jobs: Home Health and Personal Care Aides — is the most in-depth analysis of America’s home care jobs available.

The report concludes that despite being the nation’s most high-demand occupation, the home care and personal assistance workforce is characterized by:

• Poor wages
• Inconsistent training requirements
• Inadequate health care coverage
• High injury rates
• Unpredictable hours
• Heavy reliance on public benefits

As a result, the report warns, our nation is unprepared to meet the needs of its rapidly aging population.

“At a Crossroads”

“Carework in America is at a crossroads,” said PHI Director of Policy Research Dorie Seavey, Ph.D., a labor economist and the nation’s leading expert on the home care workforce. Seavey authored the report with PHI Policy Associate Abby Marquand, M.P.H.

Seavey continued:

“We can continue the status quo of poorly supported and poorly compensated jobs, consigning home care workers to near-poverty earnings and home care to a revolving door of caregivers. Or, we can leverage this workforce’s enormous potential as both an underutilized asset in our health care system and as one of the strongest job growth engines that our economy has to offer.”

Between 2008 and 2018, the home care workforce is expected to grow at rates four to five times faster than jobs in the overall economy.

Hopes for Report

“Our hope is that this resource will promote a better and broader understanding of the workforce, as well as the large and growing eldercare/disability services industry it supports,” wrote PHI National Policy Director Steve Edelstein in the report’s foreword.

“We also hope that it will facilitate a more informed public discussion of key issues shaping the future of in-home services, aiding the development of both effective policy solutions and a targeted industry response,” Edelstein continued.

For more information on the direct-care workforce, including the PHI State Data Center, Chart Gallery with downloadable graphs and charts, and Fact Sheets, visit PHI PolicyWorks.

– by Deane Beebe and Matthew Ozga

Direct-care workers in training

A new PHI analysis found that only 15 states require home health aides to have more training hours than are federally mandated, yet 30 states and the District of Columbia require certified nurse aides (CNAs) to have more training hours than the federal requirements.

In 1987, the federal government set a training standard of 75 hours, including a minimum of 16 hours of clinical training, for both home health aides and CNAs who are employed by Medicare-certified nursing homes or home care agencies.

“Our analysis shows that state home health aide training requirements have not kept pace with their nursing home aide training requirements, even though these direct-care workers provide essentially the same care and services,” said Steve Edelstein, PHI national policy director.

“Although it is clearly time to revisit the federal standards, having states move ahead on their own to upgrade training requirements is a step in the right direction.”

In Retooling for an Aging America, a 2008 report, the Institute of Medicine (IOM) recommends that the federal minimum training requirement be raised to at least 120 hours for both CNAs and home health aides and that competency in elder care be demonstrated as a criterion for certification.

Other Findings

The PHI analysis also found that:

• 4 states meet the IOM recommended training standard for home health aides;
• 14 states meet the IOM recommended training standards for CNAs;
• 13 states require more than 16 hours of clinical training for home health aides — the federal minimum training requirement; and
• of the states that exceed the federal training standard, 9 require home health aides to be CNAs, and 4 allow CNAs to become home health aides with supplementary training.

Trend Toward Home and Community-Based Care

Today, the majority of direct-care workers, including personal care aides, are employed in home and community-based settings (pdf).

By 2018, home and community-based direct-care workers are likely to outnumber facility workers by nearly two to one.

“Current federal training standards have not kept pace with changes in public policy and services delivery and do not adequately prepare the direct-care workers who provide the lion’s share of paid hands-on long-term care,” Edelstein said.

“The federal government must modernize training requirements for direct-care workers to help them gain the skills and knowledge they need to help elders with chronic and complex medical conditions live as independently as possible where they prefer — in their homes and communities.”

To compare the training requirements for home health aides and certified nurse assistants in each state, visit the PHI PolicyWorks website.

– by Deane Beebe

The average private-pay rates for home health aides remained $21 for the third straight year, even as the overall cost of long-term care continues to rise in the U.S., according to a newly released study.

Meanwhile, adult day service centers, which employ direct-care workers, saw their daily cost-of-care rate increase slightly to $70, from $67 in 2010.

The study was published last month by MetLife Mature Market Institute, the research wing of the insurance company.

Only about half of the cost of home health aide services actually goes to the aide herself. According to PHI research, the median hourly wage for home health aides was $9.85 in 2009, the last year for which data are available.

Long-Term Care Costs Rising Overall

MetLife’s study shows that, overall, the cost of obtaining long-term care in most settings continues to rise.

In 2011, the daily average rate for a private room in a nursing home increased by 4.4 percent, to $239. In assisted living communities, meanwhile, the average monthly rate rose to $3,477, an increase of 5.6 percent.

The CLASS Program, a voluntary long-term care insurance program that was passed as part of the Affordable Care Act, was created to help people pay for the skyrocketing costs of long-term care.

However, the Obama administration could not demonstrate that the program would be financially solvent. While advocates continue to press for the program, its future remains uncertain.

A separate MetLife survey on the “retirement income IQ” of pre-retirees (aged 56-65) found that many are misinformed about how they will be paying for long-term care: 42 percent of respondents incorrectly believe that such care is covered by health insurance, Medicare, or disability insurance.

– by Matthew Ozga