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States Are Paving the Way for Direct Care Workers

December 3, 2018

When it comes to policy reforms on the direct care workforce, states are increasingly assuming the mantle–creating stronger compensation and training standards, promoting recruitment and retention, and imagining workforce solutions that meet the unique characteristics of their states, among other solutions. What are some highlights from this year, and what’s in store for the years ahead?

Stephen Campbell and Allison Cook drive PHI’s state advocacy around the country, monitoring and advising on key developments for this workforce. In this interview, they reflect on the enormous potential of state leadership in a rapidly evolving policy landscape.

Q: It seems that states are gradually enacting policy reforms that strengthen and stabilize the direct care workforce. What’s driving this trend?

Stephen Campbell: Policymakers are acting now because advocates have successfully explained how the workforce shortage affects society and the economy. The new demand for care has led many states to help people pay for services. Yet they still don’t have enough workers, and people can’t get the services they need.

Q: Allison, we often tout New York as a state that has taken impressive strides toward strengthening the direct care workforce. What are some of those achievements?

Allison Cook: New York has a long history of strengthening this workforce. It has set wage and benefit minimums for certain segments of the home care workforce, passed the nation’s first “Domestic Worker’s Bill of Rights,” and implemented paid family medical leave—among other achievements.

Q: Stephen, is there a state-level policy development from this year that holds promise for the future of the field?

Campbell: Texas will soon collect more data on the home care workforce, which they will use to create workforce solutions. According to the state’s report on this topic, these interventions could support wages, training, supervision, child care support, and peer mentorship for workers. That’s the kind of innovative thinking we need right now.

Q: Allison, what are New York policymakers considering right now for this workforce?

Cook: They are largely trying to figure out what to do about the workforce shortage. How do we ensure that we have enough quality home care workers? We offered some ideas this fall, but it’s going to take a strong, concerted effort from state advocates.

Q: Are there specific New York policy approaches for this workforce that you want other states to replicate?

Cook: Two come to mind. The first is New York’s “Workforce Innovation Program,” which dedicates Medicaid funding to support training for long-term care workers. The second is the state’s new advanced home health aide occupation, which New York is beginning to implement. By allowing advanced aides to administer certain medications, consumers will have better supports and workers will have access to a career ladder.

Q: Stephen, you recently spoke in Maine about the importance of state-based strategies that make long-term care more affordable to the state’s residents. Why are these strategies also important for the direct care workforce?

Campbell: Maine had a ballot initiative that could have gone a long way toward fixing our broken system. Most people spend down their money on care until they’re poor enough to qualify for Medicaid. That disturbing trend also strains state budgets, which in turn limits funding to this sector, exacerbating the workforce shortage in direct care. Programs like the one  proposed in Maine, which was turned down by voters, could save people from poverty and bolster the workforce.

Q: Allison, you’ve written about the differences in need for people who live in rural parts of New York from those who live in urban areas. What are some challenges facing home care workers in rural areas?

Cook: Recruiting and retaining home care workers is even more difficult in rural areas—there are a smaller supply of workers, difficulties with transportation, and many workers struggle to access training. PHI is currently working with a coalition in New York to think through transportation strategies, because it’s such a challenge.

Q: Stephen, you’ve written several case studies where state policy leaders brought together–through work groups and long-term coalitions, as two examples–a range of stakeholders in the long-term care industry to begin transforming direct care jobs in their states. What do you see as the value of this approach?

Campbell: We can only create programs and policies that work for everyone when everyone has a seat at the table. At a minimum, workers, employers, state officials, and people who need care should all have a say. There’s no limit to what we can accomplish when we come together and work toward a common goal.

Q: As you look ahead, where would you want you want state lawmakers to focus their attention regarding this workforce?

Campbell: We need better data on the workforce. We don’t know the precise scope of the workforce shortage, and we rarely ask workers what they need to stay on the job. We can only solve our problems after we have clearly identified and understood them.

Q: Allison, what is one policy aspiration you have for New York’s home care sector in the next year?

Cook: My biggest hope is for the state to establish a Home Care Jobs Innovation Fund. It would support pilot projects to address recruitment and retention in this sector. Policymakers could also use the results from these pilot studies to help address the workforce shortage.

6 Noteworthy State Policy Developments in 2018

  1. Arizona required Medicaid health plans to collect data and develop workforce interventions with the goal of improving recruitment and retention among direct care workers.
  2. Maine passed a bill to increase Medicaid reimbursement rates for direct care workers, helping to improve wages for workers who support older people and people with disabilities.
  3. Massachusetts enacted a law that will require LGBT cultural competency training for state funded or licensed providers of services to older adults.
  4. Minnesota launched Direct Support Connect, a statewide job board that help consumers find workers and helps workers find the right employment fit.
  5. Wisconsin launched WisCaregiver, a training program for new nursing assistants that also matches them with employers.
  6. The Texas Health and Human Services Commission issued a report to improve recruitment and retention among the state’s Medicaid-funded personal care aides.

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