A recent issue of the National Academy on an Aging Society’s Public Policy & Aging Report is devoted entirely to the evolution of long-term care and trend toward home- and community-based services.

The report, entitled “Advancing Home and Community-Based Services: Transforming Policies, Programs, and Service Delivery in Long-Term Care,” (pdf) contains articles by national long-term care experts, including articles on the history of long-term care, trends toward consumer-directed care, and the long-term care workforce.

The article “Strengthening the Direct-Care Workforce: Preliminary Recommendations from a National Panel of Experts in Long-Term Care” highlights the preliminary findings of a national panel convened by the Benjamin Rose Institute on Aging to “enhance the capacity of both the direct-care workforce and family caregivers to provide quality care.”

The national panel addressed four key issues:

• supply of direct-care workers and family caregivers;
• readiness or capacity of both direct-care workers and family caregivers to provide care;
• retention of direct-care workers and family caregivers in their roles; and
• quality or outcomes of direct-care workers’ and family caregivers’ care.

Increasing Supply

To increase the supply of direct-care workers and family caregivers, the panel highly recommends continuing the expansion of consumer-directed care programs. It also suggests drawing on these labor sources to build the direct-care workforce:

• immigrant populations;
• displaced workers over 55 years old who lost jobs in the current recession; and
• people with developmental disabilities.

Improving Worker Capacity

To better prepare direct-care workers for their jobs, the panel recommends the following:

• increase the federal and state training requirements for direct-care workers;
• expand training and education programs; improve their design, content, and delivery; and evaluate their effectiveness;
• design curricula around the core competencies needed;
• build training partnerships; and
• train family caregivers and develop and test models in which direct-care workers provide the training.

Retaining Workers

To improve the retention of direct-care workers, the panel advises improving wages and benefits as well as career advancement opportunities. Better supervision was also suggested as a proven strategy that helps keep direct-care workers on the job.

The panel addresses the relationship between staff turnover and the continuity and quality of care. It recommends tracking staff turnover and retention and disseminating and replicating best practices for retaining staff.

Best Practices

Several innovative practices that aim to improve the recruitment, training, and retention of direct-care workers across the spectrum of facility- and home- and community-based service are showcased in PHI’s Best Practice Profiles.

The Public Policy & Aging Report’s Winter/Spring 2010 issue was sponsored by the Benjamin Rose Institute on Aging.

– by Deane Beebe

The U.S. Senate has proclaimed September 12-18 to be 2010 National Direct Support Professionals Recognition Week.

This is the third consecutive year that the Senate has unanimously approved a resolution to designate a specific week to honor direct support professionals. The resolution (pdf) was sponsored by Sen. Ben Nelson (D-NE) and had multiple co-sponsors.

A dozen states are also recognizing Direct Support Professionals Recognition Week this year.

Advocacy Planned

The American Network of Community Options and Resources (ANCOR) and United Cerebral Palsy (UCP) are calling on direct support professionals, self-advocates, and family members to “Call on Congress” on September 14 to let them know about the need for better wages for community residential direct support professionals.

The groups are urging that members of Congress support the Direct Support Professional Fairness and Security Act (H.R. 868), which would amend Title XIX of the Social Security Act to provide funds to states to enable them to increase the wages paid to targeted direct support professionals in providing services to individuals with disabilities under the Medicaid program.

ANCOR is sponsoring a Governmental Activities Seminar and a “Direct Support Professionals to DC” event from September 12-14. The three-day event will culminate with visits to members of Congress on the final afternoon.

Providers are encouraged to bring their direct support professionals with them to Capitol Hill. Registration information is available online.

ANCOR has also provided 10 ideas (pdf) for events and other actions to celebrate Direct Support Professionals Recognition Week.

– by Deane Beebe

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.

Within hours of the U.S. House of Representatives passing legislation to extend the Federal Medical Assistance Percentages (FMAP) increase to states, President Obama signed the bill into law.

By extending FMAP through the end of 2011, the federal government will distribute an additional $16.1 billion in Medicaid funding to states.

House Votes Along Party Lines

The representatives voted 247 to 161 to approve the state-aid package (H.R. 1586) during a special emergency session held on August 10. Just two Republicans voted to provide relief to the cash-strapped states; only six Democrats voted against the bill.

House Speaker Nancy Pelosi (D-CA) called the representatives back to Washington, D.C., from summer recess to vote on the legislation, after the Senate unexpectedly passed it.

“We are pleased that Congress did the right thing and voted in favor of extending additional funding to states for their Medicaid programs, funds essential to preventing further erosion of coverage and services,” said PHI Government Relations Director Carol Regan.

“However, this was accomplished, in part, by rolling back a temporary increase in food stamps,” Regan added. “We will work with our allies in the Leadership Council of Aging Organizations to restore assistance to low-income families relying on this program.”

Offsetting the Cost

To offset the cost of the state-aid package, several provisions are in place, including accelerating the timetable to halt temporary increases in food assistance benefits.

The $26 billion bill has been called the Jobs Bill, because it also includes $10 billion for states to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

A chart (pdf) on how the funding will be allocated in each state is available from the Center on Budget and Policy Priorities.

– by Deane Beebe

The Patient Protection and Affordable Care Act will improve the health care of nearly 30 million women in the U.S., according to an issue brief published by The Commonwealth Fund.

By the time the law fully takes effect in 2014, up to 15 million uninsured women will be eligible for subsidized coverage, and an additional 14.5 million insured women will see improved coverage and/or reduced premiums.

Low-income women will especially benefit from the law, the issue brief states.

President Obama signed the Patient Protection and Affordable Care Act this past March as part of his administration’s effort to enact national health reform.

Implications for Direct-Care Workforce

Perhaps the most significant provision of the act will be an expansion of Medicaid eligibility to cover adults earning up to 133 percent of the federal poverty level (currently about $14,400 for a single adult).

An estimated 8.2 million uninsured women between the ages of 18 and 64 will be eligible for Medicaid when that provision takes effect in January 2014, The Commonwealth Fund report found.

A significant number of these millions of uninsured women are members of the direct-care workforce, which is 90 percent female, PHI research (pdf) suggests.

Approximately one out of four direct-care workers is uninsured, and many of them would be eligible for Medicaid under the new eligibility rules. The median annual income of direct-care workers is just $17,000; personal and home care aides make an average of $12,000 a year.

PHI has compiled a chart (pdf) on other health-reform provisions that will affect the direct-care workforce.

More Helpful Provisions

The Commonwealth Fund’s issue brief details several other provisions that will benefit women.

Beginning September 23, 2010

• Health plans will be required to cover a wide variety of services without requiring cost-sharing. Those services include screenings for breast cancer, and cervical cancer, as well as osteoporosis screenings for women age 65 and older.

Beginning January 1, 2014

• Insurance companies will be required to accept every individual who applies for coverage, and will be forbidden from charging higher premiums based on gender or pre-existing medical conditions.
• Health plans sold through state insurance exchanges will be required to cover maternity and newborn care.

– by Matthew Ozga

The Federal Medical Assistance Percentage (FMAP) increase is expected to be extended, since the U.S. Senate has voted to pass it.

Without the FMAP extension, many states were planning to cut or even eliminate health care programs serving poor and elderly residents.

The Senate voted on August 5 to pass the federal state-aid package that includes $16.1 billion to extend the FMAP increase through 2011.

First the Senate had to surmount a Republican filibuster — an outcome that seemed unlikely by all accounts just one week ago. Once the Senate voted on August 4 to end the debate, the bill headed to the Senate floor where it passed, 61-39.

Calling Representatives Back for the House Vote

Members of the U.S. House of Representatives have already left for summer recess. However, in an uncommon move, House Speaker Nancy Pelosi (D-CA) called them back to Washington, D.C. to vote on the measure next week.

Once the measure is passed in the House, as expected, the bill will be sent to President Obama, who has been pushing for its passage.

Extension Will Prevent Layoffs and Service Cuts

The $16.1 billion FMAP increase is part of a larger, $26 billion state-aid package of which $10 million is targeted to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

The bill was tied up in the Senate until two Maine Republicans, Susan Collins and Olympia Snowe, joined with Democrats to end debate on the bill.

“At a time when our economy is still regaining its footing and state budgets are strapped, this FMAP extension is critical to maintaining services for elders and people with disabilities, as well as ensuring stability to the direct-care workforce that provides those services,” said Steve Edelstein, PHI’s national policy director.

“We applaud the Senate leadership and Senators Collins and Snowe for putting the needs of our most vulnerable citizens at the forefront and for refusing to let this vital legislation die.”

– by Deane Beebe