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Massachusetts State House in Boston

Massachusetts lawmakers heard testimony on November 15 on a Senate bill to establish a task force to ensure that there is an adequate direct-care workforce to meet the rising demand for long-term services and supports in the state.

The proposed direct-care task force — comprised of representatives from state agencies that employ or contract for direct-care services — would seek to gather accurate data across the current workforce, including:

• the number of workers,
• turnover and vacancy rates, and
• wages and benefits.

The task force would also:

• assess the state’s current training and credentialing infrastructure;
• develop workforce policies that ensure an adequate supply of frontline caregivers, especially in home and community-based settings; and
• report their findings to the governor and legislature by December 31, 2012.

“We Need to Ensure These Are Good Jobs”

“Families depend on these workers to care for their loved ones — often so that they can work themselves,” said State Senator Pat Jehlen, co-chair of the Massachusetts Joint Committee on Elder Affairs, who introduced “An Act to Establish a Task Force Relative to the Commonwealth’s Direct-Care Workforce” (S.45).

“If Massachusetts is going to meet the rapidly growing demand for this workforce, we need to ensure that these jobs are good jobs with decent wages, health coverage, better training, and opportunities for career advancement,” she said.

Senator Jehlen Presents Case in the Globe

 
An op-ed by Senator Jehlen (left) entitled “Is Massachusetts Prepared to Care?” was published by The Boston Globe a day before the hearing.

Massachusetts’ nearly 104,000 direct-care workers comprise the largest occupational group in the state today. The demand for this workforce is expected to grow in the state by at least 21 percent by 2018.

Poor wages, however, will make it difficult to attract workers. The median hourly wages for home care aides and personal care attendants was $12.23 and $12.48, respectively, and $13.53 for nursing aides, in Massachusetts in 2010. The median hourly wage for all occupations in the state was $20.13.

“Not Able to Access Healthcare Ourselves”

In testimony (pdf) delivered to the Joint Committee on Children, Families, and Persons with Disabilities, Victoria Entzminger, a personal care attendant employed to care for her nephew with multiple disabilities, said:

“I am proud to provide him with this care, but I am struggling myself. Personal care attendants do not receive any health insurance through our jobs. While we provide healthcare supports to consumers, We often are not able to access healthcare ourselves.”

Also testifying on behalf of the bill were:

• Lisa Gurgone, executive director, Massachusetts Council for Home Care Aide Services
• Paul Dzialo, president/CEO, Affinity Home Health Care
• Russ Davis, executive director, Jobs with Justice

For more information about the bill — and the direct-care workforce in Massachusetts in general, including downloadable charts and graphs — visit PHI Massachusetts on the PHI PolicyWorks website.

– by Deane Beebe

PHI Massachusetts, a new section of the PHI PolicyWorks website, will provide news, facts, and other resources about the state’s direct-care workforce.

The site also contains information on several state-focused priorities, including educating policymakers about the direct-care workforce, transforming care environments, and building skills for workers.

Visitors can sign up for e-mails alerting them to new Massachusetts content at the PHI Massachusetts homepage.

The PHI Massachusetts page is the third state-focused page that PHI has introduced this year, following PHI New York and PHI Michigan.

“We are thrilled to have this platform to speak out about the unique challenges and opportunities facing Massachusetts’s largest occupational group,” said PHI Massachusetts State Director Amy Robins.

Task Force Bill Would Help Workers

One of those unique opportunities is “An Act to Establish a Task Force Relative to the Direct-Care Workforce,” a bill recently introduced to the Massachusetts legislature by State Senator Pat Jehlen (D).

If passed into law, the task force bill would require the state to take steps to ensure that it has an adequate workforce and infrastructure to meet the rising demand for long-term care services and supports.

The bill (S45) is covered in depth at the new PHI Massachusetts site.

A public hearing for the bill will take place on November 15 at 10:30 am at the Massachusetts State House.

Massachusetts State House in Boston

Both the Massachusetts House and Senate have passed surplus reserve bills that would provide some direct-care workers in the state with a one-time wage supplement if the state has reserve tax revenues of at least $20.6 billion by January 15, 2012.

Eligible direct-care workers and human service workers who earn less than $40,000 a year would benefit from the legislation, which earmarks $10 million for a Direct-Care Worker’s Salary Reserve.

The wage supplement was included in the surplus reserve bills because the direct-care workers who will likely be eligible have not received a wage raise in three years, explained PHI Massachusetts Policy Director Amy Robins.

While the language in the bill does not provide much detail, Lisa Gurgone, executive director of the Massachusetts Council for Home Care Aide Services, said that the language tracked previous legislation that made clear which workers would be eligible for the salary reserve wage supplement.

The direct-care workers who were eligible in 2009 were:

• homemakers and personal care homemakers who provide long-term services and supports to clients enrolled in the Massachusetts Home Care Program administered through the state’s Executive Office of Elder Affairs and the Massachusetts Rehabilitation Commission;
• direct-care workers who are employed by social service agencies that contract with Commonwealth’s Executive Office of Health and Human Services; and
• home health aides who work as homemakers and personal care homemakers for agencies that have contracts with Aging Services Access Points, which provide case management services and long-term services and supports to elders.

Direct-care workers who are employed in settings such as nursing homes, certified home health agencies, and assisted living facilities that are paid “class-rates” (set by the state’s Health and Human Services Division of Health Care Finance and Policy) would most likely not be eligible for the bonus.

In fiscal year 2009, direct-care workers received a one-time salary reserve bonus, but the subsequent state budgets lacked adequate funding for a salary reserve.

According to the Associated Press, 30,000 direct-care workers would be eligible for the salary reserve bonus should the bill be signed into law.

It is anticipated that Massachusetts Governor Deval Patrick will sign the supplemental budget proposal, but he could still veto the Direct-Care Worker’s Salary Reserve provision.

– by Deane Beebe

Massachusetts State House in Boston

PHI Massachusetts lent its support to two bills at a July 19 hearing on home and community health care provider policies, held by the Joint Committee on Public Health.

“An Act Relating to Training for Certified Nurses’ Aides and Direct-Care Workers,” Senate Bill 1121, calls for a review of current training standards for home health aides and certified nurse aides (CNAs) in the state.

“An Act Relative to Home Health Aides,” Senate Bill 1138, would expand the current role of home health aides (HHAs) in the state and, with appropriate training and oversight, allow them to administer some medications.

Facilitating a Career Lattice

Passage of the training standards bill would be well-timed: Massachusetts is one of six states to receive a Personal and Home Care Aide State Training (PHCAST) demonstration grant from the Department of Health and Human Services.

“The PHCAST demonstration grant will position Massachusetts as a leader on training standards for personal care attendants and personal care aides nationally — and also lay the foundation for a portable credential in the state,” said PHI Massachusetts State Director Amy Robins in her hearing testimony.

“A close examination of training standards for CNAs and HHAs could help facilitate the creation of a clearly articulated and intentional career lattice among direct-care occupations. This would allow workers to advance to new positions and move across settings — keys to cultivating, recruiting, and retaining the direct-care workforce Massachusetts will need in the coming years,” Robins’ testimony (pdf) concluded.

Medication Administration

Senate Bill 1138 provides a very attainable advancement opportunity for HHAs who are interested in medication administration.

“The experience of others demonstrates that this can be done safely and effectively — and that this strategy also helps ensure the best value for our health care spending, with all working to the top of their training and licensing,” Robins’ testimony (pdf) said.

The bill “would send a clear signal that the state recognizes the importance of this vital workforce and the need to do more to improve these jobs and create meaningful advancement opportunities,” her testimony continued.

There are nearly 100,000 direct-care workers in Massachusetts. Direct-care jobs are the second largest occupational grouping in the state and are expected to grow by 22 percent by 2016, dramatically outpacing the growth of other jobs.

Home and community-based direct-care jobs are among the state’s lowest-paying jobs, paying wages that fall below the state’s low-wage threshold.

“Quite simply, the state must do more to cultivate a high-quality, well-trained and stable workforce,” Robins says. “These two bills are important steps in the right direction.”

For more information on the direct-care workforce in Massachusetts, see State Facts: Massachusetts’ Direct-Care Workforce (pdf).

– by the PHI Policy team

The Family Caregiver Alliance (FCA) and National Center on Caregiving honored PHI Massachusetts with its “2010 Best Advocacy Award” for sponsoring Come Care with Me Days.

PHI’s Come Care with Me Days give elected officials the opportunity to learn firsthand about direct-care workers’ jobs by shadowing an aide at work. In addition, the participants gain a better understanding of the critical need to build an adequate, stable, and skilled direct-care workforce.

“Thank you for your excellent example of working with elected officials to understand the important work undertaken by the nation’s home care workers,” wrote Kathleen Kelly, the executive director of the FCA. “We hope this experience will remain with them as they make budget and programmatic decisions affecting home care workers, patients, and family caregivers.”

Bill Filed to Assess if Massachusetts Is Prepared to Care

Throughout an afternoon in September 2010, Massachusetts State Representative Kate Hogan, co-chair of the Elder Caucus, worked alongside a home health aide who provides critical supports three times a week to her homebound client.

One week later, Massachusetts State Senator Pat Jehlen, Senate Chair of the Committee on Elder Affairs, joined a homemaker/personal care attendant on her weekly visit to the home of her 102-year-old client.

Just months after participating in a Come Care with Me Day, Jehlen filed a bill to establish a task force to determine Massachusetts’ preparedness for the CLASS Plan. The task force would be charged with collecting and examining the state’s direct-care workforce data, and assessing the Commonwealth’s infrastructure for supporting efficient long-term services and supports and mechanisms to ensure quality care.

A hearing on the bill (SB45) will be held in the fall.

“The Come Care with Me Days gave Senator Jehlen and Representative Hogan the opportunity to participate in direct-care work firsthand,” said PHI Massachusetts Director Amy Robins, who organized the events. “These legislators deserve a lot of credit for their interest in this workforce and their willingness to roll up their sleeves and actually do this work, which is physically and emotionally demanding.”

PHI has also sponsored Come Care with Me Days in Pennsylvania and Iowa since the advocacy campaign kicked off in 2009.

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

For more information on the campaign, contact PHI Director of Government Affairs Carol Regan.

An announcement [scroll down] about the eight other “2010 Best Of” award categories and recipients is available on the Alliance’s website.

– by Deane Beebe

(L-R) Massachusetts State Sen. Pat Jehlen, Personal Care Attendant Philomena Ahern

Massachusetts State Senator Pat Jehlen, chair of the Committee on Elder Affairs, introduced a bill on January 20 to establish a task force to determine the state’s preparedness for the CLASS Act by examining its direct-care workforce.

The CLASS Act, established under the health reform law, is the voluntary federal insurance plan that will help consumers purchase long-term services and supports.

“There is an enormous, predictable increase in demand for a well-trained and readily available direct-care workforce in Massachusetts, and we must be ready with the supply,” said Jehlen, who participated in a PHI-sponsored Come Care with Me Day.

The task force would be convened by the state’s Executive Office of Health and Human Services and include staff from that office, the Executive Office of Labor and Workforce Development, and government departments that provide management, delivery, or funding of direct-care services and employment.

Assessing the Data and Infrastructure

The task force would assess current direct-care workforce data and make recommendations to improve it, including:

• collecting available data sources on the number of workers, turnover and vacancies, and average wages and benefits;
• identifying gaps in data;
• planning for collecting and analyzing the workforce data on an annual basis; and
• providing recommendations on how to develop a sustainable, regular data reporting system.

The task force would also examine the infrastructure for supporting efficient long-term services and supports and mechanisms to ensure quality, and make recommendations for improvement, including an:

• analysis of current and projected workforce capacity;
• assessment of the current training and credentialing infrastructure;
• assessment of the quality of support for consumers as employers, supervisors and trainers; and
• assessment of the adequacy of the existing infrastructure for connecting consumers and workers.

In addition, the bill calls for an analysis of the impact of the state’s Community First program on workforce issues to ensure that the state’s response to CLASS also addresses the needs of this initiative.

The bill states that the task force would be required to present a report to the Massachusetts governor and legislature by June 30, 2012.

Jehlen Shadowed Direct-Care Worker

Jehlen filed the legislation just months after participating in a Come Care with Me Day, a project in which legislators shadow direct-care workers to better understand direct-care worker jobs and the critical role they play in meeting the needs of the growing number of elders and people with disabilities.

Jehlen worked beside Philomena Ahern, a homemaker and personal care attendant with Homemaker Services, at the home of Stella Murphy, a 102-year-old woman, whom Ahern helps weekly.

In an interview filmed during the Come Care with Me Day, Jehlen says, “If we want to keep people doing this work, we need to pay them enough to live on.”

More information on the Massachusetts direct-care workforce (pdf) is available on PHI’s website.

– by Deane Beebe