PHInational.org

A new PHI report examines how three home care companies have successfully managed to control their overtime costs while maintaining their reputation for high-quality care.

The report, Can Home Care Companies Manage Overtime Hours? Three Successful Models (pdf), discredits home care industry claims that the Obama Administration’s proposal to revise the companionship exemption to extend minimum wage and overtime protections to home care workers would dramatically increase agencies’ overtime costs, since any overtime worked by aides would have to be compensated at time and half.

“These real examples tell us that, once there is a financial incentive for home care companies to manage overtime hours, they won’t just stand still and let their businesses suffer but instead will adopt modern staffing and scheduling practices, just like the companies profiled in the report,” said PHI Director of Policy Research Dorie Seavey, co-author of the report.

Staffing and Scheduling Practices to Manage Overtime

The report reveals how three home care agencies with differing case loads, service areas, and business models — Community Care Systems in Illinois; Addus HealthCare, a nationwide company; and Cooperative Health Care Associates in New York City — have independently implemented similar staffing and scheduling practices to manage overtime.

The most notable practices for managing overtime by these companies are:

• Electronic timekeeping and scheduling that enable “real-time” monitoring of aide availability, workloads, and overtime.
• Designation of new aide positions specifically designed to pick up incidental hours due to call-outs, worker absences, or emergencies.
• Proactive scheduling to spread work hours more evenly across the agency’s available aides.
• Splitting high-hours cases into multiple shifts shared by two or three aides.

“Once one company figures out how to minimize its overtime costs by more efficient scheduling, the rest will either follow or go out of business. That’s how competitive markets work,” Seavey said.

Strong Evidence for Successful, Quality Home Care Businesses Despite Overtime Pay

The authors conclude that the experiences of these three home care companies offer strong evidence that it is possible to grow and run successful home care agencies that have reputations for high-quality care and pay overtime at time and a half. The three companies are operating in 20 states and pay overtime even when not required to do so.

By spreading hours more evenly across their workers, carefully monitoring their workforce data, and designating aide positions designed to pick up incidental hours, these companies manage their overtime so that it does not become a costly business expense that undermines business profitability.

The directors of two of the companies that had “high-hour” cases reported that they “believe that provider continuity that results in overtime work has drawbacks that can affect the quality of care received by the client, including aide fatigue and burn out.” These companies use scheduling guidelines to split high-hour cases between two consistent aides so that continuity of care for the client is maintained.

Nationally representative surveys show that less than 10 percent of aides report working more than 40 hours a week (pdf).

“The real problem for this workforce is not overtime but ‘involuntary’ part-time work, which means aides who are assigned part-time hours by their employers but would like to work more hours,” Seavey said.

Can Home Care Companies Manage Overtime Hours? Three Successful Models (pdf) was made possible with support from the Ford Foundation.

– by Deane Beebe

In an article published in the January-February 2012 issue of AgingToday, a publication of the American Society on Aging, PHI proposes developing an “advanced aide” position that could play a critical role on care teams to improve outcomes and cost efficiencies.

“Making the Most of Direct-Care Workers with a New Role on the Care Team” (pdf) explains that with delivery system reforms moving toward managed care and the Affordable Care Act‘s emphasis on testing new coordinated care models, this is an ideal moment to “engage in a thoughtful redesign of the role of the direct-care worker.”

One of the specific opportunities the authors mention is the recent request for proposals for the Center for Medicaid and Medicare Innovation “Health Care Innovation Challenge” grant.

Well Worth the Investment

The creation of an advanced aide position “would be well worth a substantial investment in training, support and compensation,” write the authors, PHI Policy Analysts Gail MacInnes and Meghan Shineman.

“Advanced aides could support health promotion, improved chronic care management and better care transitions — resulting in less institutionalization, fewer re-hospitalizations, and decreased emergency room visits.”

Employers could determine how advanced aides “could play a stronger role in a more integrated care team,” suggest the authors, who add that it is “too early to articulate a precise portable definition” of the Advanced Aide position but the time is ripe for experimentation.

Enhancing the role of direct-care workers is the intent of a bill recently introduced by Senator Robert Casey (D-PA) to establish demonstration projects that focus on care coordination and service delivery redesign for older adults with chronic illnesses, or those at risk of institutional placement.

– by Deane Beebe

Before we turn the calendar and get started on the work that lies ahead in the New Year, PHI is taking a moment to reflect on some of the resources it has developed in 2011 to provide timely and accurate policy, practice, and research information on the direct-care workforce.

Below is a list of PHI website portals and publications created by our PolicyWorks staff and Training & Organizational Development Services team.

We trust you will find these resources — as well as the frequently updated PHI National Clearinghouse on the Direct Care Workforce and Chart Gallery, PHI newsletters, and the entire PHI website — helpful to your ongoing efforts to improve the quality of long-term services and supports for elders and people living with disabilities.

Instrumental to this goal is improving the quality of jobs for direct-care workers, who provide 70-80 percent of the paid hands-on long-term care.

Wishing you a happy, healthy, and peaceful New Year!

– The PHI Staff

_________

Grant Opportunities

• PHI Guide to CMS Health Care Innovation Grants, November

State-Specific Resources

• PHI State Data Center: Comprehensive State-by-State Data on the Direct-Care Workforce, September
• Wisconsin’s Direct-Care Workforce, December (pdf)
• Michigan’s Direct-Care Workforce, September (pdf)
• State-by-State Projected Demand for New Direct-Care Workers, 2008-18, August (pdf)

Companionship Exemption

• Fair Pay for Home Care Workers Campaign to Revise the Companionship Exemption
• Value the Care, No.1 Why Home Care Workers Should Not be Exempted From the Fair Labor Standards Act, November (pdf)
• Value the Care, No.2 Fixing the “Companionship Exemption” Will Improve Jobs, December (pdf)

Wages and Benefits

• State Chart Book on Wages for Personal Care Aides, 2000-2010, August (pdf)
• PHI Earn, Keep, Save MORE tax resource center, January

Health Reform

• Medicaid Matters…in Super Committee Deficit Reduction Deliberations, September (pdf)
• Medicaid Matters…to the American People, May (pdf)
• Medicaid Matters…for Long-Term Services and Supports, April (pdf)
• PHI Facts 4, Health Care Coverage for Direct Care Workers: 2009 Data, March (pdf)

Workforce

• Caring in America: A Guide to America’s Home Care Workforce, December
• Improving Jobs and Care: A National Sector Strategy, May (pdf)
• Building Infrastructure to Support CLASS: The Potential of Matching Service Registries, April (pdf)
• The Direct-Care Worker at a Glance, March (pdf)
• Facts 3: Who Are Direct-Care Workers?, February (pdf)

Training

• Home Health Aide Training Requirements by State, December
• Nurse Aide Training Requirements by State, December

Case Studies/Best Practices

• Best Practices in Long-Term Care: Organizations that Illustrate a “Quality Care through Quality Jobs” Approach to Sustaining and Growing a Long-Term Care Business
• The Business of Caregiving: A Series of Case Studies Showcasing Exemplary Employers in the Eldercare/ Disability Services Industry

The estimated 2.5 million people employed as home health and personal care aides provide crucial long-term care to elders and people with disabilities, yet their jobs are inadequately supported and compensated, according to a comprehensive new PHI analysis of the workforce.

The just-published 120-page report — entitled Caring in America — A Comprehensive Analysis of the Nation’s Fastest-Growing Jobs: Home Health and Personal Care Aides — is the most in-depth analysis of America’s home care jobs available.

The report concludes that despite being the nation’s most high-demand occupation, the home care and personal assistance workforce is characterized by:

• Poor wages
• Inconsistent training requirements
• Inadequate health care coverage
• High injury rates
• Unpredictable hours
• Heavy reliance on public benefits

As a result, the report warns, our nation is unprepared to meet the needs of its rapidly aging population.

“At a Crossroads”

“Carework in America is at a crossroads,” said PHI Director of Policy Research Dorie Seavey, Ph.D., a labor economist and the nation’s leading expert on the home care workforce. Seavey authored the report with PHI Policy Associate Abby Marquand, M.P.H.

Seavey continued:

“We can continue the status quo of poorly supported and poorly compensated jobs, consigning home care workers to near-poverty earnings and home care to a revolving door of caregivers. Or, we can leverage this workforce’s enormous potential as both an underutilized asset in our health care system and as one of the strongest job growth engines that our economy has to offer.”

Between 2008 and 2018, the home care workforce is expected to grow at rates four to five times faster than jobs in the overall economy.

Hopes for Report

“Our hope is that this resource will promote a better and broader understanding of the workforce, as well as the large and growing eldercare/disability services industry it supports,” wrote PHI National Policy Director Steve Edelstein in the report’s foreword.

“We also hope that it will facilitate a more informed public discussion of key issues shaping the future of in-home services, aiding the development of both effective policy solutions and a targeted industry response,” Edelstein continued.

For more information on the direct-care workforce, including the PHI State Data Center, Chart Gallery with downloadable graphs and charts, and Fact Sheets, visit PHI PolicyWorks.

– by Deane Beebe and Matthew Ozga

A new PHI PolicyWorks analysis of wage trends for personal care aides (PCAs) finds disturbing evidence that the already low wages earned by these aides are eroding in the midst of these difficult economic times.

For the first time since these wages have been reported (1998), the national median wage for PCAs reversed direction and crept downward slightly, due to a decline in PCA wages in one-third of states (17). In contrast, the average wage for all jobs in the economy increased from $15.95 in 2009 to $16.27 in 2010.

In 2010, 34 states reported average hourly wages that fell below 200 percent of the Federal Poverty Level, according to the analysis reported in PHI’s updated State Chart Book on Wages for Personal Care Aides.

Wages below 200 percent of the federal poverty level ($10.42) are low enough to qualify workers for many state and federal public assistance programs.

“Fully two-thirds of states continue to show very low wage levels for personal care workers,” said Dorie Seavey, PHI director of policy research. “And we know from other federally sponsored surveys that, in 2010, fewer PCAs worked full-time throughout the year than in previous years. These two things together — fewer work hours and stagnant or declining wages — translate into lower earnings and family income for these workers.

“These very low wages are a significant obstacle to meeting the country’s rapidly growing demand for personal assistance services,” Seavey continued. “They also jeopardize the economic security of hundreds of thousands of caregivers who make it possible for others to live independently.”

Data Spans 10 Years

The updated chart book tracks PCA wages in all 50 states and the District of Columbia, and presents data from 2000 to 2010.

Other highlights include:

• In 2010, within the continental U.S., state nominal median wages ranged from $8.14 in West Virginia to $12.53 in the District of Columbia; real median wages (in 2000 dollars) ranged from $6.41 to $10.14.
• Over the 10-year period, 26 states showed a decline in real median wages for these workers. Fourteen states saw real wages fall by 5 percent or more.

State of the Nation’s PCA Workforce

The forthcoming PCA Workforce Advisory Panel, established by the Affordable Care Act, is charged with examining the condition of the nation’s PCA workforce. Specifically, the panel is to advise Congress on its assessment of PCA workforce issues, including wages and benefits, and the adequacy of the workforce relative to expected future demand for in-home services and supports.

Additionally, the U.S. Department of Labor is considering whether the current regulatory scope of the “companionship exemption” under the Fair Labor Standards Act continues to be appropriate in light of substantial changes in the home care industry over the last 35 years. That exemption currently precludes a broad swath of the PCA workforce from wage and hour protection.

“Narrowing the exemption won’t result in an instantaneous improvement in PCA wages,” Seavey said, “but it will end the second-class status of these jobs, and help put them on a stronger footing.”

– by the PHI Policy team

PHI President Steven Dawson

PHI President Steven Dawson argues that both a flagging economy and efforts to move toward new models of care provide the opportunity for the health care industry to redefine the role of the home health aide.

In a guest blog post for the Collaboration for Homecare Advances in Management and Practice (CHAMP), Dawson writes that “greater person-centered, cost-effective care is standing before us.”

He recommends that home health aides be given the tools they need to practice at the top of their license.

The CHAMP Program, based at the Center for Home Care Policy & Research of the Visiting Nurse Service of New York, is a national initiative to advance home care excellence for older people. The online site provides home care clinicians with evidence-based tools, e-learning opportunities, and expert advice.

– by Deane Beebe