PHInational.org

Three brief stories on direct care:

_________

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.

_________

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.

_________

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.

_________

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.

_________

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

Direct-care workers in training

The Iowa Department of Public Health (IDPH) was awarded a $2.2 million Personal and Home Care Aide State Training Program (PHCAST) demonstration grant to develop and pilot a training and credentialing model for direct-care workers.

The three-year grant, which was awarded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, will be targeted to one urban and one rural region in the state.

Direct-care professionals who participate in the project will work in a variety of settings and provide services and support to Iowa’s elders and people living with disabilities.

“The focus of the project is to develop a direct-care training and credentialing system that can be replicated nationwide,” said Erin Drinnin of the IDPH Bureau of Health Care Access.

“The goal is to provide responsive and flexible training, promote the highest quality of care, and develop career pathways to professionalize the direct care workforce in Iowa,” Drinnin said.

One Step Closer to Professionalization

The funded project is based on the recommendations of the Iowa Direct Care Worker Advisory Council, which was established by the Iowa Legislature in 2008. The Advisory Council was previously known as the Iowa Direct-Care Worker Task Force, which was established in 2005.

“With the grant, Iowa will move one step further toward the establishment of a Board of Direct-Care Workers, which was legislated in 2010,” said Iowa Caregivers Association Executive Director Di Findley, who is a member of the Advisory Council. “Through the grant we will be able to pilot the recommendations of the Advisory Council that will ultimately credential, promote, and support the professionalization of this vital workforce.”

“Finally, direct-care workers will receive the professional status they deserve,” Findley continued. “We appreciate the Iowa Department of Public Health’s leadership in securing this grant to advance the work of Iowa’s governor-appointed Direct-Care Worker Advisory Council.”

Iowa is one of six states to receive a PHCAST demonstration grant. The five other states are California, Maine, Massachusetts, Michigan, and North Carolina.

– by Deane Beebe

Iowa’s direct-care workers still lack adequate wages and benefits, according to an Iowa CareGivers Association survey that is set to be released in the coming days.

The survey, conducted by the Child & Family Policy Center, is the third — and so far, most comprehensive — overview of Iowa’s direct-care workforce published over the past decade. The last survey was released in 2004.

Like the rest of the country, Iowa is facing a shortage of direct-care workers just when the demand for their services is peaking. The aging of the baby-boomer generation will create a need for an additional 10,000 new direct-care workers in Iowa alone over the next 10 years.

In that context, the need for high-quality direct-care jobs is more urgent than ever.

“The needs of persons with disabilities and aging Iowans will go unmet if we continue to ignore and undervalue this incredibly important workforce,” said Di Findley, the executive director of the Iowa CareGivers Association.

“We can no longer, as a society, get by thinking that we can compensate people poorly simply because they are nice, caring people,” she continued.

Specific Survey Findings

Among the findings in the 2010 Iowa survey:

• Iowa’s direct-care workers are among the lowest-paid in the state, earning an average of $11.50 an hour, compared with the median hourly wage of $14.40 for all Iowa workers.
• A majority of direct-care workers in Iowa work full-time hours — but nearly half (49.9%) report household incomes that fall below 200% of the federal poverty level. Nearly one out of five direct-care workers in Iowa (18.2%) are below the federal poverty line entirely. Many rely on public benefit programs such as food stamps and child care assistance to make ends meet.
• Across the board, direct-care workers are less likely to be covered by health insurance than non-elderly workers throughout Iowa.
• More than one-fifth of all direct-care workers in Iowa say they are actively trying to leave the field, mostly due to low pay and poor benefits.

The survey suggests that some of the financial difficulties faced by Iowa’s hard-working direct-care workers could be offset by expanding public services, such as Medicaid eligibility and earned income tax credits, to more Iowans.

It also recommends that the Iowa government use its position of as a primary purchaser of direct-care services (under Medicaid) to raise wages and provide more benefits.

– by Matthew Ozga