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Senator Al Franken (D-MN)

With the support of three of his colleagues from the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP), Senator Al Franken (D-MN) introduced the Home Care Consumer Bill of Rights Act (S. 1750) on October 20.

Franken plans to incorporate the bill (pdf) into the upcoming reauthorization of the Older Americans Act (OAA).

The bill aims to guarantee basic rights, including protection from abuse and neglect, to older Americans who receive long-term services and supports in their homes and communities.

Specifically, the Act would:

• direct states to develop a Home Care Consumer Bill of Rights;
• establish a voluntary Home Care Ombudsman Program to support states that choose to provide ombudsman services to resolve the concerns and complaints of older adults who receive home and community-based services; and
• develop quality standards for home and community-based services so that older adults and their families can make more informed decisions about who provides their services.

Remaining at Home a Top Priority

“It became very clear to me after meeting with seniors from Moorhead to Winona that remaining independent and at home is a top priority for our seniors,” Franken said.

According to a May 2010 environmental scan (pdf) of Medicaid-funded long-term services and supports by the Center for Health Care Strategies, 41 percent of Medicaid expenditures for long-term services and supports are for home and community-based services.

The increasing number of older Americans in need of long-term services and supports who choose to receive services in their homes and communities rather than in nursing homes makes Franken’s bill particularly relevant.

These rights, protections, and standards are already available for nursing home residents.

– by Gail MacInnes, PHI National Policy Analyst

Sen. Bob Casey (D-PA)

On May 26, the U.S. Senate Special Committee on Aging, chaired by Senator Herb Kohl (D-WI), hosted a hearing on the pending reauthorization of the Older Americans Act of 1965 (OAA).

The law governs a nationwide network of agencies and programs to deliver social services to older adults to help them maintain independence in their homes and communities.

The hearing, entitled “Meals, Rides, and Caregivers: What Makes the Older Americans Act So Vital to America’s Seniors,” featured testimony by:

• Kathy Greenlee, assistant secretary, Administration on Aging (AoA); U.S. Department of Health and Human Services [testimony];
• Rosalynn Carter, former First Lady and president of the Rosalynn Carter Institute for Caregiving; and
• others, including an advocate, a service provider, a state long-term care ombudsman, and a beneficiary of OAA programs.

The witnesses addressed a wide range of topics, including:

• the needs of family caregivers;
• new programs to be administered by AoA (the CLASS program, the State Health Insurance Assistance Program, and the Senior Community Service Employment Program);
• increased responsibilities of long-term care ombudsmen; and
• options for administering OAA programs more efficiently.

Specialized Training Necessary

Senator Bob Casey (D-PA), a member of the Committee, asked Carter to comment on evidence-based programs for the specialized training necessary for caregivers –- especially direct-care workers.

Casey paid tribute to the commitment of direct-care workers, saying “I have been…overwhelmed by the kind of care that is delivered by direct-care workers — how strong they are, how dedicated they are — willing to do back-breaking and sometimes seemingly impossible work on behalf of those who need that care and on behalf of their families.”

Carter responded by sharing information about approaches the Institute is testing to provide training to family caregivers of individuals with Alzheimer’s Disease, referred to in their October 2010 report, “Averting the Caregiving Crisis: Why We Must Act Now.”

Supporting the Direct-Care Workforce

Responding to the same question from Senator Casey, Assistant Secretary Greenlee commented that it “will take many different federal organizations working together” in order to address how the U.S. will “support the public programs — the CLASS Act, Medicare and Medicaid programs, the programs we have under the OAA, disability programs — with a paid workforce and provide enough support to that workforce so that they have meaningful career ladders, but also so that they have the skill set to serve an increasingly aging population.”

The Leadership Council of Aging Organizations, of which PHI is a member, submitted recommendations (pdf) on the reauthorization of OAA, some of which will bolster the direct-care workforce.

– by Gail MacInnes, PHI National Policy Analyst

PHI joined more than 300 ombudsmen, long-term care consumers, nursing home family and resident council members, professionals, government officials, nursing home employees’ union representatives, and advocates this week at the Consumer Voice‘s 35th Annual Meeting and Conference, which kicked off in Orlando, Florida, on October 18.

PHI was one of the sponsors of this year’s conference, and helped several direct-care workers attend the event.

Person-Centered Care and Culture Change the Buzz

Many of this year’s conference sessions have focused on — or included discussion of — strategies to achieve culture change and deliver person-centered care. The role of the direct-care workforce in achieving culture change was highlighted throughout these workshops.

PHI, which is currently partnering with SAGE on the National Technical Assistance Resource Center for LGBT Elders, was pleased to see a workshop addressing the challenges of supporting LGBT elders.

At “Gay and Gray or Heading That Way,” presenter Debi Lee, lead regional ombudsman, Centralina [North Carolina] Area Agency on Aging, discussed her organization’s project on bridging the gap between direct-care workers and lesbian, gay, bisexual, and transgender (LGBT) elders through relationship building, training, mutual support, and advocacy.

Lee noted that, in order for the project’s second phase to be more successful at bridging that gap, its events will take place in nursing facilities and while direct-care workers are on the clock, rather than on their own unpaid time.

Models for Quality Improvement

At “Innovative Collaborations to Improve Nursing Home Life for Residents, Family, and Staff,” two innovative models were presented.

Direct-care workers from Virginia’s Trinity Mission Health and Rehabilitation (pictured below) discussed how their facility used Civil Monetary Penalty funding for its quality improvement project to reduce certified nursing assistant turnover by 25 percent. To achieve their goal the facility works to:

• empower CNAs
• provide CNAs with more support
• enhance CNA awards and recognition opportunities
• enhance CNA skills and training
• create a CNA mentorship program for new staff
• involve CNAs in care plan meetings

“The CNAs are key members of the team; they know and work closely with the residents,” said Claire Curry, legal director of the Virginia-based Legal Aid Justice Center, which initiated the Community Partnership for Improved Long-Term Care, Trinity Mission’s project partner.

Presenters (L-R): Sheila Faulkner, Brittany Burgess, Melva Proctor, Latisha Ayres, Phyllis Crenshaw, and Zelda McGruder

“It is preposterous when the CNAs are not a part of the care planning meetings…. [Their input] is essential to delivering person-centered care,” Curry said.

During this session, Karlin Mbah, family council coordinator and policy advocate for FRIA: The Voice and Resource for Quality Long-Term Care, discussed a project the organization is launching in 2011 with family councils and the 1199 SEIU Labor Management Project.

In this collaboration, family caregivers and direct-care workers are strengthening their relationships by looking at the meaning of the word “dignity” as it applies to workers, family members, and residents.

“Family and friend caregivers believe that working together from the bottom-up — formal and informal caregivers — can bring person-centered care to nursing homes,” Mbah said.

OAA Reauthorization Act and the Direct-Care Workforce

PHI National Policy Analyst Gail MacIness was a panelist for the plenary session entitled “Older Americans Reauthorization Act — Listening Session,” where she discussed PHI’s recommendations (pdf) on:

• improving training and empowerment for the direct-care workforce;
• building infrastructure for self-directed services; and
• incorporating workforce planning and assessment into the aging services network.

Official listeners from the U.S. Senate Special Committee on Aging and the Administration on Aging participated in the panel presentation.

Preventing Elder Abuse

A presentation on stopping elder abuse included information on how professionals can help.

During the Q and A, PHI staff had the opportunity to highlight the role of direct-care workers in preventing abuse, as well as PHI’s free curriculum, Adult Abuse & Neglect Prevention Training.

– by Deane Beebe

Kathy Greenlee, Assistant Secretary for Aging, HHS

Health and Human Services Assistant Secretary on Aging Kathy Greenlee released a statement on July 14 to commemorate the 45th anniversary of the Older Americans Act (OAA), which Congress is expected to consider for reauthorization in 2011.

Greenlee notes that the number of Americans age 60 and over have more than doubled since President Lyndon Johnson signed the OAA into law in 1965.

She forecasts that “reliance on family members, who currently provide 80 percent of the long-term care assistance for our nation’s seniors, will increase,” since people age 80 and over are the fastest-growing age group and will need long-term care.

Greenlee also calls the Affordable Care Act (ACA) an opportunity “to harness the successes and progress of the last four decades to further improve the health and lives of older Americans and support their caregivers.”

PHI OAA Recommendations

PHI has made several recommendations (pdf) to the Administration on Aging (AoA) on the 2011 reauthorization of the OAA, including:

• improving training and employment for direct-care workers;
• incorporating workforce planning and assessment in the aging services network; and
• building infrastructure for self-directed services by strengthening matching service registries.

This year, PHI has been in conversation with AoA staff and advocates on how the reauthorization of the OAA could be the opportunity to advance matching-service registries, which facilitate connections between consumers who receive self-directed care in their homes and the independent direct-care workers who provide that care.

Greenlee said the OAA, in combination with the creation of Medicare and Medicaid just about two weeks later and Social Security in 1935, “have served as the foundation for economic, health, and social support for millions of seniors, individuals with disabilities and their families.”

– by Deane Beebe

Allison Lee, PHI’s federal policy and campaign manager, testified at the February 25 listening session on the reauthorization of the Older Americans Act. Read the full story

The Administration on Aging (AoA) will convene three “listening forums” on the impending reauthorization of the Older Americans Act (OAA). Read the full story