Gas Prices & Transportation Webinar

from PHI: 

PHI has been covering the effects of rising gas prices on direct-care workers since early this summer. Now, as our nation’s economic crisis grows more severe, the challenge to these low-wage workers has intensified.

The National Direct Service Workforce Resource Center held a webinar earlier this week called “Gas Price Increases & Other Transportation Challenges for Direct Service Workers.” The presentation included an overview of the problem, a description of approaches used by states and providers to address the issue, and information on related Medicaid reimbursement policies and options.

On one slide of the powerpoint used in the webinar, we learn the following about the impact of rising gas prices on area agencies on aging:

• over 50% said they have cut back on programs
• 90% say they expect to make cuts in the 2009 fiscal year
• 70% say it is more difficult to recruit

For more information, download the 18-slide powerpoint (ppt 373k) used in the presentation.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

LTC Employer Speaks Out on Health Reform

from Health Care for Health Care Workers: 

Last week, the Pennsylvania Health Access Network, of which HCHCW-PA is member, held a rally in Harrisburg to call on the Pennsylvania State Senate to pass bills that would provide health insurance coverage to thousands of uninsured Pensylvania residents - including many direct-care workers.

Lori Michael, the owner of a home nursing care company in Schuylkill County and an advocate for HCHCW, cited unaffordable health coverage as a major business issue.  Lori spoke about the impact the lack of affordable health insurance has on her ability to retain and recruit direct-care workers to serve the ever growing client base.  “People in Pennsylvania want to age at home,” said Lori Michael, owner of Lori’s Angels in Schuylkill Haven. “We want to help them do that. We need help from state government.”   The rally and Lori’s comments were covered in the Scranton Times and on PCN network.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

Upcoming Webinar: Gas Prices and Other Transportation Challenges for Direct Service Workers

from Hollis Turnham:


The DSW Resource Center will host a webinar on the topic of high gas prices and other transportation challenges for direct service workers in home and community-based settings on September 23, 2008 at 3:00 pm Eastern.  This webinar will feature an overview of the problem, approaches that states and providers have used to help cover transportation costs for these workers, and information on related Medicaid reimbursement policies and options.

Reserve your Webinar seat now!

Attention Providers and States: If you have a transportation policy, please contact us in advance or contribute to the discussion during the webinar. We hope to have a lively discussion!

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

PHI EXPERT INTERVIEW: Steven Dawson

Getting real about retention
This is the fourth in a series of PHI Expert Interviews, which bring you insights from four senior PHI staff. They’re an impressive group — among the nation’s leading experts on long-term care’s direct-care workforce — and collectively they’ve spent decades studying the challenges facing the workforce and how to address them. We think you’ll be interested in what they’ve learned.

When Steven Dawson came out of the workforce development field in 1992 to join Peggy Powell in heading up the Paraprofessional Healthcare Institute, PHI’s sole purpose was to raise funds and provide technical support for Cooperative Home Care Associates. Over time, Steven led PHI into the broader long-term care arena, where its policy and practice experts work with employers and lawmakers to support and stabilize the nation’s direct-care workforce.

Steven has written about the impending direct-care workforce crisis (pdf) and the link between quality jobs for direct-care workers and quality care for long-term care consumers. Through the years, his emphasis has been on creating workplaces that are intentionally re-designed to retain direct-care staff.

“A constantly churning workforce is the enemy of quality care — ask anyone whose mother has had to deal with five different home health aides within a month, or with a blur of CNAs in the nursing home. The industry still manages to attract hundreds of thousands of skilled, caring workers every year, but once hired, these frontline staff are too often treated as if they were invisible. So, of course they leave,” he says.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

WA long-term care initiative turns in signatures

OLYMPIA, Wash. (AP) -- An initiative to increase training for long-term health care workers appears to be the final measure headed for the fall ballot.
Supporters of Initiative 1029 say they turned in more than 315,000 voter signatures on petitions delivered Thursday to Secretary of State Sam Reed. That should be enough to guarantee a spot on the ballot.
The initiative would require long-term care workers to pass a certification exam, complete more training and undergo background checks. The Service Employees International Union is a major supporter.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Out of Gas?

Everywhere I go, people are talking about how the high price of gas is affecting home care workers and agencies. Organizations are contacting me and my colleagues for ideas on how to deal with it, so I’d be very interested to hear from people in other parts of the country. How are employers and workers and clients dealing with it? Are any states planning a response to this crisis? If so, what’s being considered?

Four-dollar-a-gallon gasoline exacerbates all recruitment and retention problems, and I fear that it forces workers to make some very difficult choices. Employers are calling workers to offer them cases and having the workers do the gas calculations and say “I can’t afford to take this one.” Home care aides are seeing their co-workers go to other jobs where they don’t have such stressful transportation issues.

Here in Michigan, in the waiver program that funds home care for people who are eligible for nursing home services, I’m hearing that the only time a worker must be paid for transportation is when they’re driving the client, taking them shopping or the doctor or the pharmacy or something like that. People aren’t getting paid for all the driving they have to do just to get to their clients.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

New York Fact Sheet: Caregivers without Health Care

Download the report (pdf 180K)

New York state has been “a national leader” in expanding health care coverage for home care aides and other workers, yet 30 percent of its home care workers lack insurance according to a fact sheet from PHI’s Health Care for Health Care Workers campaign.

Caregivers Without Coverage focuses on home care workers because they are the largest and fastest-growing segment of the state’s direct-care worker population. It explains the conditions contributing to the high rate of uninsurance among direct-care workers, including low wages that make it difficult to afford premiums and copays.

Among the facts it presents:

• One in seven low-income workers in New York City is employed as a home care worker;
• Starting wages for home health aides are just $7.50 - $8 an hour in New York City, though its cost of living is one of the highest in the nation; and
• The statewide median hourly wage for home care workers is $9.74 an hour, compared to $16.91 for all workers.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Joanne Rader: “It’s the Direct-Care Worker, Stupid”

“My passion for working with people with dementia, for making life better for them, has been my major motivating factor. But over time, I keep saying to myself: ‘It’s the direct-care worker, stupid,’” says Joanne Rader. “The only way to make the lives of people with dementia better is to improve the working lives of the direct-care workers. We need to put the things in place that let them provide relationship-based care.”

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Free Dementia Care Guide Now Better than Ever

A dementia care guide that has been helping direct-care workers since 2006 is now better than ever.

Knowledge and Skills Needed for Dementia Care: A Guide for Direct Care Workers in Everyday Language 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. It was developed by a team of experts and reviewed by many more, including more than 60 home health aides and CNAs.

“Most people who provide hands-on care for individuals with dementia have big, warm, caring hearts,” says Dementia Project Coordinator Micki Horst. ”They want to learn all they can about how best to care for and interact with someone with dementia. We developed this guide to give them a tool for assessing their own competencies.”

The updated version includes useful additions:

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Voices Institute Graduates - May the Root Thrive!

We just completed another historic and successful step forward for the movement to empower direct care workers and to fix our broken long-term care system!

It is clear that Direct Care Workers want a voice and to have their voices heard to improve the profession and the quality of care and services. It was fitting that direct care workers from 12 states met at a place whose motto is: May the Root Thrive! The 25 leaders from 12 states gathered at the DeKoven Center are the roots of our growing movement! I have no doubt that each and every one of the attendees will ensure that the long-term care care-gap is avoided and direct care workers are empowered by applying the powerful tools we all learned at our five day training program.

The events I witnessed at the Voices Institute Inaugural class reminded me of the gracious, generous and powerful nature of direct care workers and their ability to meet any challenge and thrive: flexibility, ability to solve problems, address crisis situations, balance challenging schedules are the stuff that the daily care-giving experience is made of. And so, all the Voices Institutes leaders gathered and we learned speech making, fundraising, organizational and self empowerment strategies and we all thrived in the intense and challenging environment Bob Hudek designed for us. Thank you Bob Hudek for locating the perfect learning environment and for designing a curriculum that gave us comfort, hope and thought us powerful tools that along with Vera’s empowerment tools will lead us to success.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Explaining the Care Gap

f you need someone to understand the urgency of the growing care gap in long-term care, you might want to pass on a copy of Occupational Projections for Direct-Care Workers 2006-2016.

“Our analysis suggests that demand for direct-care workers over the next decade, particularly in home- and community based settings, will continue to outpace supply dramatically-unless policymakers and employers work together to make these jobs competitively attractive compared to other occupations,” says the six-page fact sheet by PHI Director of Policy Research Dorie Seavey.

Short text blocks and charts like the ones reproduced here interpret U.S. Bureau of Labor Statistics data in often striking ways. For instance, did you know the U.S. is expected to need a million additional direct-care workers, for a total of 4 million, by 2016? Or that direct-care workers will outnumber teachers from kindergarten through high school combined (3.8 million), fast food & counter workers (3.5 million), and cashiers (3.4 million)?

That additional million workers represents an increase of 34 percent in just one decade, the fact sheet points out, and we can’t count on finding all those people in the usual pool of workers - women aged 25 to 54 - since that pool is expected to increase by less than 1 percent between 2006 and 2016.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Caregiving is Women’s Work

Caregiving is women’s work.

It is with that simple statement in mind that I went to the Raising Women’s Voices Conference last month, sponsored by the Avery Institute, Merger Watch, and the National Women’s Health Network.

I was invited to participate on the opening plenary panel to discuss voices that are traditionally left out of health care reform discussions. I talked about direct-care workers — and about Health Care for Health Care Workers and the broader work of PHI.

The conference brought together women’s health advocates, providers, and women in general to talk about health care issues and shape a women’s agenda for health care reform. There were the usual PowerPoint presentations and policy recommendations, but the way the organizers encouraged presenters to tell our stories made it clear from the start that this was no ordinary conference. Raising Women’s Voices lived up to its name, honoring the power of women’s voices and experiences as consumers and providers.

In my day-to-day work talking with policymakers, I have to show lots of facts and figures about direct-care workers not having health insurance and figure out how to “make the case” that this issue matters. At this conference, people listened intently when I opened my presentation with the story of Iya’ Negra, a direct-care worker in Maine. Iya’Negra was diagnosed with fast-growing fibroid tumors after she was kicked by a consumer with Alzheimer’s and the pain from the kicking did not subside. Because she had no health insurance, her health problem turned into a crisis for her whole family.

Sure, the fact that one in four direct-care workers is uninsured was a new and shocking statistic to many at the conference, but what struck them most was how that issue impacts the day-to-day lives of workers, the consumers they assist, and their families.

DCW Calls for an End to Management-Sanctioned Discrimination

Licensed Nursing Assistant Patti Green just notified me about a strong piece she’s written about a widespread and little-discussed problem: racial discrimination against direct-care workers in long-term care and the role management plays in allowing it.

“Under the guise of resident/patient rights, aides of color are constantly victims of resident harassment and disrespect. Management bars these aides from caring for said residents - and this leads to resentment and bad morale among all the aides,” she writes in The Quiet Discrimination.

This is an issue that everyone who cares about the quality of direct-care jobs needs to be aware of. As Patti said in her email, this industry-wide pattern of discrimination is “an important issue and one more reason why many aides just leave the work.”

IOM Report “Major Step Forward” for DCWs

“It is clear that a change in culture is needed - that both health care workers and health care organizations need to change the way they think about direct-care workers and, in particular, that the direct-care workers need to be seen as a vital part of the health care team,” says Retooling for an Aging America: Building the Health Care Workforce, a new report from the Institute of Medicine (IOM). The institute is part of the National Academy of Sciences.

The report, from the IOM’s Committee on the Future Health Care Workforce for Older Americans, also calls for concrete improvements in the quality of direct-care jobs. It advocates a three-pronged approach:

• More, and more effective, education and training;
• Increased wages and benefits; and
• Improvements to the work environment, such as empowerment strategies and culture change.

When the IOM talks, Congress generally listens. Past IOM reports have led to major improvements in our health care system - like the Nursing Home Reform Act of OBRA 1987, which grew out of an IOM report on long-term care. The current report is focused on how we can prepare for the coming baby boomer “age wave” by ensuring that the nation has an adequate and capable geriatric care workforce.

Martha Stewart, Institute Of Medicine Testify At Aging Hearing On Expanding Health Care Workforce

Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing to address the impending severe shortage of health care workers who are adequately trained and prepared to care for older Americans. The committee reviewed key factors that are contributing to the deficiency, such as the lack of geriatric training in the medical education system and the need for federal and state training requirements for direct care workers, such as home health aides and personal care attendants. The panel also heard from family caregivers that enhanced education and training would help them develop the necessary skills to provide the best possible care for an ailing family member. Currently there are over 44 million Americans serving voluntarily as the sole source of care for an older family member or loved one. Chairman Kohl announced his plan to incorporate lessons from today's hearing into legislation to expand, train, and support all sectors of the health care workforce, including doctors, nurses, direct care workers, and family caregivers.

"By the year 2020, it is estimated that the number of older adults in need of care will increase by one-third," said Chairman Kohl. "The United States will not be able to meet the approaching demand for health care and long-term care without a workforce that is prepared for the job. Fortunately, understanding what we need to change is half the battle, and this hearing provides us with that knowledge."

The hearing was the first in which Congress reviewed the Institute of Medicine's (IOM) major recommendations for improving and expanding the skills and preparedness of the health care workforce in their report, "Retooling for an Aging America: Building the Healthcare Workforce," released Monday. Dr. John Rowe, Chairman of the IOM's Committee on the Future Health Care Workforce for Older Americans, focused his testimony on the report's recommendations. Joining him on the first panel was Dr. Robyn Stone, Executive Director of the Institute for the Future of Aging Services at the American Association of Homes and Services for the Aging. Dr. Stone's testimony highlighted the weaknesses and limitations of the current health care system in meeting the needs of aging boomers.

On the second panel, businesswoman and author Martha Stewart testified on the role of family caregivers in providing essential services and support to loved ones. Ms. Stewart shared with the committee her experience as a caregiver for her mother, and how it shaped her decision to establish the Martha Stewart Center for Living, a model clinic for coordinated outpatient geriatric services at Mount Sinai in New York. Dr. Todd Semla, President of the American Geriatrics Society, made the case for using existing law to increase the number of trained geriatricians practicing in the U.S.

Patti Green: We Have to Learn to Speak Up

“Most of the people that get into this work are women, and they have kids,” says Patti Green of her fellow direct-care workers. “A lot of them are single. They need to earn a decent hourly rate of pay, and they need to have health insurance.”

“That would attract more people, and then if they had the good screening and training we could weed out those that don’t really have a heart for it.”

“They listened to me - I was kind of surprised”
A natural leader, Green has become an expert on the state of direct-care work in America by running what amount to online break rooms for direct-care workers. Nursing Assistant Resources on the Web, the blog she started 10 years ago and now runs with the help of two other direct-care workers, is a trove of free articles, thoughtful blog posts, FAQs, and useful links. And at NursingAssistant@yahoogroups.com, the online community Green launched around the same time and still moderates, 750-plus members engage in a lively exchange of ideas, asking questions, venting frustrations, and offering each other affirmation and support.

Anna Ortigara on Learning from Direct-Care Workers

“There has been a lot of paternalism about direct-care staff – the notion that they are not really adults,” says Anna Ortigara. “People wonder: Are they really capable of being in a lead role? Can they be trusted to make good decisions? Are they capable of self-direction?”

Instead of these questions, Ortigara believes, we should ask ourselves: “How can we possibly think we are going to improve long term care without involving frontline workers? We need them at the table in order to achieve cultural transformation - and why wouldn’t we want them at the table?”