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January 24, 2007
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In This Issue:
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Heads Up for New Hampshire
A new issue brief explains "what makes direct-care workers leave
their jobs and why we must act" in New Hampshire. Written by Terry
Lochhead for PHI's Northern New England LEADS program,
Home Alone in New Hampshire
is intended for long-term care consumers, their families, and
lawmakers.
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Evaluating Dementia Care Skills and Training Programs
A tool from Michigan helps direct-care workers determine whether they
have the skills they need to deliver person-centered dementia care --
and where to go for assistance if they need training. It also helps
supervisors, policymakers, and others evaluate dementia care training
programs. An online self-assessment will be available soon.
"There's so much training available, but people didn't know how
to evaluate whether it was effective. This was a way to gauge that,"
says Maureen Sheahan, PHI's Michigan Practice Specialist and one of
many collaborators who helped develop the publication.
The competencies described in
Knowledge and Skills Needed for Dementia Care: A guide for Direct Care Workers
were identified by a group convened by the Michigan Dementia
Coalition and reviewed by a larger group that included more than 60
home health aides and CNAs.
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Recent Additions
Click here
to see more of what's new in the Clearinghouse.
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Iowa Studies Health Care Expansion
Inspired in part by a panel of policymakers and advocates from
Massachusetts, Iowa lawmakers are drafting a health care reform bill
for consideration during next year's state legislative session.
The Massachusetts policymakers visited Iowa last month to discuss
their state's plan to provide universal health care coverage. "The
main message was: 'We did something in Massachusetts; you can do
something in Iowa. And don't be afraid of doing something big,' "
says John Hale, then the policy director for the Iowa Better Jobs
Better Care initiative and now the policy director for the Iowa
CareGivers Association. "Our mantra for the day was, 'Let's get
serious about health care reform.' "
About 100 people attended the by-invitation event, including
representatives of large insurance companies, labor unions, business
organizations, and community organizations as well as several
legislators and key people from key government agencies. "I left
there very optimistic about where this is going to take us," says
Hale.
Click here to view
Real People, Real Stories: The Uninsured and Underinsured in Iowa,
a moving eight-minute video prepared by the Iowa CareGivers
Association to introduce the Massachusetts group's testimony.
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Pennsylvania's Governor Unveils Plan to Insure One Million
On January 17, Governor Ed Rendell (D-PA) unveiled a health care
reform plan that could make health insurance available to about 1
million Pennsylvanians who lack coverage. The governor wants to
develop a program similar to an expansion he proposed for the
Children's Health Insurance Program (CHIP), which fully subsidizes
health insurance for children from low-income families and makes
coverage available to other children for fees based on their family
income.
The wide-ranging proposal also calls for banning smoking in the
workplace, increasing taxes on all forms of tobacco, and lifting
certain restrictions on nurse practitioners in order to cut costs and
improve access to care.
Details are available from the Governor's
Office of Health Care Reform.
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More Information
Click here to read more from and
about the HCHCW campaign.
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AARP, SEIU Unite in Call for Better Health Care Coverage
AARP, Business Roundtable, and Service Employees International Union
joined forces to launch an effort to engage politicians,
businesspeople, and the general public in finding broad-based,
bipartisan solutions to the health care crisis. The premise of the
Divided We Fail
campaign is that all Americans should have access to affordable,
quality health care - including choices involving their long-term
care - and that the costs should not burden future generations. The
partnership plans to take an active role in the 2008 election, urging
candidates to support health care reform and financial security. "We
want to push the political process and break the gridlock and get
Congress to work in a bipartisan way that we can support," said AARP
CEO Bill Novelli.
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Best Practices in European Long-Term Care
Resources
from a conference held by AARP last year are available online for
people interested in learning from how several European countries
have made long-term care an integral part of their health care
systems. The reports, which discuss drawbacks as well as the
advantages of these systems, look at lessons the U.S. might apply to
its own patchwork system of long-term care services.
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Disability Rates among Elders Continue to Decline
"Change in Chronic Disability From 1982 to 2004/2005 as Measured by Long-Term Changes in Function and Health in the U.S. Elderly Population,"
published in the November 28, 2006 issue of
Proceedings of the National Academy of Sciences, examines the
rate of chronic disability among elderly U.S. residents using data
from the National Long-Term Care Survey. The researchers found that
the rate of chronic disability is declining - and the rate of decline
has accelerated over the past two decades. The disability rate among
people 65 and older dropped from 26.5 percent in 1982 to 19 percent
in 2004/2005. "This continuing decline in disability among older
people is one of the most encouraging and important trends in the
aging of the American population," says NIA Director Richard J.
Hodes.
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The Facts about Long-Term Care Financing
A pair of newly revised fact sheets from the Georgetown University
Long-Term Care Financing Project provide up-to-date information on
how long-term care is financed.
National Spending on Long-Term Care,
by Harriet L. Komisar and Lee Shirey Thompson, looks at total
spending for nursing home and home care services nationwide, in total
and by major payers.
Medicaid and Long-Term Care,
by Laura Summer, describes Medicaid's role in financing long-term
care, with a particular focus on home and community-based services
and how states' provision of these services may be affected by the
policy changes in the Deficit Reduction Act of 2005.
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AARP Chronicles the State of Long-Term Care and Independent Living
Across the States 2006: Profiles of Long-Term Care and Independent Living,
the latest edition of AARP's biennial collection of data on long-term
care and independent living in each state, is now available free of
charge. Included are charts showing consumer demographics, maps
showing which states require what kind of training for caregivers,
charts listing key demographics for each state, and much more. To
order a copy, call 202-434.3890 or e-mail
ppi@aarp.org.
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The Care Gap Hits China
An article
inthe January 2 edition of the Boston Globe describes the
challenges facing China's enormous and growing elder population, many
of whom are struggling to adapt to a new landscape in which state
supports have been withdrawn and adult children have left in pursuit
of jobs in distant cities.
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Tools for Calculating Seniors' Living Costs
Two new reports
from the Boston Foundation's Massachusetts Elder Economic Security
Standard Project report on the difficulties facing low-income seniors
in providing for their needs and provide a way of calculating living
expenses for an elder individual or couple. Although one is geared
for the state of Massachusetts and the second for the Boston area,
much of the information in them can also be generalized to apply to
other areas.
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Which kinds of workplace improvements do you think direct-care
workers need most?
Changes that provide workers with more responsibility and require
more accountability, like being involved in decision making or
scheduling: 32%
Changes that provide workers with support, such as improved
benefits or new learning opportunities: 68%
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Dear Friend
The Paraprofessional Healthcare Institute (PHI), the parent
organization for the Clearinghouse that publishes this newsletter, is
looking to fill several new positions, including a development writer
and a state director for Massachusetts. Click on the home page of
our website and scroll
down for these and other job descriptions, which include information
on how to apply.
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DOL Funds Implementation of Nursing Home Apprenticeship Program
A three-year, $1.6 million grant to North Central Kansas Technical
College will fund the expansion of the Health Support Specialist
(HSS) apprenticeship program developed by the Kansas Department of
Commerce. The Golden Horizons Career Works Nursing Home
Apprenticeship Program provides a career path for universal workers
in nursing homes, which includes training in culture change.
Click here
for the rest of the story.
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Help Shape the Reporting of BJBC Research
If you're interested in research on the direct-care workforce,
AcademyHealth is offering a rare opportunity to comment on a group of
studies before they are published, perhaps even shaping the way they
will be presented in print.
The results of four studies funded by the Better Jobs Better Care
project will be published in a special issue of The Gerontologist
later this year, but before they are published, AcademyHealth is
hosting author-moderated online discussions of the draft versions.
Participants are invited to "pose questions to the authors, provide
insight on policy implications, and voice personal perspectives on
pertinent workforce and LTC issues." The discussions began on January
10 and continue through today.
The four manuscripts are:
Click here
and then log on to the LTC Workgroup's
LTC Workforce Interest Group Forum
to join the discussions or view other people's comments.
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Variations in Requirements for PCAs May Harm Care Delivery, Warns HHS
Wide variations within states in both the qualifications required of
personal care attendants and the agencies that monitor compliance
"may make it difficult for states to ensure that attendant
requirements are met," according to a new report from the Office of
the Inspector General at the U.S. Department of Health and Human
Services.
States' Requirements for Medicaid-Funded Personal Care Service Attendants )
found 300 sets of attendant requirements among the 50 states, as
requirements often vary among programs and even by delivery models
within programs. The six most common requirements, in order of most
to least common, are:
- Criminal or other background checks;
- Training in some basics, such as CPR, universal precautions,
or how to assist with activities of daily living;
- Some supervision, such as a bimonthly or quarterly home
visit by an RN or LPN and more frequent telephone check-ins;
- A minimum age, most commonly 18 but sometimes as young as
14;
- Passing a health test, such as testing negative for
tuberculosis or passing a physical exam; and
- Some minimum level of education and/or literacy. This
usually means reading well enough to follow instructions or having
either graduated high school or completed a GED.
Only seven states apply uniform requirements to all their
attendant care programs. Five programs using the consumer-directed
delivery model have no requirements at all for their attendants. In
addition, states sometimes delegate responsibility for ensuring that
attendants met requirements to another entity, such as a home health
agency, beneficiary, or case manager.
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Minimum Wage Hikes Should Benefit Direct-Care Workers
Direct-care workers typically make more than the minimum wage, but
many are likely to benefit from the minimum wage raises going into
effect in states across the nation. In addition, those in states that
have not yet raised their minimum wages may benefit from the national
hike that will likely be passed this year.
As a result of successful ballot initiatives that passed
overwhelmingly in November, Arizona, Colorado, Missouri, Montana,
Nevada and Ohio raised their minimum wages this month. Another three
states will raise their minimum wages as a result of legislative
action over the past year.
Click here
for the rest of the story.
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IOM to Issue Study on Healthcare Workforce Needs
The Institute of Medicine has begun the process of fielding a
consensus study to determine the type and size of the workforce
needed to care for our growing population of elders.
The study will first examine the health care needs of the over-65
population, then the forces that shape the health care workforce and
its practice, including education, training, modes of practice and
reimbursement.
An ad hoc committee of 15 experts will meet over 15 months to
consider these issues.
Two public workshop sessions will inform the committee's
discussion.
Study contacts are Megan McHugh, Senior Program Officer
(202-334-3982) and Tracy Harris, Program Officer (202-334-2918).
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Report Calls on Government to Ensure Adequate Pay and Benefits
To facilitate the provision of consistent and competent care, state
and federal policies should ensure that direct-care workers earn
enough -- and get sufficient benefits -- to support their families
and remain in the workforce, according to a report from the Carsey
Institute at the University of New Hampshire.
Both full-time and part-time direct-care workers are
significantly less likely than workers in other occupations to have
health insurance through their jobs, according to
"An Examination of Full-Time Employment in the Direct-Care Workforce."
What's more, despite the urgency of ensuring that there are enough
workers to care for a growing population of elders and people with
disabilities, policymakers have not focused on improving working
conditions for direct-care workers.
The article, which ran in Volume 25, Number 5 of the
Journal of Applied Gerontology, provided a socioeconomic and
demographic profile of the direct-care workforce in long-term care.
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Iowa Report Calls for Major Improvements to Boost Recruitment and
Retention
Iowa's government should establish six direct-care worker
classifications based on their functions and implement consistent,
appropriate educational and training requirements and standard
curricula for each, according to a new report to the state.
The report
was submitted by the Iowa Direct Care Worker Task Force to Governor
Tom Vilsack and the Iowa Department of Public Health (IDPH) and the
state general assembly.
The task force was appointed by Governor Tom Vilsack "to develop
comprehensive recommendations to improve the quality of care Iowans
receive by improving and streamlining educational and training
requirements for our direct care workforce."
In addition to recommending reclassification and improved
training for direct-care workers, it recommends a number of other
changes. It also recommends the following systems changes to ensure
proper implementation and oversight:
- IDPH should be made responsible for implementing the
recommended changes
- IDPH should establish a direct-care worker governing body to
oversee certification and impose professional standards; and
- The state should ensure that the governing body includes all
six classifications of direct-care workers plus other key long-term
care stakeholders.
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A Coke for the Supreme Court
The U.S. Supreme Court has agreed to rule on
Long Island Care at Home et al. v. Coke.
The court's decision will determine whether federal overtime pay
rules apply to home care aides who work for agencies and other
organizations.
The lower-court decision, by the U.S. Court of Appeals for the
Second Circuit, found that the "companionship exemption" that has
been in effect for such workers for several decades was invalid,
making the workers eligible for minimum wage and overtime
compensation requirements under the Fair Labor Standard Act.
The Supreme Court is expected to rule on the case by the end of
this year's session in June.
Click
here
for more background on the case and
here to
follow the progress of the Supreme Court's hearing of the case.
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State Strategies for Improving Wages and Benefits
A set of Power Point slides describing state and local strategies for
improving wages and benefits for direct-care workers is now available
online.
The slides were used in a January 10 conference call during which
Dorie Seavey of the Paraprofessional Healthcare Institute discussed
findings from
Paying for Quality Care: State and Local Strategies for Improving Wages and Benefits, a paper she coauthored with PHI's Vera Salter.
Click here
for the Power Point slides or a copy of the paper.
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February 24, 2007
National Association of Workforce Boards (NAWB) Annual Forum
March 06, 2007
National Center on Caregiving at Family Caregiver Alliance (FCA) and
American Society on Aging (ASA) National Conference
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