State Policy and Practice Activities

At the state level, PHI policy and practice experts provide technical assistance to coalitions, individual providers, government agencies, unions, and other workforce advocates concerned with the quality of jobs in long-term care—and the impact of an unstable workforce on consumer care.

Much of PHI’s state-level work focuses on assisting providers to improve recruitment and retention through the implementation of workplace and caregiving practices that support the relationship between direct-care workers and consumers. In addition, PHI supports state coalitions that are advocating for public policies that will support a stable, competent, and compassionate direct-care workforce.

California

PHI has provided policy analysis and assistance related to California's public authorities, which provide publicly funded home care services to people living with disabilities. For the LA county public authority, PHI analyzed the potential of a workforce registry to improve both customer service and the quality of jobs for personal assistants (see Envisioning a Quality Jobs/Quality Care Registry for Los Angeles County's IHSS Program). PHI also examined the collaborative process by which the public authority system was developed and implemented throughout the state in Collaborating to Improve In-Home Supportive Services: Stakeholder Perspectives on Implementing California's Public Authorities.

Iowa

PHI supports the Iowa Better Jobs Better Care demonstration program, which is planning to develop a direct-care registry, expand an existing mentoring program from CNAs, and to examine avenues for providing health insurance to direct-care workers.

Maine

Maine’s Coastal Enterprises, Inc. received funding from the state’s Department of Labor to lead a culture change demonstration project. PHI has provided training to the participants, who are implementing peer mentoring programs in both nursing home and home care settings across the state. In addition, PHI is working with two nursing homes that are implementing more comprehensive culture change programs in their institutions. PHI has also provided support to Maine’s Direct Care Workforce Coalition, a group of consumer, worker, and provider organizations seeking to improve recruitment and retention of workers across long-term care.

Massachusetts

For four years, PHI has been facilitating the Massachusetts Direct Care Workforce Initiative, a stakeholder coalition that includes consumer advocacy groups, four state provider associations, and worker advocates, including SEIU. With PHI’s support, the coalition successfully lobbied the state legislature to increase resources for training and career advancement opportunities for direct-care workers across long-term care. The Massachusetts Extended Career Ladder Initiative as well as its scholarship program for women transitioning from welfare into nurse assistant training and employment are models of collaboration between the workforce development community and long-term care providers.The Direct Care Workforce Initiative launched a campaign to improve access to health insurance for direct-care workers in 2003. In the first stage of the project, workers and employers participated in focus groups, sharing their experiences and frustrations with the barriers to adequate health coverage. Participants were then asked to share these stories in the public arena, to build greater awareness of the problem. Through their efforts, DCWI helps to build public support for expanding health insurance coverage to low-wage health care workers across the state.

Michigan

In April 2003, PHI released a comprehensive analysis of the state’s direct-care workforce crisis, Michigan’s Care Gap. The paper has galvanized diverse efforts to improve the quality of direct-care jobs across long-term care. In addition to bringing this issue to the forefront of policy discussions in the state, PHI provides technical assistance to the Michigan Direct Care Workforce Initiative, which has brought together diverse stakeholder organizations to identify effective recruitment and retention strategies.

New Hampshire

In New Hampshire, PHI is closely affiliated with Quality Care Partners, a worker-owned home care agency located in Manchester. In addition, PHI provided technical assistance to the New Hampshire Culture Change Demonstration Program, funded by the Department of Labor. For this project, PHI facilitated developing participatory processes at each of 5 nursing homes that included all levels of staff in discussions of organizational mission and values. PHI then supported these nursing home culture change committees in identifying and implementing specific changes in workforce and caregiving practices.

New York

In New York, PHI is closely affiliated with the worker-owned home care agency Cooperative Home Care Associates and Independence Care System, a managed care agency for people with severe disabilities living in the community. In addition, PHI is providing technical assistance to workforce and culture change initiatives sponsored by the Jewish Homes and Hospitals, Brooklyn's Center for Nursing and Rehabilitation, and Family Home Care Services. With funding from SEIU 1199, PHI is also researching home care expenditure rates across the state of New York to determine the range and pattern of variation in Medicaid home care expenditures and the impact of varied rates on workforce stability.

North Carolina

The North Carolina Department of Health and Human Services has contracted with PHI to provide two train-the-trainer programs to teach coaching supervision skills to staff developers who will train nursing home and home care supervisors across the state. In addition, PHI is supporting the state’s Better Jobs Better Care initiative, which is defining a group of high-road workplace and caregiving practices that long-term employers can choose to implement in order to receive special licensure and increased reimbursement from the state.

Oregon

PHI provides technical support to Oregon's Better Jobs Better Care demonstration, which is seeking to improve working relationships between direct care workers and supervisors, and between workers and the people and families they serve.

Pennsylvania

PHI's Pennsylvania staff support a range of workforce and culture change initiatives, including the state's Better Jobs Better Care program. Through BJBC, Pennsylvania is sponsoring several workforce demonstrations and preparing a universal entry-level curriculum for direct-care workers across settings. PHI is also affiliated with the Philadelphia worker-owned home care agency, HomeCare Associates.In spring 2003, PHI released Pennsylvania's Care Gap, an analysis of the workforce crisis that confronts the state's rapidly aging population.

Rhode Island

Quality Partners of Rhode Island, the state's quality improvement organization, is working with PHI to develop a leadership training for nursing home administrators that focuses on how to include staff at all levels, including direct-care workers, in the change process. PHI is conducting a three-part leadership training that will be tested in several venues, including at the American College of Health Care Administrators Marketplace meeting in December 2003, and the American Health Quality Association Meeting in March 2004. A final curriculum will be developed and distributed through the QIO network.

Vermont

PHI provides technical support for Vermont’s Better Jobs Better Care demonstration, which is seeking to improve training opportunities for direct-care workers throughout the state.


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