Jack Mills

A guest column by Jack Mills, Executive Director of the National Network of Sector Partners (NNSP), an initiative of the Insight Center for Community Economic Development.

NNSP released a brief last week that provides important lessons for health care providers and direct-care workers. From Hidden Costs to High Returns: Unlocking the Potential of the Lower-Wage Workforce (pdf) reports on the experience of dozens of health care organizations and manufacturing companies.

These employers have found that investments in lower-wage workers directly benefit their bottom lines while their workers move up to better jobs. The brief documents the benefits for employers and provides lessons to help other employers follow suit.

Companies highlighted in the brief include the Visiting Nurse Association of Eastern Massachusetts (VNAEM), which employs 160 people at its home care agency and two assisted living facilities for low- and moderate-income seniors and individuals with disabilities.

Aides Should Get the Pay and Respect They Deserve

As VNAEM CEO Linda Cornell points out, aides are low on the organization’s wage ladder, but they are “the people who have the most responsibility in our organization for the direct hands-on care that our patients and residents receive.” Their performance on the job consequently has a huge effect on service quality and customer satisfaction.

VNAEM’s goal is for every patient and resident to be treated as you would want your loved ones treated, and its ultimate goal is to have everyone in the association recognize and embrace direct-care workers as equal members of the care team. Their approach was that certified aides and nurses’ aides should receive high-quality training, and the pay and respect that they deserve.

Funding from the Commonwealth Corporation’s Extended Care Career Ladder Initiative (ECCLI) supported VNAEM’s early work toward its goals with B&F Consulting in 2004-2005. Over the next two years, VNAEM teamed up with other health care employers and a nonprofit workforce organization, called Employment Resources, Inc. (ERI), to form a collective recruitment and training program for entry-level aides.

Ms. Cornell and her staff had long felt that the standard training required for certified aides and nurses’ aides was too rudimentary to ensure the quality of care that the association wanted to be known for. “In the industry,” she says, “the training did not match what we need…. It was just a bare minimum, no real hands-on training.”

Industry-Focused Workforce Development

Fortunately, ERI was working on an approach to the broader, industry-wide change that Ms. Cornell had in mind. With an ECCLI grant, ERI designed a program specifically tailored for employers who — collectively — hired lots of aides every year. Since so many participated, the program could recruit widely, train large numbers of people, greatly improve the kind of training each candidate received, and yet keep the cost per worker low for each employer.

How the Program Worked

• The program took place at the participating companies’ facilities, so trainees received an immediate, firsthand experience of the working environment.
• A one-on-one assessment of each worker and assessments of supervisors’ and managers’ needs were performed at the outset.
• The employers paid 100 percent of their employees’ salaries while they were being trained.
• The training included various kinds of adult basic education and English as a Second Language, depending on the needs.
• The program paid for transportation and child care when needed.
• Employees who completed each stage of the curriculum got an immediate boost in wages.
• Wages rose from $10 to as much as $16 per hour for completing the full regimen.
• Graduates have become equal members of care teams.
• Several graduates have become Team Leaders and several others have become nurses.

The program also involved and trained supervisors and managers at every level to:

• ensure that the companies know how to get the best results from the newly trained workers;
• get every level to buy into culture change regarding how important all of the workers are at every level; and
• understand how they can better lead.

Given that the need for well-trained employees is common across the health sector, it was logical for ERI to reach out to a number of health care organizations in the region to form a program together. All of the employers worked together to design the training. ERI was at the “center of the wheel” in implementing the design. It brought together other organizations to deliver the services that employers and workers needed.

So-called “sector initiatives” like this one have been shown, in rigorous independent evaluations (pdf), to yield higher earnings and steadier work for participants with low incomes who also face multiple barriers. VNAEM and other employers that participate in sector initiatives receive major benefits too, as documented in other studies and as the brief describes in detail.

Funding for From Hidden Costs to High Returns: Unlocking the Potential of the Lower-Wage Workforce (pdf) was generously provided by the Hitachi Foundation.

A home health aide in training

A new study by Pennsylvania State University researchers found that home health aides who had training are less likely to be injured on the job, and aides who felt they did not have good support from their supervisors were also more likely to suffer injuries.

The researchers also concluded that home health aides who had not experienced on-the-job injuries had a higher rate of job satisfaction and lower turnover “intentions.”

Benefits of Training

The study found that how employees felt about their workplace and training affected the probability of injuries. Employees who felt that their training had not prepared them well enough for the job were three times more likely to be injured than employees who thought that their training prepared them well.

The aides who felt their training prepared them well, not only had lower workplace injury rates, but they were also more likely to rate their organization highly as a place to work and seek services from.

“What this suggests is that investing finances into soft resources can have tangible benefits to organizations,” Deirdre McCaughey, assistant professor of health policy and administration at Penn State and lead author on the study, said in a press release about the study.

“Organizations tend to cut back on spending on soft resources, especially during hard economic times, because there is usually no tangible benefit,” she continued.

Good Supervisor Support

How home health aides perceived the support they got from their supervisors also affected on-the-job injuries, reported the study’s authors. The aides who felt they had poor supervisor support were one-and-a-half times more likely to have one injury, and three times as more likely to have three injuries, than the aides who considered their supervisors to be supportive.

“The study confirms what PHI has found it its own work over 20 years — that well designed adult-learner centered training and good supervisory supports improve retention and job satisfaction,” said PHI National Director of Curriculum and Workforce Development Peggy Powell.

The Penn State researchers analyzed data from the nationally representative 2007 National Home Health Aide Survey, which was funded by the U.S. Department of Health and Human Services and conducted by the Centers for Disease Control and Prevention.

The research findings were reported at the 2010 Academy of Management (AOM) Annual Meeting on August 9.

“Who Needs Caring? We Do! Workplace Injury and Its Effect on Home Health Aides,” was selected as a “Best Paper” for the AOM’s Annual Meeting Proceedings. The conference proceeding article can be purchased for $20 by contacting the AOM Communications and Publishing Coordinator at mdavis@pace.edu.

Visit PHI’s Training and Organizational Development Services website for more information, including PHI Coaching Supervision^SM (pdf).

– by Deane Beebe

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

Local sector employment programs are effective in helping economically disadvantaged Americans find quality jobs, according to a new study.

The study was published in August by Public/Private Ventures (PPV), a nonprofit organization that supports low-income communities, and was funded by the Charles Stewart Mott Foundation.

It found that low-income, low-skilled people who used the programs generally fared better at finding and keeping good jobs, compared with those who did not participate in the programs.

Sector employment programs go beyond mere job-training programs, in that they concentrate their skills training within specific occupational sectors, such as construction, computer repair, or health care.

Findings of Study

The PPV study, entitled Tuning into Local Labor Markets, evaluated three sector employment programs — one each in Milwaukee, Boston, and New York City.

PPV charted the progress of nearly 1,300 study participants for two years. Half of them used one of the three sector employment programs, while the other half — the control group — did not.

Compared with the control group, participants in the sector employment programs:

• earned significantly more money;
• worked significantly more hours;
• found work more consistently; and
• were more likely to work at a job that included benefits, such as health insurance and paid time off.

Implications for Direct-Care Workforce

Sector employment programs that include health care components can be a boon to aspiring direct-care workers, the study shows.

For example, one of the three sector employment programs included in PPV’s study — the Milwaukee-based Wisconsin Regional Training Partnership — includes a health care track. Program participants trained within this track were “significantly more likely” to earn their certified nursing assistant (CNA) certification than members of the control group, the PPV study found.

PHI has long been considered a national example of sectoral employment strategies targeted to the direct-care workforce. PHI’s affiliates, Cooperative Home Care Associates of the South Bronx and Home Care Associates of Philadelphia, have modeled this type of sectoral training for more than 20 years, and together annually enroll more than 500 training participants.

“This PPV study used the ‘gold standard’ of social research — randomized control — to prove that sectoral employment strategies create measurable financial benefits for low-wage workers,” noted Steven Dawson, president of PHI.

“The timing of its release is exceptionally important, given the country’s desperate need to help low-income workers find solid employment. It is a strong rebuttal to those in Washington, D.C. policy circles who have long claimed that ‘training doesn’t work.’

“Yet, training focused on a particular occupation is only one half of an effective sectoral strategy,” added Dawson. “The other half is strengthening the employment practices of that sector’s employers — from improved supervision and peer mentoring, to better compensation and career ladder development.”

– by Matthew Ozga

Direct-care workers in training

The House Committee on Financial Services passed the Public Housing Reinvestment and Tenant Protection Act of 2010 (H.R. 5814) on July 27, which includes provisions to fund training for public housing residents to become home health and personal care aides.

If enacted, a three-year, federal pilot grant program would be established to train public housing residents to provide home health and personal care services and supports to public housing and federally assisted rental housing residents who are elderly or living with a disability, including veterans.

Home care providers, community health centers, faith-based organizations, labor organizations, public housing agencies, and state and local government agencies that have established — or provide assurances that they will establish — an employment training program would be eligible to apply for a grant.

The funding is targeted to programs that primarily serve urban, rural, or Indian populations, as well as people in Puerto Rico or the U.S. Islands.

Under the act, the U.S. Department of Housing and Urban Development (HUD) would receive $2.5 million for distribution in each fiscal year: 2011, 2012, and 2013.

Recognizing Workers’ Needs

In addition to supporting home health and personal care aide training, the grant money could also be used to cover transportation and child care expenses for the public housing residents in the training programs.

“This model recognizes the needs that many home care aides have as they transition to work, particularly child care and transportation,” said PHI New York State Policy Director Carol Rodat. “Funding for these critical supports is seldom available, which is why the grants envisioned in this legislation are so important.”

Income earned from providing home care services will apply toward the public housing residents’ eligibility for federal housing on a graduated basis for the first three years, with no income applying in the first year.

These provisions of the Public Housing Reinvestment and Tenant Protection Act of 2010, sponsored by Rep. Maxine Waters (D-CA), were taken from the Together We Care Act of 2009, introduced by Rep. Nydia Velázquez (D-NY) in December 2009 and cosponsored by Rep. Barney Frank (D-MA), the Financial Services Committee Chair, and Waters.

“Home care is a profession that will be in high demand for years to come and this legislation will offer hard-working public housing residents the tools they need to enter this field,” said Velázquez when she introduced the Together We Care Act last December.

– by Deane Beebe

Penalties paid by nursing homes that violate Medicare regulations could be redirected to fund advanced training programs for direct-care workers, if regulations proposed by the Centers for Medicare and Medicaid Services (CMS) are implemented.

These are the first regulations to be proposed as part of the nursing home transparency provisions of the Affordable Care Act.

CMS is requesting comments by August 11 on this, and other, proposed regulations related to civil monetary penalties (CMPs). Nursing homes pay CMPs when they violate Medicare and/or Medicaid quality-of-care requirements.

Instructions for filing comments can be found in the July 12 edition of the Federal Register (pdf).

Distributing CMP Funds

Monetary penalties collected from facilities that violate Medicaid regulations go into government coffers to be spent on programs that “directly benefit facility residents.” Since 2002, direct-care worker training programs have been included within that category.

CMP funds derived from Medicare violations, meanwhile, are redirected to the U.S. Treasury, and are added to general revenues.

CMS is now proposing to use half of the CMP money garnered from Medicare penalties to support activities that benefit facility residents.

“The Affordable Care Act’s provisions are a welcome recognition that all CMPs ought to be put back into programs to benefit the residents,” said Hollis Turnham, PHI Midwest director. “I’m hopeful that once the regulations are finalized, CMS will have new resources to serve residents, including enhancing the skills of frontline staff.”

Past Uses of CMP Funds

In the past, funds from nursing home Medicaid violations have been used to fund many different kinds of programs pertaining to direct-care workers.

For example, Indiana has used CMP funds to pay for advanced dementia training. Meanwhile, North Carolina funded instruction for PHI Coaching Supervision^SM training with CMP money. And, a program in Kansas helped subsidize a skill-improvement training for direct-care workers there.

Other Proposals

CMS has issued several other proposals on how to modify the CMP collection system:

• CMP funds will be placed in an escrow account if the facility decides to formally appeal the penalty.
• An independent informal dispute resolution process will be created to foster greater transparency in the appeal process.
• Facilities that self-report violations and quickly work to correct them can see a reduction in their CMP of up to 50 percent.

– by Matthew Ozga