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On January 18, the U.S. House of Representatives Committee on Ways & Means voted 23-13 to repeal the Community Living Assistance Services and Supports (CLASS) program, by approving the Fiscal Responsibility and Retirement Security Act (H.R. 1173).

The Committee’s approval clears the bill to be voted on by the full House.

Advocates for older adults and people with disabilities — as well as for direct-care workers — have been supporters of the CLASS program, the voluntary, federal insurance plan created under the Affordable Care Act to help people purchase long-term services and supports (LTSS).

The CLASS program would also establish a national Personal Care Attendants (PCA) Workforce Advisory Panel to advise Congress on the adequacy of the number of PCAs, their wages and benefits, and access to the services that PCAs provide.

Advocates Oppose the Bill

CLASS supporters have organized to oppose the advancement of H.R. 1173 (pdf).

On January 17, more than 50 organizations sent a letter (pdf) to the Ways & Means Committee leadership opposing the bill.

Caring Across Generations also mobilized its supporters, generating hundreds of calls to Committee members opposing repeal.

The Obama Administration halted implementation of the CLASS program in October due to concerns about its viability. However, the Administration also opposes repeal, arguing that CLASS provides a framework for future action to meet the LTSS needs of older Americans and people with disabilities.

Senator Jay Rockefeller (D-WV) is leading efforts to defend CLASS against repeal in the Senate.

– by Gail MacInnes, PHI National Policy Analyst

A study published in Seniors Housing & Care Journal examines the relationship between The Green House model of long-term care and the empowerment of the direct-care workers who provide that care.

The authors of the report, Barbara Bowers and Kim Nolet of the University of Wisconsin School of Nursing, interviewed more than 100 employees at 11 Green House–affiliated facilities throughout the country — including 68 “Shahbazim,” the Green House term for certified nursing assistants.

Their findings offer “some insight into direct-care staff empowerment as experienced in The Green House model of culture change,” including both the benefits and the challenges of empowerment, the authors write.

They note that many providers believe that direct-care worker empowerment is connected to better quality of care and better quality of life for residents, and is an important strategy for promoting worker satisfaction and retention.

Benefits and Challenges of Empowerment

For example, Bowers and Nolet report that Shahbazim at Green House facilities derive positive feelings of empowerment and respect from the fact that they do not have supervisors constantly “checking up on them.”

They also report that Shahbazim feel empowered to initiate contact with consumers’ family members about specific care practices.

However, the empowerment that comes with greater independence in the workplace can also pose challenges, Bowers and Nolet write. For example, Shahbazim found that dealing with conflicts between co-workers is more difficult without close supervision.

“Many of the Shahbazim did not feel adequately prepared to deal with interpersonal conflicts,” Bowers and Nolet write.

“This report substantiates the positive impacts on job quality of the Shahbazim role,” said PHI National Director of Training & Organizational Development Services Susan Misiorski. “It also highlights why conflict resolution skills, which PHI offers as part of our suite of coaching and communication training, are so important.”

Green House Background

The Green House Model is a model of care designed to create a greater sense of community among long-term care staff, residents, and residents’ families.

In addition to empowering workers, the Green House model strives to build a sense of community by implementing physical changes to create small homes and restructuring staffing hierarchies.

The Green House model has been adopted by many skilled nursing homes throughout the country, including at The Cottages at St. Martin’s in the Pines, in Alabama, which was the subject of a PHI case study earlier this year.

– by Matthew Ozga

The Health Care Innovation Challenge, which will provide up to $1 billion in grants from the Center for Medicare and Medicaid Innovation to “test creative ways to deliver high-quality health care services and lower costs,” was launched by the Department of Health and Human Services (HHS) on November 14.

“The Innovation Challenge is an exciting opportunity to design creative care models that expand the role of direct-care workers in an array of long-term care settings,” said Steve Edelstein, PHI national policy director. “It also signals the importance of HHS’s commitment to models that integrate these frontline workers into the care team to improve the care outcomes for elders and people living with disabilities.”

Grants ranging from approximately $1 million to $30 million for a three-year period will be awarded to applicants proposing the most compelling new ideas to deliver better health, improve care, and lower costs for people enrolled in Medicare, Medicaid, and CHIP — particularly those with the highest health care needs.

New Models of Workforce Development and Deployment

The Innovation Center will give preference to proposals that include “development and/or deployment of health care workers in new, innovative ways.” For example:

• new roles and skills for an existing workforce,
• new types of workers to support core transformation of the health care delivery system, and
• team-based models as better methods to serve a particular population.

Successful proposals, according to the grant guidelines, must include an innovative, explicit workforce development plan, one that requires new roles for all staff engaged in the new models of care and new skills to manage team building and care coordination.

“Training and educational experiences will be needed” to develop the skills required for the “health care workforce of the future,” states the announcement, which also notes that “preference will be given to projects that implement their care improvement activities faster than six months.”

The Innovation Center was created under the Affordable Care Act as part of the Centers for Medicare and Medicaid Services (CMS).

More information on the Health Care Innovation Challenge is available on the CMS website.

Important Health Care Innovation Challenge Dates

• Letter of intent: due December 19, 2011
• Applications: due January 27, 2012
• Awards Granted: March 2012

– Originally published at PHInational.org by Deane Beebe

PHI Midwest Director Hollis Turnham conducted a workshop about how to improve the odds for the successful use of person-directed services on October 27 at the 36th Consumer Voice Annual Conference & Meeting in Grand Rapids, Michigan.

“Tools for Improved Consumer Self-Direction: Living the Life You Want” provided information on the pros and cons of self-direction as well as the step-by-step activities to recruit, hire, and supervise a personal assistant.

PHI has developed informational tools and processes to meet the challenges of using person-directed long-term supports and services.

“Usually, we conduct these workshops with a person who currently uses self-direction and who mentors others to become more skilled employers and supervisors,” Turnham said. “This workshop was designed to not only lay out the tools but to also give a taste of the planning and work needed to successfully recruit, select, and hire your first direct-care worker.”

Consumers’ Responsibilities of Directing Caregiving Staff

Turnham led local ombudsmen and other advocates from around the country in using person-directed services tools, checklists, and agreements in the same ways that frail elders and people living with disabilities are encouraged to take on the responsibilities of directing their own caregiving staff.

The exploration began with a discussion of “describing what a really great day would look like,” which allows people who are considering self-direction to imagine, plan for, and prioritize life as the “supervisor.”

The workshop participants reported that they saw the value of this discussion for nursing home residents who are considering a transfer or discharge, even if self-direction was not in their future.

While the participants were encouraged to be very specific about the degree and kinds of assistance needed with activities of daily living, instrumental activities of daily living, and other health related items, the workshop focused on:

• people’s preferences, such as providers’ compatibility with dogs or cats;
• the advantages and disadvantages of hiring family or friends;
• rules of the house (such as smoking or no-smoking);
• the importance of a job description;
• using open-ended questions in the interviews; and
• how to be a good supervisor.

“For most of us, we need to learn new skills to be a successful employer, particularly when supervising our own direct-care staff,” Turnham said.

For information on PHI’s training for consumers directly employing personal care aides, contact Peggy Powell, PHI national director of workforce and curriculum design.

– by the PHI Policy team

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

The CLASS program dodged another potentially fatal blow last week when a Republican-led repeal attempt was defeated in the Senate.

Senator Jay Rockefeller (D-W.V.) blocked a request made by Sen. John Thune (R-S.D.) to advance a measure to repeal CLASS. Thune’s request needed unanimous consent to pass.

Additionally, AARP and 50 other aging and disability-rights groups sent a letter to House leaders last week urging them not to repeal the CLASS Act, the Affordable Care Act provision that would create the voluntary long-term care insurance program known as CLASS.

On October 20, PHI wrote that advocates of the CLASS Act remain hopeful that the program will eventually be implemented.

– by Matthew Ozga