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An article in the May/June issue of LeadingAge Magazine highlights the challenges and rewards involved with managing ethnic and religious diversity in long-term care organizations.

Written by Jane Sherwin, the article quotes several experts in the field, including PHI Organizational Change Consultant MariaElena Del Valle.

“Workforce diversity needs to be made a priority,” Del Valle says in the article. “We have to acknowledge that the world has changed.”

Del Valle highlights her experiences working with Independence Care System (ICS), a New York-based managed long-term care plan (and PHI affiliate).

“As ICS grows, so does the diversity of its population,” Del Valle says in the article. “There are Russians, Chinese, and Koreans, and the staff needs to be culturally competent, so the organization will seek to use existing staff personal networks to reach out to new employees that understand the language and the culture.”

To learn more about how PHI can help your organization address cultural diversity, check out the PHI Coaching & Consulting Services website.

– by Matthew Ozga

(L-R) E.J. Dionne, Marki Flannery, PHI President Steven Dawson, Laine Romero-Alston

The Aspen Institute Workforce Strategies Initiative (Aspen WSI) convened an audience of 100 long-term-care and workforce development stakeholders in Washington, D.C., on May 3, for an expert discussion on the challenges that direct-care workers face and strategies workforce development leaders can use to improve the quality of these long-term-care industry jobs.

Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers, the thoughtful and lively discussion, was moderated by E.J. Dionne, a Brookings Institution senior fellow and Washington Post columnist, and featured:

• Steven Dawson, PHI President
• Marki Flannery, Partners in Care President, and
• Laine Romero-Alston, Ford Foundation Program Officer.

Maureen Conway, executive director of the Aspen Institute Economic Opportunities Program, framed the conversation by explaining that 40 percent of the jobs created since 2010 are low-wage jobs and direct-care occupations are the “lowest-paid jobs” with “uncertain hours.” She asked whether poor quality, direct-care jobs had “to be that way?”

Low-Wage, Not Low-Skill Jobs

Dawson explained the employment and income characteristics (pdf) of the direct-care workforce and that personal care aides and home health aides were projected to be the first and second fast-growing occupation in the nation by 2020.

He highlighted the particular challenges of home care workers, such as working in isolation and the need to have “emotional intelligence” to navigate a client’s home and the relationships within it.

“These are low-wage jobs but certainly not low-skill jobs,” Dawson said.

Valued and Respected

Flannery reported that her agency employs 9,800 home health aides — the largest licensed home care agency in the country — and described the profile of people seeking jobs as home health aides since the economic downturn.

Partners in Care has a turnover rate of 23 percent — significantly lower than the 60 percent national average, Flannery said. She attributes her agency’s high retention rate to its training partnership with PHI.

Using the PHI Coaching Approach^SM, Partners in Care’s managers, supervisors, and aides were trained in communication techniques that made the aides feel “valued and respected,” she explained, adding that the training also led to improved worker satisfaction and better patient outcomes.

Flannery also discussed the challenges of being a “high road employer” that pays aides a decent wage while reimbursement rates from public funding and private insurers go down.

Multi-Prong Strategies

Romero-Alston spoke on the importance of using “multi-prong strategies” to both “raise the floor” of direct-care jobs and “create opportunities for career pathways.” She identified a specific barrier to a good job that needed to be overcome: the exclusion of home care workers from basic labor protections such as minimum wage and overtime pay.

Romero-Alston added that the Obama Administration has “taken great strides” over the last few months to revise the so-called “companionship exemption” through a rule change proposed by the U.S. Department of Labor.

Video and Handout Available

To watch the discussion, including audience questions, an 80-minute video is available on the Aspen Institute website along with its overview (pdf) of the direct-care workforce.

“Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers” was the Aspen WSI’s second discussion this year in a series entitled, “Reinventing Low-Wage Work: Ideas That Can Work for Employees, Employers and the Economy.”

– by Deane Beebe

Iowa state capitol building

A budget bill passed by the Iowa Senate last week would support training standards and career paths for the state’s direct-care workforce.

The bill (SF 2336) sets the FY 2013 budget for the Iowa Health & Human Services Department (HHS). It would establish and fund:

• core training standards for direct-care workers,
• specialized training opportunities, and
• career advancement opportunities.

SF 2336 would also create a Board of Direct Care Professionals to oversee the implementation of these new training standards and career pathways.

The board will help “provide direct-care workers with the professional status they deserve,” said Di Findley, the executive director of the Iowa CareGivers Association.

The state House version of the HHS budget bill, which passed April 18, does not include funding for the Board of Direct Care Professionals. This and other discrepancies between the two bills will be negotiated and resolved in a future conference committee, Findley said.

Bill Draws on Council Report

In crafting the bill, state senators drew upon recommendations made by the Iowa Direct Care Worker Advisory Council. In a report (pdf) to the governor and state legislature submitted in March, the council suggested ways for the state to build a stable and qualified direct-care workforce.

The council’s recommendations “are designed to stabilize and strengthen the direct-care workforce to reduce turnover costs, improve quality, and ensure access to services,” the report says.

Established by the state legislature in 2008, the Iowa Direct Care Worker Advisory Council comprises a broadly representative coalition of stakeholders, including direct-care workers, consumers, employers, and other health professionals. The council reports to the state Iowa Department of Public Health.

“What I am most proud of is the leadership taken by direct-care workers in moving this historical piece of legislation (SF 2336) forward,” Findley said.

– by Matthew Ozga

The Direct Service Workforce Resource Center is sponsoring a webinar entitled “Core Competencies for the Direct Service Workforce” on April 23 at 3:00 – 4:30 p.m. EST.

The webinar will feature a discussion by national experts on competency-based standards and also include presentations on local successes in Ohio and California. It will explore current work on standardized core competencies for the direct service workforce as well as potential to use and expand these efforts.

To participate, register online.

– by Deane Beebe

Iowa state capitol building

Direct-care workers in Iowa will be required to obtain a license to be a caregiver if a bill making its way through the state legislature becomes law.

The bill would affect direct-care workers in nursing homes as well as those in home care, assisted living, and community-based settings, according to McKnight’s Long-Term Care News.

The bill has already been approved by a state Senate committee, and is awaiting a vote by the full Senate. If approved, it will move to the state House.

At 70,000 strong, direct-care workers comprise Iowa’s largest workforce, with an additional 12,000 estimated to be needed to meet the rising demand for care in the next decade.

Legislation Draws Support

If passed, the legislation would establish state standards for direct-care worker training and licensing. It would also establish career pathways for specialized and advanced aide positions, reports the Cedar Rapids Gazette.

Many of those changes would be overseen by a newly created Board of Direct Care Professionals, said Di Findley of the Iowa Caregivers Association, which supports the bill.

Findley, along with Kent Sovern of AARP Iowa and Rob Denson of Des Moines Area Community College, argued that the legislation is crucial to reducing turnover and raising quality of care across the board in an editorial published in the March 1 Des Moines Register.

Major System Change

“We’re really talking about a major system change” if the bill passes, Findley told PHI. In the new system, direct-care workers of all types “would receive more consistent and standardized education that would follow them from one setting to another,” Findley added. Workers, not their employers, would own their own credentials under the terms of the bill.

The legislation would allow direct-care workers to receive their education through a variety of venues, including community colleges, universities, employers, and online training courses.

Direct-care workers will also have the option to specialize in areas of interest such as Alzheimer’s, brain injury, mental health, oral health, and end-of-life care.

All of these factors would empower direct-care workers, Findley said, allowing them to “feel better prepared to perform their responsibilities.”

If the bill passes, direct-care workers “will finally receive the professional status they have long deserved,” Findley said.

– by Matthew Ozga

On February 13, President Obama released his budget, which outlines significant new health care investments, some changes in Medicare and Medicaid, and investments in jobs programs.

The Big Picture

President Obama’s fiscal year 2013 budget plan (4.5 MB pdf) would cut taxes by $4.1 trillion over 10 years. Most of this revenue loss results from his proposal to make permanent 79 percent of the Bush tax cuts, which would reduce revenues by $3.5 trillion over a decade. Counting added interest on the national debt, the President’s proposed Bush tax cut extensions would cost $4.2 trillion over a decade.

The budget plan includes some proposals that, together, would raise $1.1 trillion over a decade. The most prominent of these include scaling back tax subsidies for the wealthy, starting to crack down on offshore tax avoidance by U.S. corporations, asking the “too-big-to-fail” banks to pay for their government guarantee, and ending tax subsidies to oil and gas companies.

Health and Human Services

Obama’s budget for 2013 calls for $76.4 billion — $300 million more than last year — for the U.S. Department of Health and Human Services (HHS). Medicare and Medicaid spending could be reduced by $364 billion over 10 years, with most of these savings achieved by weeding out wasteful spending rather than shifting costs to beneficiaries.

Highlights include:

• Medicaid would be cut by more than $50 billion — including $17 billion over 10 years by establishing a new, and already controversial, “blended rate” for Medicaid and CHIP in 2017 and $21 billion by reducing provider taxes and increasing Medicare cost-sharing requirements (which would increase state Medicaid costs since Medicaid pays the Medicare cost-sharing requirements for the “dually eligible”).
• Medicare would see $267 billion in cuts, many of which had been proposed earlier, including $35 billion from reduced provider “bad debt” payments; $9 billion from graduate medical education payment cuts; $56 billion gleaned through payment changes; and $155 billion from requiring drug manufacturers to provide Medicaid rebates for all low-income beneficiaries.
• Funding would increase for both the implementation of health care reform’s state-based insurance exchanges and an acceleration of “state innovation waivers,” which would allow states to implement alternatives to the law in 2014 rather than 2017. The Affordable Care Act‘s Prevention and Public Health Fund would be cut by $4 billion over 10 years.
• $3.1 billion would be invested to support the creation of 25 new health centers nationwide and funding for 2,800 new primary care providers.
• The Administration on Aging budget request is $7.1 million over the total amount enacted for FY12. It includes $8 million for Adult Protective Services, including $7 million for demonstration projects; $10 million in mandatory funding for Aging and Disability Resource Centers (ADRCs); and an additional $9.5 million for Alzheimer’s Disease Supportive Services.

Other Key Provisions

The Obama budget calls for $350 billion in job growth measures, spread mostly between FY 2012 and FY 2015. These include:

• $50 billion in road and transit maintenance and upgrading;
• $30 billion to modernize at least 35,000 schools;
• $30 billion to hire and retain teachers and first responders under Project Rebuild, which will hire workers in low-income communities (to “re-purpose” residential and commercial properties); and
• a new small business tax credit for companies that hire new workers.

Job training and placement funding increases for low-income youth and adults are urgently needed. Thus, the budget supplements existing Workforce Investment Act funds, with a new initiative called Pathways Back to Work. This is a $12.5 billion project that will provide subsidized jobs and training for low-income, low-skilled workers, and summer and year-round jobs and training for youth.

Information on the Medicare/Medicaid and Older Americans Act sections is on the HHS website. (See the HHS Budget in Brief for the Medicare and Medicaid section, which begins on page 48.)

An overview of the budget is available on the Office of Management and Budget website.

– by Carol Regan, PHI Government Affairs Director