Many direct-care workers may qualify for the earned income tax credit (EITC), a refundable tax credit designed for low- and moderate-income working individuals and families. The maximum 2009 EITC is $5,657, depending on family size and income. As many as 24 states have a state EITC that provides an additional credit on state taxes.

People who are eligible for the EITC can save even more money by avoiding paying commercial tax preparers. Instead, workers can have their taxes done for free at a volunteer income tax assistance (VITA) site. These sites are available in most communities across the country starting in mid to late January and are staffed by IRS trained and certified volunteers.

“When it comes to taxes, every dollar that someone does not spend on preparation fees is a dollar that can be put towards improving their future,” says Ross Yednock, director of the Asset Building Policy Project of the Community Economic Development Association of Michigan.

Another option is I-CAN! E-File, a free alternative to other on-line tax programs which is available to anyone, regardless of income. I-CAN! is easy to use, provides on-line support, and can help people become more comfortable with doing their own taxes — and taking charge of their finances.

Both VITA and I-CAN! are also an alternative to expensive “rapid refund” loans, getting people their refunds within 10 days at no cost.

“We want to increase the number of EITC-eligible filers who use free VITA tax sites or I-CAN, because too often they go to commercial tax preparers and pay as much as 30 percent of their EITC for a ‘rapid refund’ loan,” says Peter Ruark of the Michigan Statewide EITC Coalition and the Michigan League for Human Services.

As tempting as a “rapid refund” may be, they come at a cost. In addition to the fee that commercial providers charge to process “rapid refunds” the loans can come with interest rates as high as 200 percent.

PHI is helping to get the word out about EITC, VITA, and I-CAN! E-File through the Earn, Keep, Save MORE campaign. The Michigan campaign provides employers with information and tools to share with their staff and can answer workers’ questions about these services and programs. To find VITA sites in other states, contact the local United Way, or visit the IRS or State Treasury Department websites.

Tameshia Bridges

By Tameshia Bridges, Michigan Senior Workforce Advocate

This tax year, PHI’s Michigan office launched the Earn, Keep, Save MORE outreach campaign, an effort to increase income for direct-care workers. The campaign equipped employers with information and resources they could use to educate their staff about federal and state earned income tax credits (EITC) and free tax preparation services available in the community.

The EITC provides an important opportunity for low-wage workers to build economic assets. Through the EITC, direct-care workers in Michigan can receive tax credits ranging from a few hundred dollars — to over $5000. Yet many workers don’t apply because they are unaware that they are eligible for these state and federal benefits.

Working with 14 employers in 7 counties across Michigan, PHI’s Michigan office provided information to more than 2,200 workers about the EITC and volunteer income tax assistance (VITA) services through paycheck stuffers, brochures, and posters in their workplaces.

In addition, these resources were made available through the  Earn, Keep, Save, MORE website to eldercare and disability services employers that did not work with PHI directly.

Earn, Keep, Save MORE provides an example of how employers can help link their staff to available community resources — a service that is one of the elements of a quality job.

New Passages, a provider of community-based behavioral health services, including adult foster care homes, partnered with PHI on this project.  Jamie Bragg-Lovejoy, vice president of quality, compliance, and risk management, felt Earn, Keep, Save MORE was timely for her organization. “Our chance to collaborate with PHI regarding free employee income tax preparation provided a wonderful opportunity for our organization to demonstrate our on-going efforts to enhance the employee benefit program for our direct-care workforce,” she said. “This was especially important given the economic conditions we have faced over the past year.”

In addition to educating the eldercare and disability services community about the availability of important asset-building resources, this effort also helped raise awareness within the asset-building and EITC community that the direct-care workforce, which is one of the fastest-growing employment sectors in Michigan, should be a target for education and outreach regarding the services they offer.

We look forward to continuing this work next tax season, while recognizing that getting people to use free tax services as opposed to employing a commercial preparer takes time and continued education on the benefits of these services.

PHI has released a fact sheet on Michigan’s direct-care workforce (pdf). The eight-page document reveals that while demand for workers  is at a historic high and growing, the labor pool is shrinking and poor job quality is adding to the difficulty of attracting and keeping new workers.

These factors, warns the fact sheet, are leading to a potential workforce crisis for the long-term care industry and the families who rely on long-term care services and supports.

Some key facts from the report:

• Roughly a quarter of the state‘s direct-care workers do not have any health insurance.
• A third of Michigan’s direct-care workers live in households that rely on some kind of public benefits, such as Medicaid or food stamps.
• In 2007, the average Michigan direct-care worker received an annual income of $16,446.

“The problem for Michigan,” says PHI Midwest Director Hollis Turnham,
“is that the low wages earned by most  direct-care workers put these jobs at income levels that do not support a family.

“Greater investment in direct-care jobs would make them more attractive to workers from shrinking industries like manufacturing, helping to keep Michigan residents employed here — rather than moving out of state.”

The document concludes with five policy recommendations for improving Michigan’s direct-care jobs including increasing wages, improving training, and improving access to health benefits.

To encourage workers to take advantage of the credits, PHI Michigan has launched a campaign called “Earn, Keep, Save  MORE.”

“Paycheck stuffers, posters, and brochures have gone out to 14 homecare, nursing home, and assisted living employers in seven counties across the state,” says PHI Michigan Senior Workforce Advocate Tameshia Bridges. “The materials will reach just over 2,200 workers.”

In addition to the print materials, an Earn, Keep, Save  MORE website is available where users can download the materials mentioned above and access direct links to related resources.

The campaign also alerts direct-care workers to free tax filing and preparation services which can help them realize additional savings.

“Employers who are participating in this campaign see it as good way to help strengthen their relationship with staff,” says Bridges. “And in this economy, the extra savings at tax time could certainly help a lot of people.”

Bridges has already begun to hear from workers seeking more information. If you have questions? Contact her at tbridges@phinational.org or 517.372.8310.

NOTE: Although this campaign focuses on Michigan, the federal EITC is applicable to workers from any state.

Her address, titled “The Workforce Crisis in Long Term Care: Proven Tools to Help Meet the Challenge,” laid out the demographic imperative for improving the quality of direct-care jobs through evidence-based practices that improve retention.

Rodat focused on collaborative efforts underway in New York State to improve training, provide greater supports to direct-care workers, and develop opportunities for advancement.

Rodat also held a workshop on “The 12 Steps for Creating a Culture of Retention,” using PHI’s work developed for the Commonwealth of Pennsylvania to assist organizations aiming to bolster retention practices. Workshop participants used the workbook and checklists (pdf) developed by PHI to identify and solve challenges in their own organizations.

Joining Rodat on the program was Carol Helsel, Vice-President of Human Resources for Porter Hills Retirement Communities & Services in Michigan, who presented the workforce initiative OPEN – Opportunity Partnership & Empowerment Network Health Field Collaborative.

Aaron Toleos, Online Communications Director
atoleos@phinational.org

Are rising gas prices making it harder for you to deliver or receive care? Add your comments at the end of this post. 

We all feel the pinch from high gas prices, but for home care workers it’s more of a punch. As PHI President Steven Dawson puts it: “The doubling of gas prices over the past few years has been like a pay cut for many home care workers — particularly those serving clients in rural areas.

“Policy makers like to believe that home care is cheaper than nursing homes, but that’s only true because home care workers are paid less than nursing home workers, often without health benefits,” adds Dawson. “There’s not much good to say about higher gas prices, except perhaps that they will now force policy makers to look more closely at the real costs of shifting toward home-based care, and in response create realistic reimbursement policies that will offer home care workers a true livable wage and benefits.”

When PHI’s Michigan State Director Hollis Turnham wrote about the home care gas crisis in our blog in June, talking about the problems she was already hearing about, anticipating others, and asking what other people were experiencing, the response was swift and impassioned. An employer called rising gas prices “the 500 lb gorilla in the room for home care agencies.” A home care worker talked about seeing turnover increase and “looking for something closer to home myself.” The head of a home care and hospice aide recruitment agency said he planned to do “something very tangible to address this issue,” though he wasn’t ready yet to say just what. 

People need a place to share information and ideas, learn how others are coping with the crisis, and vent a little. We hope this section of our blog will be that place for you.

If you have experiences, ideas, or information to share, please leave a comment. And if you want to learn more about how rising gas prices are exposing the fault line underlying our home care delivery system, read on. 

Wages Fall as Gas Prices Rise

Wages that average less than $10 an hour, combined with the difficulty of piecing together full-time work from a patchwork of cases, have always added up to low annual earnings for personal and home care aides. In 2006, their median annual earnings totaled just $13,000, and about half lived in a household that relied on Medicaid, food stamps, or other public assistance.

What’s worse, raises have been failing to keep up with inflation in many states. Nationwide, real earnings for personal and home care aides fell by 4 percent between 1999 and 2006, according to PHI’s State Chart Book on Wages for Personal and Home Care Aides, 1999-2006. (pdf)

Now wages that were stretched paper thin are being strained to the breaking point by the price of gas, and home care workers, employers, and clients are paying the price.

Some home care workers can reach their clients by bus or subway, but most need a car. Keeping up with car payments, upkeep, and insurance while keeping the gas tank filled has never been easy, but it’s becoming much harder since gas prices have topped $4 a gallon. Take Fahntah Staples, a personal care assistant in Philadelphia. Fahntah earns about $400 a week before taxes, and lately she’s been paying $160 a week for gas. Her job reimburses her just $20 to $25 for mileage. “It would be a lot cheaper to catch the bus, but the schedules don’t work,” she says. “I need to get from one part of the city to another in about half an hour between clients, and sometimes I’d need to take three different buses.”

Stephanie Butler, a home health aide with Keystone Home Health Services in Philadelphia, is caught in the same trap. “I love my job—I love to take care of people,” she says. “It’s always been what I love to do, all my life. But this puts a strain on it. I’m seriously considering getting a job where I can just go one place and stay all day, because the gas is killing me.” A single mother of three, Butler can’t afford to take her girls anywhere after work. “The kids say, ‘Mom, where are we going?’ and I say, ‘Well, we’re not going much of anywhere, because I got to make this gas last.’”

Mileage Reimbursement Can’t Keep Up

Aides who work for an agency are almost always reimbursed for the miles they drive between clients – usually between about 30 cents/mile and the IRS’s current rate of 58.5 cents/mile – but workers who are hired directly by the people they assist get no mileage reimbursement at all. Even agency employees are not reimbursed for driving to and from home at the beginning and end of their shifts, and those miles can add up fast – particularly if they have only one client or live far from the people they assist. Helen Hanson (pictured at left), a home care worker in Maine, drives more than 120 miles a week to earn just over $200 before taxes. “I love my job,” she says, but the high cost of gas is making her wonder if she can afford to keep it – especially since recent state budget cuts reducing the amount of time she can spend with a client are causing her to earn less for the same amount of travel.

The monthly mileage checks that used to cover gas and at least part of the car payment for workers like Brenda Nachtway (pictured below) no longer cover even the cost of gas. “I‘ve only been about to budget $100 a month for gas, and it’s now costing me $230 a month,” says Nachtway, a hospice aide in Lewisburg, Pennsylvania. I’m finding it difficult to make up that difference. This is one of the reasons I work three jobs.”

Mileage rates may be too low for workers, but they’re too high for the agencies that employ them. Churchill Hindes, president and CEO of a Visiting Nurse Association that serves two rural counties in northwestern Vermont, says his agency pays roughly $2,000 a day in employee mileage reimbursement.

“Each year, we reimburse 1.5 million miles of travel. That’s the equivalent of three round trips to the moon. No insurance company in the world, including Medicare and Medicaid, will pay us for that, so we’re absorbing those costs. We’ll probably spend three-quarters of a million dollars on mileage reimbursement this year – 120 to 150 thousand dollars more than last year.”

In addition, “once or twice a year,” Hindes’ agency gives a $25 gas card to everyone on the staff who drives to see clients. “It’s a sign of solidarity with our staff, because it’s an important issue,” he says. But the money didn’t go far this year. “It used to be a fill-up and now it’s half a tank.”

Employers Struggle to Keep Workers, Serve Far-Flung Clients

A survey by the National Association of Area Agencies on Aging found that more than half of the agencies had already cut back on delivery of home care and other services because of fuel costs, and 90 percent expected to make cuts next year.

Sherry Gast (pictured), the office manager for WellsBrooke Premium Home Health Care in East Lansing, Michigan, says she feels for the workers who “have to decide between spending money on gas and other basic needs.” She also worries about her clients, who need to be able to rely on quality care. “When you bring somebody into your home, it’s very scary,” she says. “That person has to be a quality person, who is competent and well trained and ready to do whatever they need to do – yet still compassionate and sensitive to the fact that this is somebody’s home, sensitive to the emotional needs of the client. It’s difficult to ask competent, professional, compassionate staff to work part-time for about $9 an hour and then to travel 20-40 miles per case, when gas is at $4.25 per gallon.”

Gast says she’s been able to find good staff to serve all her clients so far, although it’s gotten a lot harder to find people to help those who live far away. But not all employers can say the same.

“We’ve had some people who have been long-term supporters of this agency that we’ve had to end relationships with because we couldn’t provide any staffing,” said Bridgette Menger-Anderson, manager of a Minneapolis home health service, in a June 5 Minnesota Public Radio report. And a July 22 Associated Press article cites a not-for-profit home care and hospice company in Montana that is “looking at discontinuing service in the state’s back country.” The company serves two sparsely populated Montana counties covering 7,136 square miles.

Other employers are finding it hard to recruit the caregivers they need. Suzanne Russell, executive director of Home Caring Services in southeastern Iowa, says her nonprofit agency is losing good candidates because it can reimburse only 40 cents a mile. “Some of the for-profit agencies are giving employees more, and we have lost some good applicants because we could not match their mileage.”

Employer Solutions

Agencies are trying various ways of coping with the gas crisis. Among them:

• Paying a one-time stipend for each trip taken by staff to see clients. Some pass on the extra cost (often between $5 and $15) to the client.
• Providing cars and gas for employees.
• Pushing for the use of tele-health care systems that monitor vital signs electronically, to cut back on the number of visits needed by home care professionals.

Policy Solutions

“The gas price crisis demonstrates how precarious our home and community-based service system really is,” says PHI National Policy Director Steve Edelstein. “Our failure to adequately compensate home care workers and assist with transportation costs puts them and the people they care for at risk. States need to revamp their reimbursement systems to ensure that these workers earn a living wage, with regular updates to keep up with inflation.”

No reforms to Medicaid’s home care payment rates have been proposed yet, but South Dakota Senator Tim Johnson plans to introduce a bill to reform Medicare’s payment rates in order to “close the gap between the current Medicare reimbursement and rising gas prices.”

For publicly financed programs, one possible approach is mandating emergency pass-throughs of additional funds to home care and personal assistance providers to cover higher transportation costs — but significant monitoring would be required to make sure that the additional funds reached workers’ pockets in a timely fashion.

Ultimately, according to Dorie Seavey, PHI’s Director of Policy Research, the solution lies in improving Medicaid reimbursement policies so they do two key things:

1. Establish systematic, on-going methods for setting payment rates based on providers’ actual costs and competitive market rates, and
2. Build in regular evaluation of the adequacy of rates over time, including emergency reviews based on sudden increases in key costs, such as transportation.

“Right now,” says Seavey, “most states set their payment rates for home- and community based home care services in an ad hoc fashion — without reference to any market analyses or minimum competitive standards for wages and benefits, without reviewing actual provider costs, and without a commitment to review and update these rates in a systematic and ongoing way.”

Read more about PHI’s state and federal policy recommendations for improving direct-care worker wages and benefits, and the government payment policies that play such a key role in determining this compensation.

Read more about gas prices on PHI’s blog or make it an RSS feed

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

The Progressive Leadership and Advocacy Network (PLAN) is for “emerging advocacy leaders working to effect positive change for low-income women and their families.” It helps participants become more effective advocates by strengthening their leadership and advocacy skills, in-depth policy knowledge, and networks of connection in the field. It is run by the National Women’s Law Center.

As a participant in the 2008 PLAN, Bridges will attend conferences this fall and next spring. She’ll also have many other opportunities for discussion and learning – and to connect with a growing network of PLAN members.

More than 200 people applied for just 20 positions this year, but Bridges is “a great candidate for this experience,” says PHI Michigan State Director Hollis Turnham.

“Her most striking talent and gift is to connect with all kinds of people in doing her advocacy,” Turnham says.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

As Gas Prices Soar, Elderly Face Cuts in Aid is brimming with sobering facts, figures, and quotes – like one from home Katie Clark in Union, Michigan. A single mother of two, Clark says an elderly couple she assists are “just like family to me,” but she sometimes has to borrow money so she can get to their house. Clark earns about $250 a week and spends $100 of it on gas.

Leave a comment below, or read more about this problem and what people are doing to address it.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

Four-dollar-a-gallon gasoline exacerbates all recruitment and retention problems, and I fear that it forces workers to make some very difficult choices. Employers are calling workers to offer them cases and having the workers do the gas calculations and say “I can’t afford to take this one.” Home care aides are seeing their co-workers go to other jobs where they don’t have such stressful transportation issues.

Here in Michigan, in the waiver program that funds home care for people who are eligible for nursing home services, I’m hearing that the only time a worker must be paid for transportation is when they’re driving the client, taking them shopping or the doctor or the pharmacy or something like that. People aren’t getting paid for all the driving they have to do just to get to their clients.

I’m also beginning to hear about agencies that are looking at per-trip payments. I was told about one that was giving $2, and I just read about another that’s paying $5.

Gas is already a lot higher than $4 a gallon some places. Agencies in the Upper Peninsula are having a hard time finding people to take cases. People just can’t afford travel costs in rural areas. My concern is that, at some point, many more home care aides are going to say: “It’s more expensive for me to take this case than to turn it down.”

I’m also worried about home health aides who have worked with the same clients for a long time and developed personal commitments to them – the pressures on them to choose between paying their electric bill or filling up their gas tank so they can get to those clients. I don’t know how they’re handing it. What sorts of sacrifices are they making? What does it feels like to tell a client: “I can’t afford to serve you any more”?

I don’t know self-directed consumers and their attendants are dealing with the high price of gasoline. In Michigan, the consumer-directed Home Help program does not pay for any transportation costs for these providers of services and supports.

I wonder if clients or agencies are getting calls from aides to report “I ran out of gas,” or “I’m on empty and I don’t have money to put gas in the car.” Are gas prices causing more no-shows? Are more workers leaving home care to work in facility-based services?

A friend of mine asked, are agencies figuring out a way to schedule more efficiently, so there’s not as much driving? But she’s a consumer advocate, so she also said that suggestion would take us right back to the problem of scheduling services at the convenience of the agency or worker rather than the consumer.

But what’s the alternative? To go without services altogether because there’s not enough money in the system to send out a worker? We now have to schedule in a way that saves gas – or that matches the bus schedule.

I wonder: What did people in home care do in ‘78, when there was a national gasoline shortage?

I’d really like to hear how aides, agencies, and consumers are handling the $4+ a gallon gasoline. Has any state or other body stepped forward to address the issue?

Hollis Turnham, Michigan State Director, PHI
hturnham@phinational.org

Knowledge and Skills Needed for Dementia Care: A Guide for Direct Care Workers in Everyday Language helps direct-care workers determine whether they have the skills they need to deliver person-centered dementia care — and where to go for assistance if they need training. It also helps supervisors, policymakers, and others evaluate dementia care training programs. It was developed by a team of experts and reviewed by many more, including more than 60 home health aides and CNAs.

“Most people who provide hands-on care for individuals with dementia have big, warm, caring hearts,” says Dementia Project Coordinator Micki Horst. ”They want to learn all they can about how best to care for and interact with someone with dementia. We developed this guide to give them a tool for assessing their own competencies.”

The updated version includes useful additions: an overview of the primary diseases that may cause dementia symptoms, top ten warning signs of Alzheimer’s disease and other dementia-related diseases, a description of structures of the brain, and a glossary of words used in the text.

Copies (pdf) of the new version may be downloaded free from the Michigan Dementia Coalition website. For hard copies, contact Lorie Massuch at lmassuch@mphi.org or (517) 324-7320.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org