Direct Care Workers: Essential to Quality Long Term Care

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1 Direct Care Workers: Essential to Quality Long Term Care WV Partnership for Elder Living 2013 Summit Presenter: Carla Washington

2 Outline National issues effecting direct care workers Direct Care Alliance Who are we? Community planning for long term care services 2

3 About the Direct Care Workforce Direct care workers (DCWs) provide care, services and support to people in home, community and residential settings Often known as CNAs, home health aides, personal care assistants, direct support professionals, home care workers and other similar titles Currently more than 4 million DCWs provide care to more than 13 million people in the U.S. DCWs provide about 70-80% of paid LTSS to older adults and individuals with disabilities in the U.S. 3

4 Demand for the Direct Care Workforce Growing demand -- DCW growth is 48% Number of Americans needing LTSS expected to grow to 27 million by 2050 About 1.6 million new direct care jobs this decade (by 2020) Largest occupational group by 2020, exceeding 5 million workers 4

5 Direct Care Workforce Challenges Low wages Median annual wage: $10.59 (2011) Median annual earnings: $17,000 (2010) High turnover -- between 44 and 65% annually Lack of access to benefits like health insurance, paid sick days and family leave 30% uninsured across care settings 47% forced to depend on public benefits like Medicaid (1 in 5 DCWs) or food stamps Outdated and insufficient training and education requirements 5

6 Direct Care Workforce Demographics 88% female 53% racial or ethnic minority Average age is 42 49% employed part time or full time part of the year 20% foreign born 54% have a high school level education or less 6

7 7

8 Direct care alliance National advocacy voice of direct care workers. Goal is to build a strong, empowered direct care workforce and thereby a quality long-term care system. Accomplish this by working at a grass-roots state level. Only national organization solely dedicated to improving direct care jobs through worker-led advocacy. 8

9 Dcw State Associations Texas Pennsylvania Maine New Jersey Wisconsin Minnesota New Mexico Florida Iowa Indiana Arizona 9

10 Key Policy Issues Key policy issues affecting direct care workers that the Direct Care Alliance is working on: Wages, Health Benefits, Training, and Respect. What issues affect DCWs most depends on state and local policies and employer laws or treatment from care recipients. 10

11 Respect for Home Care Workers Minimum wage and overtime protections for home care workers The U.S. Department of Labor has finalized rule change! Direct Care Job Quality Improvement Act (S. 1273/H.R. 2341) 11

12 Key Policy Issues Wages What are we trying to do about it? Fair Labor Standards Act Get s to the issue of respect=> DCWs are more than companions. DCWs provide essential and meaningful care to millions of Americans. 12

13 Key Policy Issues Wages Evelyn Coke, a home care attendant, felt so passionate about this issue that she took her employer to court requesting thousands of $ in back pay. Case reached the supreme court. Court ruled in favor of her employer and recommended that this issue be addressed by the DOL or Congress. 13

14 Health Benefits Key Policy Issues Approximately 30% of DCWs have no health insurance. Unthinkable that direct care workers provide care and are unable to receive it. We are hoping that health care reform will address the difficulties that DCWs have with getting affordable, quality care for themselves. 14

15 DCWs & the Affordable Care Act (ACA) Physically and mentally demanding Higher than average rates of chronic conditions, On-the-job health hazards One of the highest rates of on-the-job injuries 15

16 DCWs & the Affordable Care Act (ACA) Direct Care Workers Health Insurance Coverage For many DCWs: unaffordable premiums and copays, yet ineligible for Medicaid While many employers offer health insurance to direct care workers, many others do not Even when they do, premiums and copays can be too expensive, or the DCWs may not work enough hours to qualify for the plan 16

17 DCWs & the Affordable Care Act (ACA) Direct Care Workers Health Insurance Coverage In 2010, less than half of all DCWs had health coverage through an employer and about 950,000 --including 1 in 4 nursing home workers and more than 1/3 of aides working in agency-based home care-- had no health insurance at all Women make up the majority of direct care workers (88%) and they are often the primary or sole breadwinner in the family 17

18 DCWs & the Affordable Care Act (ACA) DCWs Health Coverage -- Impact on Workers, Consumers and Beyond Without health insurance coverage Longer recovery time from illness/injury Choice between seeking treatment/staying home and recovering -- or going to work sick or injured and exposing consumers to illness or injury Condition can worsen without treatment -- more expensive for treatment later on (i.e. for society, at an ED) With health insurance coverage Faster recovery time from illness/injury Can recover faster and go to work faster better quality and continuity of care for consumers Fewer postponed and emergency treatment instances less expensive for society Health care coverage for workers families improved school and work outcomes Improved economic security for workers Stronger middle class and U.S. economy 18

19 DCWs & the Affordable Care Act (ACA) The ACA is a huge victory for hundreds of thousands of DCWs and their families, taking huge steps to make health care affordable and accessible Health Insurance Marketplace (Exchange) Under the ACA, every state must have a Marketplace where individuals, families and small businesses can get health care coverage Open enrollment starts October 1, 2013; coverage may start January 1, 2014 Some will be state-run, others will be run by the federal government Contain information about health coverage options so consumers can compare plans and choose and enroll in a plan Information about programs to help consumers with low to moderate resources and income pay for health care coverage Accessible through websites, call centers and in-person assistance Important way for direct care workers to learn about their options for health care coverage 19

20 DCWs & the Affordable Care Act (ACA) Medicaid expansion Traditional Medicaid: Affordable, accessible health care coverage nationwide (each state has its own eligibility criteria) Under the ACA and the 2012 Supreme Court decision, each state can accept or reject federal funds to expand their Medicaid program to more low-income people In 2014, people with incomes up to about $15,000 for an individual/$30,000 for a family of four (138% of the FPL) will be eligible for expanded coverage 27 states and D.C. have already decided/are likely to accept this money and expand their Medicaid programs If every state expands its Medicaid program, about 460,000 uninsured DCWs will be newly eligible for health care coverage through Medicaid DCA advocacy efforts: TX, PA, VA, NM 20

21 Get DCWs Covered Campaign Generously supported by the New York State Health Foundation Education and enrollment initiative to ensure the benefits of health care reform reach low-income and immigrant communities Goal: Help direct care workers and other uninsured individuals get health insurance through the marketplace, improving their health and economic security Initial focus in NY, with additional work possible in VA, PA and beyond Approx. 2.7 million New Yorkers --including over 85,000 DCWs-- are uninsured DCA will partner with businesses and community-based organizations throughout NY to ensure people have the information and support to get the benefits that are available to individuals and small businesses (i.e. home health agencies) 21

22 Get DCWs Covered Campaign Key elements of the campaign Help DCWs and other uninsured individuals get health insurance through the marketplace, improving their health and economic security Communication and story collection Messaging that there will be problems -- enrollment is a major undertaking Participation and public messaging is crucial to the success of ACA implementation Stories of how the ACA is helping people access affordable health care Data collection About the direct care workforce and their families, as well as other uninsured people the number of enrollees, re-enrollees, etc. 22

23 Training Key Policy Issues Too often, DCWs are set up to fail. Many entry level workers get too little training or none at all. Hairdressers and Dog groomers often require more training than direct care workers. and opportunities for advancement within direct care work. 23

24 Training Key Policy Issues More experienced workers often do not get the specialized training that would help them care for people with more complex needs. There are insufficient recognition of worker skills and opportunities for advancement within direct care work. 24

25 Training West Virginia Key Policy Issues WV will need more than 20,000 paid in-home care providers for elders by Five thousand direct care positions already are unfilled because of a lack of qualified applicants. State Schools Superintendent Jim Phares, State Journal, July 12,

26 Key Policy Issues Training requirements West Virginia Home Health Aides 75 hours minimum, same as federal level Personal Care Aides Requirements, all programs Partnership WV DoEd, Bureau of Senior Services, others : competency-based test for DCWs 26

27 DCA Personal Care & Support Credential Developed as solution to lack of minimum standards for home care workers. Competency-based test for personal assistance workers in home and community-based settings. No national credentialing or training requirements for personal assistance. People who rely on their services have no reliable way to assess the knowledge of those they hire. 27

28 Personal Care & Support Credential Agency employers must devise their own assessment procedures. Workers with experience and/or training have no way to demonstrate their professionalism and skills There are insufficient recognition of worker skills and opportunities for advancement within direct care work. 28

29 Key issues - Conclusion It s all about Respect. Working conditions are such that DCWs are clearly underappreciated. Turnover rates range from 50% to as high as 100% in some areas. DCA s role is to make sure that our representatives understand why these issues should be important to them. 29

30 Worker Associations POWER = CHANGE Principles of community organizing and why they matter for direct-care worker associations and chapters. 30

31 Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for a lifetime. - Lao Tzu 31

32 The Organizer s Version of Lao Tzu s insight: If you give me a fish you have fed me for a day. If you teach me to fish then you have fed me until the river is contaminated or the shoreline seized for development. But if you teach me to organize, then whatever the challenge I can join together with my peers and we will fashion our own solution. 32

33 The Purpose of Organizing a DCW Association Create real improvements in people s lives Provide people with a sense of their own power to make a difference Change power relationships 33

34 Understanding our Self- Interests Self-interests are those things that a person feels most strongly about in their community and society and public life It is the thing that motivates a person. It is their passion or unforgettable fire. 34

35 Self-Interest: Personally-Thinking about a association What would you want a DCW Association to do for you, your workers and others? How are you willing to contribute to that? 35

36 Leaders building their associations and chapters Self-interest (example): I do what I do because I have a big heart. I care for the seniors, but I care just as much for my co-workers and those who are looking to come into this profession. We need your help to invest in the direct care workforce, however that may be. The Pennsylvania Direct Care Workers Association will be at your side helping in any way we can. 36

37 Leaders building their associations Pennsylvania s organizing focus: More training opportunities for direct care workers. These workers meet quarterly throughout the state offering free trainings to direct care workers. 37

38 So what does this mean for WV? The desire Team work Willingness to make a difference What does it look like? 38

39 HOW? WHEN? WHO? HOW-Bringing together those who have shared interests. WHEN-Starting with designing and drafting a plan. WHO+YOU= WE & US 39

40 Association Building Where is your place? What is your expertise? What is your talent? 40

41 Grassroots campaign to change the way we care for each other. Goals of the campaign: 1. Create jobs 2. Improve the quality of home care jobs 3. Provide training and career advancement opportunities 4. Provide a path to citizenship 5. Make this affordable by supporting individuals and families 41

42 DCA Needs Your Help Impacts your health and economic security Home care workers have received basic labor protections!! Let s celebrate the victory! Affordable health care, Medicare, Medicaid and Social Security are under attack How? Get involved in WV and with DCA! 42

43 Questions & Answers 43

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