PHInational.org

Sen. Tom Harkin

Senator Tom Harkin (D-IA) introduced a “sense of the Senate” resolution (pdf) on May 10 expressing the need for a comprehensive approach to expanding and supporting a strong home care workforce, as well as making long-term services and supports affordable and accessible to elders and people with disabilities.

Among the reasons cited for a comprehensive policy approach to meeting the nation’s caregiving needs are:

• Over the course of the next two decades, the number of Americans aged 65 and older will increase from 40 million to 70 million; 70 percent of Americans over 65 require some form of long-term services and supports.
• There are currently 12 million adults, nearly half of whom are 65 or older, who are in need of long-term services and supports due to functional limitations; this is project to grow to 27 million by 2050.
• The current direct-care workforce is well over 3 million strong — with an additional 1.8 million workers needed over the next decade to keep pace with growing demand. This workforce provides 70 to 80 percent of the hands-on care and personal assistance received by Americans who are elderly or living with disabilities or other conditions.
• The quality of home care jobs is poor with low wages, few benefits, high turnover and a high level of job stress and hazards.

The Resolution focuses on a range of policy solutions that include job creation, job quality, workforce training and advancement, pathways to citizenship, and strategies to make care affordable and accessible to consumers and their families.

These solutions are embedded in the Caring Across Generation policy platform and are part of its educational and advocacy efforts.

Caring Across Generations is a campaign to transform long term care in the U.S. for individuals who rely on these services and supports and for the workers who provide home care. PHI is a member of the campaign and serves on its Leadership Committee.

– by Carol Regan, PHI Government Affairs Director

The Centers for Medicare and Medicaid Services (CMS) announced the first round of recipients of the Health Care Innovation Awards on May 8.

The Health Care Innovation Challenge, launched last November, was designed to generate creative approaches to health care delivery that improve health, enhance health care, and lower costs for individuals enrolled in Medicare, Medicaid, and CHIP.

The 26 awarded projects total $122.6 million, approximately 10 percent of the $1 billion in grant funding to be administered through the Centers for Medicare and Medicaid Innovation (CMMI).

The recipient programs span a wide range of topics, including interventions to:

• improve chronic disease management for underserved populations,
• enhance primary care outcomes through the use of community health workers,
• reduce emergency care admissions, and
• lower re-hospitalization rates.

The 26 awardees were selected based on their unique approaches to addressing health care challenges, as well as their integration of workforce development and cost savings benefits for local communities.

In a call with stakeholders the day that the grants were announced, CMMI Director Richard J. Gilfillan said that the next round of awards will be announced in early June. Gilfillan would not confirm whether the second round would feature a similar number of awardees, or whether there will be a third round of funding.

The awards were originally scheduled to be announced in March, but CMS delayed the announcement in order to more thoroughly consider the 3,000-plus applications submitted at the start of the year.

– by Angelina Del Rio Drake, PHI Development Writer

Nursing home and assisted living facility care costs continued to grow while home care costs remained flat in 2011, according to Genworth Financial‘s 2012 edition of its annual Cost of Care Survey (pdf).

The report used data from more than 15,000 long-term care providers throughout the country to determine the median rates for a range of long-term care services:

• Licensed Homemaker Services — $18 median hourly rate; no change from 2011; five-year annual growth rate of 1.15 percent
• Licensed Home Health Aide Services — $19 median hourly rate; no change from 2011; five-year annual growth rate of 1.1 percent
• Adult Day Health Care — $61 median day rate; up 1.67 percent from 2011; five-year growth rate unavailable
• Assisted Living Facility, One Bedroom, Single Occupancy — $3,300 median monthly rate; up 1.2 percent from 2011; five-year annual growth rate of 5.7 percent
• Nursing Home, Semi-Private Room — $200 median daily rate; up 3.63 percent from 2011; five-year annual growth rate of 4.5 percent
• Nursing Home, Private Room — $222 median daily rate; up 4.23 percent from 2011; five-year annual growth rate of 4.3 percent

While nursing home and assisted living facility costs have steadily increased in recent years, home care costs have remained fairly steady.

The report attributes the lack of growth in home care costs to “increased competition among agencies and the availability of unskilled labor,” as well as the fact that home care companies “do not incur the costs associated with maintaining stand-alone health care facilities.”

Declining Direct-Care Worker Wages Left Unmentioned

“What the report fails to mention is that the biggest component of home care costs is direct-care workers’ wages, which over the last 10 years have actually gone down when adjusted for inflation,” said PHI National Policy Director Steve Edelstein.

“One reason their wages remain artificially low is the ‘companionship exemption,’ which excludes home care workers from federal minimum wage and overtime protections,” Edelstein added. “We can’t continue to underwrite the cost of home care by undervaluing and underpaying those who provide the services and still expect that there will be a home care worker available when we need one.”

Genworth’s website includes a section allowing current or prospective consumers of long-term care to compare rates for various services on a state-by-state basis. The website also allows for comparisons between nearly 440 discrete regions throughout the U.S.

– by Matthew Ozga

A new National Emphasis Program (NEP) for Nursing and Residential Care Facilities was released on April 5 by the U.S. Department of Labor‘s (DOL) Occupational Safety and Health Administration (OSHA) in an effort to reduce occupational illnesses and injuries in these long-term care settings.

The NEP (pdf) provides guidance for a three-year effort to use OSHA outreach and inspections to reduce specific occupational hazards in nursing and residential care facilities.

In 2010, workers employed in these settings experienced “one of the highest rates of lost workdays due to injuries and illnesses of all major American industries,” a DOL press release states.

“The incidence rate for cases involving days away from work in the nursing and residential care sector was 2.3 times higher than that of all private industry as a whole, despite the availability of feasible controls to address hazards,” DOL explains.

Nearly two thirds of the cases (62.5 percent) that involved days away from work were attributed to injuries in two categories: 1) overexertion and 2) slips, trips, and falls.

DOL identified the following hazards associated with providing care in nursing and residential facilities:

• exposure to blood and other potentially infectious material;
• exposure to other communicable diseases such as tuberculosis;
• ergonomic stressors related to lifting patients;
• workplace violence;
• slips, trips, and falls; and
• exposure to hazardous chemicals and drugs.

“These are people who have dedicated their lives to caring for our loved ones when they are not well,” said David Michaels, assistant secretary of labor for occupational safety and health. “It is not acceptable that they continue to get hurt at such high rates. Our new emphasis program for inspecting these facilities will strengthen protections for society’s caretakers.”

Nursing Aides Rank among the Highest for Job Injury and Illnesses

According to analysis by PHI of 2010 data on nursing aides from the Bureau of Labor Statistics, Injuries, Illnesses and Fatalities Program:

• Nursing aides ranked second in the list of occupations with the highest numbers of injuries and illness (53,030), after hand laborers and freight, stock, and material movers (65,040), and far ahead of police and sheriff’s patrol officers (29,150).
• Nursing aides also had one of the highest incidence rates of work-related illness and injuries (489.4 per 10,000 workers), placing them third in the list of the top five. In 2010, they experienced injury at a rate four times that of all workers combined.
• Nursing aides had the highest incidence rate for musculoskeletal disorders of all occupations (or ergonomic injuries) at 249.4 per 10,000 full-time, or more than seven times the national average (34.3 per 10,000).

Visit the OSHA website for more information, including guidance on nursing and residential care facility ergonomics and workplace violence.

– by Deane Beebe

The next webinar in the Friday Morning Collaborative Webinar Series is “Managed Long-Term Services and Supports” and will take place on April 13 from 2:00 – 3:30 p.m. EST.

The webinar will draw upon the experiences of the 12 states with managed long-term services and supports (LTSS) programs and provide an overview of key issues and guiding principles to assist state aging and disability advocates.

Learn more and register online.

– by Deane Beebe

Registration is filling up quickly for a half-day forum entitled Innovations in Care Coordination: Rethinking the Role of Home Care Workers.

The forum will be hosted by PHI and SEIU on March 1 in Washington, DC, at the Dirksen Senate Office Building, Room 106, from 8:30 a.m. to 12 p.m.

Senator Robert Casey (D-PA), who is the Senate sponsor of the event, will be speaking on “The Importance of the Home Care Workforce.” Casey introduced a bill late last year to test models that expand the role of direct-care workers.

The forum will provide an opportunity to discuss, explore, and define innovative ways home care workers can help improve the delivery of long-term services and supports.

During this time of health care transformation, participants will consider the potential for home care workers to:

• take on additional care responsibilities;
• contribute as a proactive member of the healthcare team; and
• help achieve the goals of better care at lower costs.

Speakers

Perspectives will be heard from individuals and families; home care providers and workers; and national policymakers and heath care experts, including:

• Bruce Vladeck, PhD, Senior Advisor, Nexera, Inc.
• Judy Feder, PhD, Professor of Public Policy, Georgetown University; Institute Fellow, Urban Institute
• Thomas Edes, MD, Director, Geriatrics & Extended Care, Office of Clinical Operations, U.S. Department of Veterans Affairs
• Steven Dawson, President, PHI

Registration

There is no charge to attend the forum but registration is limited. To register, see the complete agenda, and get more information, go to the forum’s online registration site.

– by Deane Beebe