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Workers gather in Mass. State House in Boston

Approximately 1,000 direct-care workers employed by state and private human services agencies throughout Massachusetts rallied for better wages at the State House on April 2.

The direct-care workers earn an average of $12 per hour and have not had a wage increase since 2008, according to the Associated Press. As many as 185,000 direct-care workers are employed by human services agencies in Massachusetts.

“I really love getting up in the morning and going to work and trying to make a difference, but it’s getting harder,” Claras Nowden, a residential director at the Center for Human Development, told WWLP, a local television station. “With the cost of living, you know, you’re taking on second jobs and it’s really getting harder to stay in human services.”

Workers Deserve Dignity and Acknowledgement

Human services workers “care for people’s extremely personal needs,” said State Senate President Therese Murray, who spoke at the rally. “They keep people alive, they keep people going to work, and the [caregivers] actually pay taxes so you know they really deserve some dignity and some acknowledgement of the work they do.”

Murray said that she is committed to improving wages for direct-care workers but only if the state has enough revenue in the budget to do so.

“If there’s more, I will promise you more,” she said.

The Massachusetts human services budget has been slashed by 25 percent over the past four years.

“The situation in Massachusetts is emblematic of the difficulty we face in many states in trying to improve the quality of direct-care jobs,” said Steve Edelstein, PHI national policy director. “Everyone agrees that these jobs are essential, but efforts to improve wages are stymied by budget choices.”

The direct-care workers provide care to people with developmental disabilities, people with physical disabilities, people with mental illness, children, elders, and other vulnerable populations.

The rally was organized by The Caring Force, an advocacy group affiliated with the Massachusetts Council of Human Service Providers, Inc.

– by Deane Beebe

Legislation proposed in Massachusetts would require that direct-care workers employed by nursing homes and their supervisors, as well as activity directors, be trained in dementia care.

Should the bill pass, the law would apply to all licensed nursing homes in the state regardless of whether the facility markets itself as having specialized dementia-care units.

Facilities that have special dementia care units would — for the first time — be required to adhere to minimum standards to “ensure safety and quality of services,” which would be set by the Massachusetts Department of Public Health in consultation with the Massachusetts Alzheimer’s Association and representatives from the nursing home provider community.

Activity programs geared specifically to people with dementia would also be mandated by the law for facilities that have dementia care units, as well as guidelines for the physical design of the unit.

Under the proposed law, such facilities would be responsible for disclosing to consumers and the state public health department exactly what services their specialized dementia care units provided.

According to a Boston Globe article, a 2005 federal report indicated that 44 states had requirements for “training, staffing, security, and other areas” for facilities that provide dementia care services.

While similar legislation has been proposed for the past seven years, it never passed. These bills were opposed by the industry because they “stipulated specific staffing levels for dementia care units,” according to the article. It notes that the Massachusetts Senior Care Association, an industry group, supports the current legislation since it does not have minimum staffing level provisions.

A provision in the bill, titled An Act Relative to Dementia Patients in Long-Term Care Facilities, states that any regulations promulgated to implement it “may not be used as a basis for higher reimbursement rates” for the licensed homes.

– by Deane Beebe

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