PHInational.org

Nearly 22,000 Pennsylvanians who participate in the state’s consumer-directed care program — and the workers who care for them — face an uncertain future if a plan promoted by state government officials comes to fruition.

Currently, Pennsylvanians who are elderly and/or have a disability can choose to hire home care aides. The workers’ wages are paid for by Medicaid waivers, and the clients who hire them are considered their employers.

Intermediary entities known as financial management services (FMS) providers, meanwhile, issue the aides’ paychecks, purchase workers compensation insurance, and handle other accounting tasks.

In January, however, state Department of Public Welfare (DPW) secretary Gary Alexander announced a plan to drastically consolidate these providers, reducing their total from 37 to no more than three, and perhaps just one.

Last year, the passage of the controversial Act 22 gave DPW the authority to make sweeping changes to the FMS system without the usual regulatory oversight by the state legislature.

Alexander’s move is part of a broader campaign by the administration of Governor Tom Corbett (R) to curtail state spending by cutting funding for many programs that benefit low-income Pennsylvanians. More than 80,000 children have been cut from Medicaid rolls since last August, and a Corbett-endorsed plan to subject food stamp recipients to an asset test was scaled back only after widespread public outcry.

“Centralizing the FMS system is counterproductive to the ideal of consumer-directed care,” said Joe Angelelli, director of the Health Services Administration program at Robert Morris University and a former PHI Pennsylvania Policy Director. “A more networked and localized approach is more person-centered and effective.”

– by Matthew Ozga

The Pennsylvania Senior Support Coalition, which includes organizations such as AARP Pennsylvania, Pennsylvania Homecare Association, and Pennsylvania Association of Area Agencies, called on lawmakers to amend the two-decade-old state law known as the Family Caregiver Support Act (pdf) at a press conference on September 26.

The coalition is urging state legislators to pass companion state House and Senate bills (HB 210/SB 639) to make it possible for non–family members to be reimbursed for providing home care services and supports to low-income elders and people of any age who are “functionally dependent,” have chronic dementia, or suffer from Alzheimer’s disease, even when they do not reside in the same home.

The organizations are seeking to update the restrictive state law so that it is in sync with the federal program of the same name. The national program permits reimbursement to primary caregivers who are not family members, or do not reside with the individual in need of care.

The advocates are also seeking other changes in the law that would increase reimbursement for the purchase of medical supplies, respite care services, and home modifications.

On October 4, however, that portion of the state House bill was amended to scale back the proposed reimbursement rates. For example, the home modification limit is now $2,000 instead of $6,000.

In an article in the Pittsburgh Post-Gazette, AARP Advocacy Manager Ray Landis said that in recent years, AARP Pennsylvania has been unable to spend all of the state funding slated for the family caregiving program “because of the restrictions on who qualifies for help.”

A spokeswoman for the Pennsylvania Department of the Aging is reported as saying that Governor Tom Corbett (R) has “not yet taken a position on the proposed changes.”

– by Deane Beebe

The Pennsylvania Supreme Court ruled on November 17 that Bayada Nurses Inc., a New Jersey-based home care company that provides services in Pennsylvania, is required to pay overtime to its home care aides.

Bayada Nurses argued that it did not have to pay its aides overtime based on a provision in the Pennsylvania Minimum Wage Act of 1968 that exempts aides from receiving overtime pay when they provide domestic services in their employers’ private homes.

The company claimed that since the aides are “under the total discretion and control of the client while performing services in the client’s home,” Bayada was a “joint employer” with its clients and should benefit from the exception provision in the 1968 Act.

Justice Debra McCloskey Todd, upholding Pennsylvania Department of Labor and Industry (L & I) regulations, ruled in the appeal that an employer that is a third-party agency does not qualify for the domestic services exemption, and, therefore, must pay its employees overtime.

Pennsylvania Offers Better Labor Protections Than Feds

While the Federal Labor Standards Act (FLSA) excludes home care aides — including those who work for agencies — from the federal minimum wage and overtime protections enjoyed by other employees, the Pennsylvania Minimum Wage Act offers greater protections to aides who work for home care agencies that provide services in the state.

Justice Todd opined (pdf) in the Bayada case that “it is permissible for a state to enact more beneficial wage and hour laws. Indeed, the federal statute establishes only a national floor under which wage protections cannot drop, but more generous protections provided by a state are not precluded.”

Poor Compensation, Greater Worker Shortage

The AARP, Pennsylvania AFL-CIO, and Service Employees International Union weighed in on the case in support of L & I, adding that “the failure to adequately compensate home health care workers, who provide services to older persons and persons with disabilities, will lead to an even greater shortage of these critical workers,” which is “exacerbated by the lack of competitive wages and the demanding nature of the work.”

“AARP is pleased by the decision of the Pennsylvania Supreme Court,” said AARP Pennsylvania Advocacy Manager Ray Landis. “High turnover rates already plague this type of work, and if workers would not be eligible for overtime pay, our fear is that the quality and consistency of the care received could be diminished.”

End the Companionship Exemption

PHI has called on U.S. Department of Labor (DOL) Secretary Hilda Solis to end the exclusion of home care workers from federal minimum wage and overtime protection, and has been conducting a campaign to end the “companionship exemption” under the FLSA.

“Pennsylvania is one of 21 states that has recognized the tremendous changes in the eldercare/disability services industry and the role of direct-care workers since the exemption was created over 70 years ago,” said PHI National Policy Director Steven Edelstein. “It is now time for the federal government to act to ensure this critical workforce enjoys the same basic labor protections other workers enjoy.”

More information on direct-care workers in Pennsylvania is available in PHI State Facts: Pennsylvania’s Direct-Care Workforce (pdf).

– by Deane Beebe

Pennsylvania Governor Edward Rendell issued an executive order on September 16 that gives consumer-employed home care aides the ability to form a union.

About two weeks later, on September 29, the Pennsylvania Home Care Association (PHA) and the Coalition for R.E.A.L. (Respected, Empowered, Accessible, Loyal) Home and Community-Based Services petitioned the court for an injunction (pdf, 1.8 MB) to halt the Governor’s order.

According to a fact sheet released by the governor’s administration, Rendell issued the order to:

• Promote rebalancing in the state’s long-term care system
• Support the consumer-employer model of home care
• Build a stable and retainable home care workforce, which would also save taxpayers’ money

The executive order would also give consumer-employed homecare workers the “ability to form a union to improve wages, gain access to health benefits, and make other improvements to reduce turnover and stabilize the workforce,” the fact sheet explains.

The governor’s order would also establish a consumer board of older adults and people with disabilities who employ their own attendants and facilitate the establishment of a registry to help consumers find aides.

Lacks Authority and Violates Privacy

The Coalition for R.E.A.L. Home and Community Based Services — a group of home care providers whose members include the Pennsylvania Association of Area Agencies on Aging, United Cerebral Palsy of Pennsylvania, and PHA — states in a press release (Word doc) that the governor “lacks authority to issue the executive order because it seeks to create organizational rights for home care attendants, which are presently not recognized under state labor law.”

The coalition is also challenging the executive order because it “violates the privacy of homecare attendants and consumers who utilize the consumer-employer homecare model” by “requiring that their names and addresses be shared with a union.”

Modeled After Other States

Home care aides “have the right to decide whether they want to form or join their union,” states the administration’s fact sheet, which references nine other states that have implemented “similar initiatives that have been proven successful,” including Oregon, Michigan, Massachusetts, and California.

The request for an injunction was filed in the Pennsylvania Commonwealth Court.

Home and community-based direct-care jobs are among the top ten fastest-growing occupations in Pennsylvania, according to PHI’s State Facts on the Pennsylvania Direct Care Workforce (pdf).

Between 2006 and 2016, job openings for personal and home care aides are expected to expand by 53 percent; those for home health aides are expected to expand by 48 percent.

– by Deane Beebe

– by Joe Angelelli, Ph.D., PHI Pennsylvania State Director

On World Alzheimer’s Day, September 21, I was in Washington with 40 other advocates representing the 28 national organizations of the Eldercare Workforce Alliance (EWA).

It was the EWA’s second annual education day on Capitol Hill, as state delegations of family caregivers, geriatricians, educators, nurses, psychologists, pharmacists, social workers, direct-care workers, gerontologists, physical therapists, and other long-term services and supports professionals visited the offices of our representatives in the House and Senate. We met with congressional staffers and shared our caregiving stories, and listened to some of their own.

Individuals and organizations from a broad spectrum are working together in an unprecedented way to engage older adults, their families, and other unpaid caregivers about the critical need to address our nation’s worsening eldercare crisis. Our purpose that day was to request full funding of geriatric education programs under Title VII and Title VIII of the Public Health Service Act, and to provide information about the EWA’s endorsement of the Direct Care Workforce Empowerment Act and the Positive Aging Act (pdf).

A Unifying Experience

It was an honor to participate with my fellow Pennsylvanians. We made for a spirited team that included two veteran direct-care workers, a physical therapy professor, a medical social worker, a geriatrician, and me, a gerontologist. Early on we learned that all of us were at some point recently direct caregivers to family members and friends. That unifying experience permitted us to speak from the heart with the hard-working staff of our representatives, to point out that we’re all in this together, and to urge action with the first baby boomers turning 65 in just a few months.

Well into the afternoon we were just six people with tired feet walking the hushed halls and sunlit sidewalks of Congress, but together — as part of the EWA — we did our part to advocate for a caring and competent eldercare workforce, one that provides high-quality, culturally sensitive, person-directed and family-focused care.

Workforce Priorities Outlined

The geriatrics workforce priorities of Title VII authorized by the Affordable Care Act, and for which the EWA was seeking appropriations to be implemented, include:

• An expansion of the number of disciplines eligible to apply for a Geriatric Academic Career Award
• A supplemental grant award program to Geriatric Education Centers to train additional faculty through a mini-fellowship program
• A requirement that Geriatric Education Centers provide training to caregivers and/or direct-care workers
• A geriatric training program for physicians, dentists, and behavioral and mental health professions
• A geriatric career incentive program to provide grants to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and chronic care management
• A program administered by the Department of Health and Human Services to offer advanced training opportunities for direct-care workers.

Title VIII includes the Nursing Workforce Development programs, supporting:

• Additional training for nurses who care for older adults
• Development and dissemination of curricula relating to geriatric care and training of faculty in geriatrics
• Continuing education opportunities for nurses practicing in geriatrics.

The Affordable Care Act also creates traineeships for advanced practice nurses pursuing long-term care, geropsychiatric nursing or other areas that specialize in care of older adults.

The Pennsylvania Direct Care Workers Association is holding its sixth annual conference on September 16 in Phoenixville, PA.

The all-day conference, entitled the “The Sky’s the Limit: Communication = Teamwork,” features Keynote Speaker David Moreau, a poet and direct-care worker for 30 years.

Concurrent workshops will be held throughout the day, including the PHI Coaching Approach^SM to Communication, which will be led by PHI Training and Organizational Development Specialist Pat Hillebrand. The workshop has been approved for 3.45 contact hours from the American Nurses Credentialing Center (ANCC).

The four-hour, PHI Coaching Approach^SM to Communication workshop will be divided between the morning and afternoon breakout sessions. To receive the ANCC credits, participants are required to attend both two-hour sessions.

The PHI Coaching Approach^SM is a unique approach to improving communication and fostering respectful relationships throughout an organization.

“I am very excited to be able to offer the PA Direct Care Workers Association a workshop in which the participants will have an opportunity to learn and practice effective communication skills as well as receive ANCC contact hours,” Hillebrand said. “I look forward to seeing everyone at the conference.”

To register for the conference, the registration form (pdf) must be completed and mailed to the PA Direct Care Workers Association, with the required conference fee, by September 2.

– by Deane Beebe