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MPRO, Michigan’s Quality Improvement Organization, has produced a video on the benefits of the consistent assignment staffing model that more nursing homes are using to schedule their staff.

The video features interviews with staff and residents from three facilities in Michigan that are using consistent assignment, which helps to strengthen relationships between direct-care workers and consumers and leads to better care and less turnover.

“Without the opportunity to form close relationships and a system that protects the continuity of the relationships, person-centered care and sustainable culture transformation cannot occur,” said PHI Organizational Change Consultant Cean Eppelheimer.

“Being well-known within the community through the practice of consistent assignment is fundamental to quality person-centered eldercare and underlies the development of a more meaningful workplace,” Eppelheimer continued.

According to Advancing Excellence in America’s Nursing Homes, a national campaign aimed at improving the quality of nursing home care, consistent assignment (pdf) means that residents see the same caregivers (registered nurse, licensed practical nurse, or certified nursing assistant) almost every time they are on duty.

“Nursing homes that begin using consistent assignments might have to change the way they manage staffers,” said Mary Jane Koren, MD, chair of the Advancing Excellence in America’s Nursing Homes Campaign and vice president at the Commonwealth Fund.

“After the initial startup, they often find the new way is a better way: They often catch medical problems in the early, treatable stages,” Koren said. “In the end, nursing homes that adopt consistent assignment reduce staff turnover and work to improve other quality measures gain something priceless: They’ll have a facility that fosters strong relationships between caregivers and residents, and offers the highest standard of care.”

– by Deane Beebe

Michigan is a step closer to establishing a permanent statewide home care registry, and a law to create a registry in West Virginia was just passed.

Michigan Petition Approved

The Citizens for Affordable Quality Home Care, which advocates for elders and people with disabilities in Michigan, has cleared the first hurdle in its efforts to create the Michigan Quality Home Care Council, a statewide registry that would help connect home care consumers with independent home care providers — and vice versa.

On March 19, the Michigan Board of State Canvassers approved the format and language of an initiative petition to amend the state’s constitution to establish the Quality Home Care Council. The question could appear on the November 6 ballot.

The next step in order to get the initiative placed on the ballot is for supporters to gather at least 322,609 signatures and submit them to the Michigan Secretary of State by July 9, according to Ballotpedia.

“The permanent establishment of a home care council will help to assure that Michigan’s citizens who have disabilities and those who are aging can connect with and choose from providers who have been screened, are compatible, and are looking for work,” said Dohn Hoyle, executive director of The Arc Michigan and treasurer of Citizens for Affordable Quality Home Care.

“We also support the training available for providers to address their safety and acquisition of skills, as well as the training offered to those who need supports and assistance regarding the selection and direction of their workers,” Holye said.

Should the Michigan Quality Home Care Council be established through an amendment to the state constitution, home care workers who register would be required to undergo background checks and have access to training. The workers would also have limited collective bargaining rights, according to a Michigan Department of State Ballot Proposal Status document (pdf).

The new registry would permanently replace the existing Michigan Quality Community Care Council, a pilot matching services registry program designed to help people with Medicaid locate personal care home care workers.

“Our previous efforts demonstrated how well a quality registry benefits those who provide these critical services so they can find enough work to make a living and stay in this field, and allows those who need the supports in order to remain in their own homes to find the right person to support them,” Hoyle said. “And, the trainings have shown the efficacy and value for the person who needed services as well as the person who provided them.”

West Virginia to Establish Home Care Registry

In West Virginia, Governor Earl Ray Tomblin (R) signed a bill [HB4062] into law on March 22 to establish a statewide home care registry through the state’s Bureau of Senior Services.

The West Virginia home care registry would be responsible for creating and maintaining a list of certified home care workers who meet the eligibility criteria established by the Bureau and approved by the legislature. Eligibility requirements would include educational and certification requirements and the completion of a criminal background check, according to the bill.

To learn more about home care registries, visit the PHI Matching Services Project site.

– by Deane Beebe

A recent report by PHI Michigan for the Michigan Department of Community Health (DCH) provides the first demographic profile and other data on direct-care workers employed by by self-directed (SD) consumers through the Michigan (MI) Choice Medicaid Waiver Program.

The report, Self-Determination and the MI Choice Medicaid Waiver Program (pdf), is based on a survey of 624 direct-care workers in the MI Choice Program. It offers recommendations and strategies to strengthen the SD program for workers and participants.

“The survey findings should stoke what should be a growing discussion of the intersection of the paid direct-care workforce and family caregivers,” said PHI Director of Midwest Policy Hollis Turnham.

“Self-direction models across the country rely on family caregivers as well as friends and neighbors to become paid direct-care workers,” Turnham said. “As self-direction grows as a delivery option, we need to acknowledge and learn more about that intersection of individual roles and public funding — both about the challenges and the opportunities.”

The survey of workers in the SD program was designed to:

• Collect baseline demographic information;
• Understand the workers’ motivations, job satisfaction, and training needs; and
• Identify strategies to strengthen and support recruitment and retention.

The report compares the findings from three types of SD workers — family, friends, and strangers — and explains that while they are “indistinguishable” in many aspects, “there are some remarkable differences among the groups.” For example, more friends and neighbors were found to be working with an individual with a disability rather than elders.

The Findings

The survey findings are summarized as follows:

Satisfaction: While SD workers are, overall, satisfied with their jobs and find the work rewarding, they indicated low satisfaction with their wages and the number of hours they work. SD workers earn wages that are among the lowest of all direct-care workers in the state, and have higher rates of uninsurance.

The SD workers — especially the SD workers who are family and friends — reported that they provided services for which they were not paid, which is an indication that the SD model is built on the informal unpaid support that these caregivers provide.

Relationships between Workers and Participants: Common assumptions about family members and friends working in the SD MI Choice Option are not reflected in the findings. In fact:

• A significant number of paid family members do want training. Almost half of the workers expressed an interest in training in specific clinical topics and communications skills.
• A majority of the family members (57 percent) do not live with the participant they support.

Recruiting and Retaining SD Workers: The MI Choice program — like every long-term care services and supports program — is challenged to find and retain qualified, competent workers. Only half of the workers indicated they intend to continue working for the participants for whom they currently provide support, which points to a “potentially high level” of turnover among these workers.

Recommendations

Based on the findings, PHI has made the following recommendations for the MI Choice program:

• Develop mechanisms to ensure that workers have the opportunity to receive training on topics that are relevant and of interest to them.
• Provide training opportunities and resources for participants to be effective employers in the MI Choice SD Option.
• Offer more and continuing work to current workers to build and sustain a workforce willing to serve SD participants.
• Explore opportunities to maximize outreach and enrollment in Medicaid and subsidized health plans under the Affordable Care Act (ACA) to secure health care for uninsured and underinsured workers.
• Identify mechanisms and opportunities for SD workers to recognize and address workload imbalances and concerns.

The project was made possible through a technical assistance award from the National Direct Service Workforce Resource Center to the Michigan Department of Community Health and, with additional funding from the Centers for Medicare and Medicaid Services State Profile Tool Grant to the Michigan Office on Services to the Aging.

– by Deane Beebe

For the third consecutive year, PHI is hosting the Earn, Keep, Save MORE website, an online tax resource center to help direct-care workers get the tax credits that they are entitled to receive and access free tax preparation assistance services.

The Earn, Keep, Save MORE website — designed for direct-care workers and employers in Michigan and across the nation — provides information on:

• state and federal Earned Income Tax Credits (EITC);
• Volunteer Income Tax Assistance (VITA) sites; and
• The Beehive — a free online tax preparation service and financial education site.

Long-term care employers are encouraged to use the site to download materials — paycheck stuffers, fact sheets, and posters — to help their employees make this a rewarding tax season.

Tax Credits Boost Income

The EITC is a refundable tax credit for low- and moderate-income families and individuals.

A family can receive an EITC of up to $5,751, depending on income and family size. Anyone eligible for a federal EITC automatically qualifies for a state EITC if their state offers it; most states do. State tax credits range from 3 percent to 40 percent of the federal EITC.

“Many who are eligible for the EITC do not claim it — either because they don’t know about it or they don’t think they will be eligible because they do not owe any taxes,” said PHI Senior Workforce Advocate Tameshia Bridges, who has been coordinating the Earn, Keep, Save MORE efforts in Michigan since the program began.

“Getting a large tax refund with the help of EITC can mean extra money to catch up on bills, buy a computer for the family, or open up a savings account.”

Free Tax Preparation Assistance

VITA sites — sponsored by community-based organizations and staffed by IRS-trained volunteers — provide free tax preparation assistance and often offer workshops on saving and financial planning.

Families with an annual income below $50,000 are eligible for free tax preparation assistance at VITA sites through April 15.

The Beehive makes it possible for people who do their taxes themselves to file both their state and federal taxes for free online.

More information on EITC eligibility, as well as materials to help employers spread the word about EITC and VITA sites, are available on the Earn, Keep, Save MORE site.

– by the PHI Policy team

Detroit Public Television, in partnership with Michigan Consumers for Healthcare, has released a video in which panel members — including PHI Senior Workforce Advocate Tameshia Bridges — provide an overview of the Affordable Care Act and address questions and concerns that people across the state have about it.

The video highlights the impact that a health insurance exchange will have on Michigan consumers and how important it is for Michiganders to tell their elected officials that creating a consumer-friendly exchange is so important for the state.

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