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PA advocates (L-R): Edith Osterholm; Jessie Van Swearingen; Christine Gessner; Dan Haimowitz; Brenda Nachtway; Joe Angelelli; Adam Wolf Axler, Legislative Assistant to Rep. Joe Sestak

– by Joe Angelelli, Ph.D., PHI Pennsylvania State Director

On World Alzheimer’s Day, September 21, I was in Washington with 40 other advocates representing the 28 national organizations of the Eldercare Workforce Alliance (EWA).

It was the EWA’s second annual education day on Capitol Hill, as state delegations of family caregivers, geriatricians, educators, nurses, psychologists, pharmacists, social workers, direct-care workers, gerontologists, physical therapists, and other long-term services and supports professionals visited the offices of our representatives in the House and Senate. We met with congressional staffers and shared our caregiving stories, and listened to some of their own.

Individuals and organizations from a broad spectrum are working together in an unprecedented way to engage older adults, their families, and other unpaid caregivers about the critical need to address our nation’s worsening eldercare crisis. Our purpose that day was to request full funding of geriatric education programs under Title VII and Title VIII of the Public Health Service Act, and to provide information about the EWA’s endorsement of the Direct Care Workforce Empowerment Act and the Positive Aging Act (pdf).

Florida advocates (L-R): Patricia Wallace, Nurse; Terri Bucher, Nurse; Kathy Hyer, Professor; Lisa Brown, Psychologist; Denise Gammonley, Social Worker

A Unifying Experience

It was an honor to participate with my fellow Pennsylvanians. We made for a spirited team that included two veteran direct-care workers, a physical therapy professor, a medical social worker, a geriatrician, and me, a gerontologist. Early on we learned that all of us were at some point recently direct caregivers to family members and friends. That unifying experience permitted us to speak from the heart with the hard-working staff of our representatives, to point out that we’re all in this together, and to urge action with the first baby boomers turning 65 in just a few months.

Well into the afternoon we were just six people with tired feet walking the hushed halls and sunlit sidewalks of Congress, but together — as part of the EWA — we did our part to advocate for a caring and competent eldercare workforce, one that provides high-quality, culturally sensitive, person-directed and family-focused care.

(L-R) Paul Malhausen, physician; Nancy Lundebjerg, Deputy Executive Vice President and Chief Operating Officer of the American Geriatrics Society and co-convener of the Eldercare Workforce Alliance; John Hale, public policy director, Iowa Caregivers Association

Workforce Priorities Outlined

The geriatrics workforce priorities of Title VII authorized by the Affordable Care Act, and for which the EWA was seeking appropriations to be implemented, include:

• An expansion of the number of disciplines eligible to apply for a Geriatric Academic Career Award
• A supplemental grant award program to Geriatric Education Centers to train additional faculty through a mini-fellowship program
• A requirement that Geriatric Education Centers provide training to caregivers and/or direct-care workers
• A geriatric training program for physicians, dentists, and behavioral and mental health professions
• A geriatric career incentive program to provide grants to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and chronic care management
• A program administered by the Department of Health and Human Services to offer advanced training opportunities for direct-care workers.

Title VIII includes the Nursing Workforce Development programs, supporting:

• Additional training for nurses who care for older adults
• Development and dissemination of curricula relating to geriatric care and training of faculty in geriatrics
• Continuing education opportunities for nurses practicing in geriatrics.

The Affordable Care Act also creates traineeships for advanced practice nurses pursuing long-term care, geropsychiatric nursing or other areas that specialize in care of older adults.

The Federal Medical Assistance Percentage (FMAP) increase is expected to be extended, since the U.S. Senate has voted to pass it.

Without the FMAP extension, many states were planning to cut or even eliminate health care programs serving poor and elderly residents.

The Senate voted on August 5 to pass the federal state-aid package that includes $16.1 billion to extend the FMAP increase through 2011.

First the Senate had to surmount a Republican filibuster — an outcome that seemed unlikely by all accounts just one week ago. Once the Senate voted on August 4 to end the debate, the bill headed to the Senate floor where it passed, 61-39.

Calling Representatives Back for the House Vote

Members of the U.S. House of Representatives have already left for summer recess. However, in an uncommon move, House Speaker Nancy Pelosi (D-CA) called them back to Washington, D.C. to vote on the measure next week.

Once the measure is passed in the House, as expected, the bill will be sent to President Obama, who has been pushing for its passage.

Extension Will Prevent Layoffs and Service Cuts

The $16.1 billion FMAP increase is part of a larger, $26 billion state-aid package of which $10 million is targeted to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

The bill was tied up in the Senate until two Maine Republicans, Susan Collins and Olympia Snowe, joined with Democrats to end debate on the bill.

“At a time when our economy is still regaining its footing and state budgets are strapped, this FMAP extension is critical to maintaining services for elders and people with disabilities, as well as ensuring stability to the direct-care workforce that provides those services,” said Steve Edelstein, PHI’s national policy director.

“We applaud the Senate leadership and Senators Collins and Snowe for putting the needs of our most vulnerable citizens at the forefront and for refusing to let this vital legislation die.”

– by Deane Beebe

Sen. Bob Casey (D-PA)

The U.S. Senate Special Committee on Aging held a field hearing on August 2 entitled “Taking Care of Mom and Dad: Why We Need a Quality Workforce to Serve Our Older Americans.”

“I called this hearing today to address a serious problem in our Commonwealth and across the nation: providing access to a quality workforce for an aging population,” said a press statement by Sen. Bob Casey (D-PA), who chaired the hearing.

Experts provided testimony on the shortage of health care workers, including physicians, nurses, and direct-care workers. They warned that with the baby boom generation turning age 65 in 2011, there will be an even greater demand for this workforce.

Witnesses included representatives of the federal government, academic medicine, a national advocacy organization, home care, and a direct-care worker association.

Senate Companion Bill to the Direct Care Workforce Empowerment Act Introduced

The day following the hearing, Casey introduced the Direct Care Workforce Empowerment Act, the companion legislation to the House bill (H.R. 5902) that was introduced on July 28 and sponsored by Rep. Linda Sanchez (D-CA).

“The number of Americans needing long-term care is expected to double in the coming decades from 13 million in 2000 to 27 million in 2050,” Casey said in a press statement about the bill. “The vast majority, 70-80 percent, of paid care will be provided by direct-care workers.”

“As a long-time leader on issues affecting direct-care workers, Senator Casey understands in a very personal way their vital role providing compassionate hands-on care and support to elders and persons with disabilities,” said PHI Pennsylvania State Policy Director Joe Angelelli. “His leadership and concern for fair treatment of home care workers is critical.”

Fastest-Growing Occupation is a Poor Paying Job

There were 3.2 million direct-care workers in the U.S. in 2008. It is projected that an additional 1.1 million new positions will be needed by 2018 (pdf).

The median hourly wage for direct-care workers in 2008 (pdf) was $10.42, compared with $15.57 for all U.S. workers that same year.

As in the rest of the nation, home health aides and personal and home care aides are among Pennsylvania’s top 10 fastest-growing occupations (pdf).

“Despite providing care and services that help millions of older citizens and people with disabilities maintain their dignity and autonomy and often remain in their homes, most direct-care workers receive low wages, little or no benefits, and insufficient training and professional development,” Casey said. “As a result, there are high turnover rates that can compromise the quality of care our older citizens and people with disabilities deserve.”

Testimony from the hearing will soon be available at the U.S. Senate Special Committee on Aging website.

– by Deane Beebe

Direct-care workers in training

The House Committee on Financial Services passed the Public Housing Reinvestment and Tenant Protection Act of 2010 (H.R. 5814) on July 27, which includes provisions to fund training for public housing residents to become home health and personal care aides.

If enacted, a three-year, federal pilot grant program would be established to train public housing residents to provide home health and personal care services and supports to public housing and federally assisted rental housing residents who are elderly or living with a disability, including veterans.

Home care providers, community health centers, faith-based organizations, labor organizations, public housing agencies, and state and local government agencies that have established — or provide assurances that they will establish — an employment training program would be eligible to apply for a grant.

The funding is targeted to programs that primarily serve urban, rural, or Indian populations, as well as people in Puerto Rico or the U.S. Islands.

Under the act, the U.S. Department of Housing and Urban Development (HUD) would receive $2.5 million for distribution in each fiscal year: 2011, 2012, and 2013.

Recognizing Workers’ Needs

In addition to supporting home health and personal care aide training, the grant money could also be used to cover transportation and child care expenses for the public housing residents in the training programs.

“This model recognizes the needs that many home care aides have as they transition to work, particularly child care and transportation,” said PHI New York State Policy Director Carol Rodat. “Funding for these critical supports is seldom available, which is why the grants envisioned in this legislation are so important.”

Income earned from providing home care services will apply toward the public housing residents’ eligibility for federal housing on a graduated basis for the first three years, with no income applying in the first year.

These provisions of the Public Housing Reinvestment and Tenant Protection Act of 2010, sponsored by Rep. Maxine Waters (D-CA), were taken from the Together We Care Act of 2009, introduced by Rep. Nydia Velázquez (D-NY) in December 2009 and cosponsored by Rep. Barney Frank (D-MA), the Financial Services Committee Chair, and Waters.

“Home care is a profession that will be in high demand for years to come and this legislation will offer hard-working public housing residents the tools they need to enter this field,” said Velázquez when she introduced the Together We Care Act last December.

– by Deane Beebe

Rep. Linda Sánchez (D-CA)

A new bill that seeks to address critical direct-care workforce issues — including extending federal wage and overtime protections to home care workers — was introduced to the U.S. House of Representatives on July 28.

If enacted, the Direct Care Workforce Empowerment Act (H.R. 5902), sponsored by Rep. Linda Sánchez (D-CA), would:

• extend wage and overtime protections provided through the Fair Labor Standards Act to home care workers;
• establish data collection and reporting requirements to monitor important workforce indicators such as size, compensation levels, turnover rates and vacancies; and
• provide grants to states to expand and support efforts aimed at recruiting, training and retaining an adequate supply of direct care workers.

“One of America’s fastest-growing workforces, home care aides have been treated by the Department of Labor as a contingent workforce for too long,” PHI President Steven Dawson said in a statement released in support of the bill.

Dawson noted that the Direct Care Workforce Empowerment Act follows on the passage of the Affordable Care Act, which included several important provisions — including additional training funds, a National Healthcare Workforce Commission, and a Personal Care Attendants Workforce Advisory Panel — addressing the needs of this workforce.

Pressing DOL to End Companionship Exemption

“Through our Campaign for Fair Pay, PHI and our allies continue to press the Department of Labor to immediately address this issue by ending the ‘companionship exemption’ for workers who provide care and support to elders and to persons with disabilities,” Dawson said.

PHI and other organizations are calling on Department of Labor (DOL) Secretary Hilda Solis to make a regulatory fix to end the companionship exemption. In 2007, the U.S. Supreme Court upheld the DOL’s authority to define “exceptions” to the federal Fair Labor Standards Act in a case brought by the late Evelyn Coke (pdf), a New York home care aide.

“Because more than 75 percent of long-term care is financed by federal programs, government needs to be part of the solution,” the Direct Care Alliance explains on its website.

“I am here to say that our nation’s laws should respect all hard-working Americans equally,” Rep. Sánchez said. “No matter whether you sit behind a corporate desk or care for an elderly person in a home, all work has dignity.”

The Direct Care Workforce Empowerment Act currently has 28 co-sponsors.

– by Deane Beebe

The U.S. House of Representatives unanimously passed the bipartisan Strengthening Employment Clusters to Organize Regional Success (SECTORS) Act of 2010 on July 19.

The SECTORS Act (H.R. 1855) would provide grants to establish or expand “sector partnerships” to identify and provide training that meets the sectoral needs of a region’s economy.

Sector — or industry — partnerships are comprised of an industry’s stakeholders, including employers, unions, education and training providers, and local workforce and education administrators.

These partnerships develop plans to grow — or save — an industry, “with a particular focus on building new workforce pipelines where skilled worker shortages exist and transforming the ways existing workers are utilized, retrained, and compensated,” according to the National Skills Coalition (formerly The Workforce Alliance).

PHI Model for Sector Strategy Approach

“The SECTORS Act would, for the first time, establish congressionally authorized funding in support of the kind of sector/ industry-based strategies that have been proven to work for both workers and employers across a range of industries,” said Andy Van Kleunen, executive director of the National Skills Coalition, which helped to develop the bill.

“PHI’s efforts in the direct-care sector, in which it brings together employers and workers to develop strategies for both workforce training and improved working conditions and supervision, has been one of the pioneering models for this sector-based approach,” Van Kleunen said.

Implementation and Renewal Grants

Under the SECTORS Act, eligible sector partnerships could apply for implementation grants of up to $2.5 million for three years and $1.5 million renewal grants for an additional three years. The Department of Labor would administer the grants.

The House bill was introduced by Reps. Dave Loebsack (D-IA) and Todd Platt (R-PA). The lead co-sponsors of the Senate version (S. 777) are Sens. Sherrod Brown (D-OH), Patty Murray (D-WA) and Olympia Snowe (R-ME).

The Senate has not yet taken up the bill for a vote.

“If SECTORS is passed by the Senate, it would create new opportunities to organize local partnerships of employers, unions, training providers and other experts in the direct-care arena, so they could develop workforce strategies similar to PHI’s across a range of local direct-care settings, and leverage new public dollars to help train and retain local direct-care workers for the long-term,” Van Kleunen said.

PHI is among the 168 organizations, including 75 employers, that endorsed the legislation (pdf).

More information on the SECTORS Act is available on the National Skills Coalition’s website.

– by Deane Beebe