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Iowa state capitol building

A budget bill passed by the Iowa Senate last week would support training standards and career paths for the state’s direct-care workforce.

The bill (SF 2336) sets the FY 2013 budget for the Iowa Health & Human Services Department (HHS). It would establish and fund:

• core training standards for direct-care workers,
• specialized training opportunities, and
• career advancement opportunities.

SF 2336 would also create a Board of Direct Care Professionals to oversee the implementation of these new training standards and career pathways.

The board will help “provide direct-care workers with the professional status they deserve,” said Di Findley, the executive director of the Iowa CareGivers Association.

The state House version of the HHS budget bill, which passed April 18, does not include funding for the Board of Direct Care Professionals. This and other discrepancies between the two bills will be negotiated and resolved in a future conference committee, Findley said.

Bill Draws on Council Report

In crafting the bill, state senators drew upon recommendations made by the Iowa Direct Care Worker Advisory Council. In a report (pdf) to the governor and state legislature submitted in March, the council suggested ways for the state to build a stable and qualified direct-care workforce.

The council’s recommendations “are designed to stabilize and strengthen the direct-care workforce to reduce turnover costs, improve quality, and ensure access to services,” the report says.

Established by the state legislature in 2008, the Iowa Direct Care Worker Advisory Council comprises a broadly representative coalition of stakeholders, including direct-care workers, consumers, employers, and other health professionals. The council reports to the state Iowa Department of Public Health.

“What I am most proud of is the leadership taken by direct-care workers in moving this historical piece of legislation (SF 2336) forward,” Findley said.

– by Matthew Ozga

Iowa state capitol building

Direct-care workers in Iowa will be required to obtain a license to be a caregiver if a bill making its way through the state legislature becomes law.

The bill would affect direct-care workers in nursing homes as well as those in home care, assisted living, and community-based settings, according to McKnight’s Long-Term Care News.

The bill has already been approved by a state Senate committee, and is awaiting a vote by the full Senate. If approved, it will move to the state House.

At 70,000 strong, direct-care workers comprise Iowa’s largest workforce, with an additional 12,000 estimated to be needed to meet the rising demand for care in the next decade.

Legislation Draws Support

If passed, the legislation would establish state standards for direct-care worker training and licensing. It would also establish career pathways for specialized and advanced aide positions, reports the Cedar Rapids Gazette.

Many of those changes would be overseen by a newly created Board of Direct Care Professionals, said Di Findley of the Iowa Caregivers Association, which supports the bill.

Findley, along with Kent Sovern of AARP Iowa and Rob Denson of Des Moines Area Community College, argued that the legislation is crucial to reducing turnover and raising quality of care across the board in an editorial published in the March 1 Des Moines Register.

Major System Change

“We’re really talking about a major system change” if the bill passes, Findley told PHI. In the new system, direct-care workers of all types “would receive more consistent and standardized education that would follow them from one setting to another,” Findley added. Workers, not their employers, would own their own credentials under the terms of the bill.

The legislation would allow direct-care workers to receive their education through a variety of venues, including community colleges, universities, employers, and online training courses.

Direct-care workers will also have the option to specialize in areas of interest such as Alzheimer’s, brain injury, mental health, oral health, and end-of-life care.

All of these factors would empower direct-care workers, Findley said, allowing them to “feel better prepared to perform their responsibilities.”

If the bill passes, direct-care workers “will finally receive the professional status they have long deserved,” Findley said.

– 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

If you have not done so already, please take a moment to give us your feedback on the PHI Quality Care, Quality Jobs newsletter by completing this anonymous survey. Thank you to all of the subscribers who already responded.

(L-R) CNA Kelly Stokes, Iowa State Senator Jeff Danielson

Iowa State Senator Jeff Danielson (D) experienced firsthand the daily routine of a direct-care worker when he participated in a recent “Come Care with Me” event.

During the event, which was organized by the Iowa Caregivers Association and supported by PHI, Danielson trailed Kelly Stokes, a certified nursing assistant (CNA) at Harmony House, a long-term care facility in Waterloo, Iowa.

Video of the Come Care with Me event is available at the Iowa Caregivers Association’s website.

“Backbreaking Work”

Danielson said the Come Care with Me event was an “invaluable” experience, and that he learned a lot about direct-care workers during his day spent trailing Stokes.

For example, he said was surprised at the sheer physical toll Stokes’s job inflicts upon her, day in and day out.

“Direct-care workers [do] backbreaking work,” said Danielson, who also works as a firefighter.

“But they’re too invisible to us,” he continued. Policymakers “need to know [what's] going on, and the public needs to be aware of that.

“We need to make sure that they are paid well [and] that they have benefits, so they can take care of their families too — just like they take care of families here,” Danielson concluded.

Pitching In

Stokes said that she enjoyed the experience as well.

“I was glad that I was able to share with someone like the senator because of the position that he has, and I was glad that he was able to pitch in and do hands-on [care],” she said.

“As a firefighter, I sometimes get called a hero,” Danielson said, “but when you see the direct-care workers here, you know that they’re the everyday heroes.”

More information about Come Care with Me, a national PHI campaign, is available online.

Come Care with Me events are a project of the PHI Health Care for Health Care Workers campaign, which is made possible with support from the Nathan Cummings Foundation.

– by Matthew Ozga

Cindy Ramer

Two brief stories on direct care:

Iowa DCW Speaks at Health Reform Conference

Iowa direct-care worker Cindy Ramer spoke about her experiences living without health insurance during a press conference honoring the one-year anniversary of health reform in Des Moines last month.

Ramer’s employer does provide health insurance; however, the coverage is so expensive that Ramer cannot afford it. Ramer incurred massive debt trying to pay for her diabetic husband’s health care costs. She eventually had to declare bankruptcy.

“I’m not asking for a handout; I’m just asking for something I can afford,” Ramer said.

Ramer said that she is hopeful that the Affordable Care Act will help her obtain subsidized health coverage via insurance exchanges.

U.S. Surgeon General Regina Benjamin also spoke at the press conference.

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Journal Issues Call for CNA Stories

Narrative Inquiry in Bioethics is encouraging certified nursing assistants (CNAs) to submit written first-person accounts of their experiences in long-term care.

The journal, published by Johns Hopkins Press, is devoting an entire issue to CNAs and their personal stories — the challenges, concerns, and rewards they face each day while caring for others.

CNAs interested in sharing their stories should send an e-mail to narrativebioethics@gmail.com. More information can be found on the Johns Hopkins website (pdf).

– by Matthew Ozga

Iowa’s direct-care workforce is among the lowest-paid employment groups in the state, according to a survey published by the Iowa CareGivers Association.

The average direct-care worker in Iowa makes just $11.50 an hour, according to the 1,276 survey respondents, a group that included certified nursing assistants, home health aides, and personal care assistants.

By contrast, Iowa’s median hourly wage for all workers is $14.40.

Nearly half (49.9 percent) of Iowa’s direct-care workers live in households earning under 200 percent of the federal poverty level.

Iowa’s direct-care workers also struggle to obtain health insurance, the survey found: nearly one-forth (23 percent) of respondents said they were not insured. Overall, 12.4 percent of Iowa’s adults lack health coverage.

Additionally, only 43 percent of direct-care workers in Iowa are offered paid sick leave.

Low Pay Discouraging to Workers

According to the survey, this lack of adequate wages and benefits is driving many Iowans away from direct care. More than 20 percent of direct-care workers surveyed said that they are actively seeking to leave the field entirely in order to find better-paying jobs.

“Workers are leaving direct care at exactly the wrong time,” said John Hale, a public policy consultant for the Iowa CareGivers Association. He notes that, of the ten jobs expected to be most in demand over the next decade, three are in the field of direct care.

“We cannot meet the future demand for workers who will enter and stay in the profession unless we make these jobs better by improving their pay and benefits,” Hale continued.

Recommendations for Future

The report offers several ways that Iowa can address the issue of low pay and benefits for direct-care workers.

For example, the report says that Iowa could insure more workers by expanding Medicaid eligibility to 133 percent of the federal poverty level. The Affordable Care Act will require all states to do that beginning in 2014, but states have the option of expanding Medicaid eligibility (pdf) at any point before then.

The report further recommends that Iowa expand eligibility levels for its subsidized child care program, as well as increase the size of its Earned Income Tax Credits.

– by Matthew Ozga