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A survey of directors of Money Follows the Person (MFP) Demonstration Programs conducted by the Kaiser Commission on Medicaid and the Uninsured found that the lack of available direct-care workers is an ongoing impediment to meeting program goals.

The MFP program, originally established in 2006 and extended until 2016 by the Affordable Care Act, provides increased federal Medicaid matching funds to states to help them transition beneficiaries from institutional settings to community-based settings. Forty-three states and the District of Columbia participate in the program.

In Money Follows the Person: A 2011 Survey of Transitions, Services and Costs (pdf), published in December 2011, Kaiser reports that since the MFP program began, the number of people transitioned to community-based settings increased dramatically — up to nearly 17,000 in 2011, from 8,902 in 2010. However, the number of people transitioned still falls well below the original program goals.

The survey, conducted in August 2011, identified two major challenges that MFP demonstrations face: housing and workforce capacity.

Bolstering the Direct-Care Workforce

About half of the MFP states reported an inadequate supply of direct-care workers, especially in rural areas. Two previous MFP surveys, conducted in 2008 and 2010, also identified inadequate workforce capacity as a leading problem.

MFP states are working to bolster the direct-care workforce by:

• establishing a direct-care service registry website;
• encouraging some beneficiaries to hire family caregivers through the consumer-directed option; and
• offering online training programs for direct-care workers that provide education and competency-based training curricula.

The Kaiser issue paper notes that “as more Medicaid beneficiaries are identified to transition to the community, and as the population continues to age, more attention to workforce and housing options will be important to help facilitate successful community placements.”

– by Gail MacInnes, PHI National Policy Analyst

Three brief stories on direct care:

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PHI Labor Day Editorial on FLSA Published in Numerous Outlets

PHI National Policy Director Steve Edelstein wrote about why the Fair Labor Standards Act (FLSA) should apply equally to all workers — including home care workers — in an editorial published over the Labor Day weekend.

Under current federal law, personal care and home care aides are explicitly excluded from the FLSA’s minimum-wage and overtime protections.

“As a result,” Edelstein writes, “the 1.7 million workers who provide loving care and assistance to our frail and disabled family members are among the most poorly paid workers in our nation.”

Edelstein’s editorial appeared in numerous media outlets, including the Black Voice News, the Union Daily Times (South Carolina), and the McDonough County Voice (Illinois).

The PHI Campaign for Fair Pay calls on Department of Labor Secretary Hilda Solis to amend the FLSA to include home care workers.

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National Falls Prevention Day Coming Soon

On Sept. 23 — the first day of fall — 41 states will join 70 national organizations and federal agencies in recognizing the fourth annual National Falls Prevention Day.

That day, the Falls Free Initiative, a coalition lead by the National Council on Aging (NCOA), will work to teach elders and their caregivers proven methods for preventing falls, including regular physical activity, annual eye checkups, and periodic medication reviews.

Falls are the leading cause of death by injury among elders.

Last year, PHI and NCOA collaborated on a free Fall Prevention Awareness curriculum, designed to help home health aides reduce falls and minimize injury to their clients.

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Texas Station Broadcasts Report on Direct-Care Staffing

KHOU, the CBS affiliate in Houston, criticized the lax staffing standards for nursing homes in Texas in an investigative report that aired on Aug. 25.

The story’s reporter, Jeremy Rogalski, found that a toothless Texas staffing law, combined with weak state oversight of the nursing home industry, has created a substandard care environment for elders and people with disabilities.

More than one-fourth of Texas nursing homes received one star out of five in the staffing-level category on the federal Nursing Home Compare scale. (In a companion report, Rogalski explains how to use the online Nursing Home Compare tool.)

Adequate direct-care worker staffing levels are crucial to quality of care, the report states. Rogalski identifies staffing levels as “the single biggest factor — the difference-maker between quality and shoddy” care in nursing homes.

– by Matthew Ozga

In December, Charlene Harrington, Ph.D., R.N., professor emeritus at the department of social and behavioral sciences, University of California, San Francisco, released an update of her report, Nursing Home Staffing Standards in State Statutes and Regulations.

This compilation includes citations for each state statute and regulation on nursing home staffing, as well as links to the information online, if available.

Harrington’s report tracks state progress toward minimum staffing ratios recommended by the Health Care Financing Administration (HCFA) (now the Center for Medicare and Medicaid Services) in a report to Congress issued in 2001.

The report, entitled “Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes” (pdf), found that “strong evidence supports the relationship between increases in nurse staffing ratios and avoidance of critical quality of care problems.” It urged a minimum of 4.1 hours of care for each resident each day, including a minimum of 2.4 hours of care per day from nurse aides.

“Some states have very low or no direct-care staffing standards. Advocates need to work to set higher standards,” Harrington said. “Low staffing standards, including and especially RN standards, are the root cause for the poor nursing home care in the U.S.”

States’ Direct-Care Staffing Requirements

According to Harrington’s report, 14 states meet or exceed the HCFA report’s recommended minimum of 2.4 hours of care per day from direct-care staff:

State	Minimum Required Hours of Care from Direct-Care Staff
Arkansas	2.8
California	3.2
District of Columbia	2.93
Florida	2.9
Idaho	2.4
Illinois	2.5
Massachusetts	2.6
Maine	2.93
Mississippi	2.8
New Jersey	2.5
New Mexico	2.5
Oklahoma	2.86
Pennsylvania	2.7
Wisconsin	3.5

In contrast, Harrington found that 16 states currently have no required minimum hours of care from direct-care staff:

• Alaska
• Alabama
• Hawaii
• Indiana
• Kentucky
• Missouri
• North Dakota
• Nebraska
• New Hampshire
• Nevada
• New York
• South Dakota
• Texas
• Utah
• Virginia
• Washington

– by Gail MacInnes, PHI National Policy Analyst

A new law in New York State will require nursing homes, hospitals, and diagnostic and treatment centers to publicly disclose staffing information beginning March 16, 2010.

As a result of the Nursing Care Quality Protection Act, which Gov. David Paterson (D) signed on September 16, patients and families will be able to review the staff-patient ratios on units and shifts in those health care facilities. Consumers will also be able to find out how the facilities determine direct-care staffing. Read the full story

“We need a little more money for those who have worked for so long. You get fussed at, hit at, bitten, kicked, scratched, slapped, ” said Ronnie Fisher, Sr., a CNA in Wisconsin for the last 23 years.

The Kenosha County Long Term Care Project is working to help people like Fisher, in a state where the average caregiver earns just over $9 an hour.

The organization is working alongside others to launch a state-wide public awareness campaign, said the Kenosha County LTC Project’s Barb Wisnefski.

Read the full story

“More and more LTC leaders are changing their workplace practices, de-institutionalizing their physical environments, and embracing person-directed care in order to get to the next level in terms of quality,” says the August cover story for Provider magazine. The article explores this phenomenon, looking at why there is “a general consensus that it is more than just the ‘right’ thing to do.”

For “Investing in Culture,” (pdf) the magazine interviewed 14 long-term care leaders, including Anna Ortigara, President and CEO David Horazdovsky of the Evangelical Lutheran Good Samaritan Society, and Barbara Frank, cofounder of B&F Consulting.

The experts talk about how improving direct-care jobs improves care quality in long-term care – and vice versa. Horazdovsky says his organization has experienced “decreased staff turnover, highly developed direct care staff skills, and increased staff satisfaction on surveys” as a result of its move to person-centered care.

Read the full story