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A Modern Older Americans Act Must Emphasize Direct Care Workers

May 13, 2019

The Older Americans Act (OAA), established in 1965, serves as the largest funding vehicle for aging services in the country. Each year, this legislation grants more than $2 billion to hundreds of area agencies on aging, state agencies, and tribal organizations, as well as more than 20,000 local service providers. Together, these entities form the “aging network,” which ensures that older people have the supports they need to survive and thrive—from transportation to home care to employment supports, and much more. It’s a critical item of legislation that reflects an aging society: people aged 65 and older represent about 15 percent of the total U.S. population—or more than 49 million people nationwide.

Recognizing that the needs of older people change over time, as does the aging services sector, the federal government reauthorizes the Older Americans Act every five years. (The last reauthorization—a three-year extension—took place in 2016 and will expire this year.) This upcoming reauthorization has begun capturing the attention of aging and long-term care advocates, most recently embodied in a new “consensus document” from the Leadership Council of Aging Organizations (LCAO), a national consortium of more than 70 organizations working in support of older people (including PHI). The consensus document delineates more than 60 recommendations for the OAA, including four items—crafted by PHI—that specifically support direct care workers employed through OAA funding.

Here are PHI’s four recommendations for reauthorization of the Older Americans Act—and why they’re needed.

Direct Care Training for Older Workers

Older workers face a host of barriers to employment and job security as they age—a widespread need that the federal government addresses largely through the Senior Community Service Employment Program (SCSEP). This critical program could also serve to train older workers as home care workers, an endeavor successfully tested under Section 502(e) of the OAA. Older workers are already a significant part of the direct care workforce—enhancing their training ensures they have the skills, knowledge, and confidence to succeed in these roles.

Recommendation: “Encourage SCSEP to train older workers to become Home Health, Personal Care Aides, and other direct care workers, as has been successfully tested in 502(e) pilots.”

Acknowledging the Workforce Shortage

A worsening workforce shortage in direct care leaves far too many consumers and their families without much-needed support. As demand for home care surges and direct care jobs remain poor in quality, the shortage will intensify in the years ahead. This recommendation requires the aging network to publicly acknowledge the reality of this shortage, elevating attention on this crisis, while encouraging area agencies and state units on aging to craft plans in response.

Recommendation: “Require area and state plans to include a statement acknowledging gaps and opportunities in the OAA-related home and community-based services (HCBS) workforce in their geographic areas; and encourage state units and area agencies on aging to develop strategies that improve workforce adequacy in OAA-related HCBS.”

Expanding Matching Service Registries

Matching service registries (or “caregiver registries”) are online platforms that connect home care consumers with workers, matching them based on needs, preferences, and availability. Unfortunately, only 19 states house such registries, and many of them are strapped financially and technologically. This recommendation would bolster both the number and quality of matching service registries, better facilitating home care services throughout the country.

Recommendation: “Encourage states to create and fund matching service registries that gather information about the needs and preferences of consumers, and the availability, skills, and preferences of workers, while incorporating, to the extent feasible, reporting on state funding and/or sponsorship of matching service referral registries into state and area plans.”

Recruitment and Retention Grants

While the poor quality of direct care jobs is the primary driver of recruitment and retention challenges for employers, many leaders in long-term care are nevertheless piloting interventions to better find and hold onto workers. This recommendation would fund the aging network to develop innovative recruitment and retention strategies that are adapted to the unique realities of their geographic areas—an idea being advocated at the state-level by PHI and a coalition of New York-based caregiving advocates.

Recommendation: “Establish grant programs that fund the implementation and evaluation of innovative strategies to recruit and retain the direct care workforce in home and community-based services (HCBS), strengthening its ability to provide high-quality care to older adults.”

A New Opportunity with Reauthorization

This spring, PHI began highlighting these recommendations at various policy-related events, including a national gathering of the aging network hosted by the National Association of Area Agencies on Aging (n4A), a Congressional briefing sponsored by the Eldercare Workforce Alliance, and the “Aging in America” national conference in New Orleans. We will continue to work with our DC-based partner organizations to advocate for a stronger focus on direct care workers in the Older Americans Act. Older people rely on direct care workers–and a present-day Older Americans Act will increasingly rely on a strong and stable workforce.

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