Building a Strong Personal Assistance Services Workforce A presentation of the Paraprofessional Healthcare Institute Paraprofessional Healthcare Institute PHI is a 10-year old non-profit national organization headquartered in the South Bronx, NY. Our mission is to create high quality jobs for direct-care and personal assistance workers in the long term care continuum and in home and community based services. PHI, who we are: PHI is a ten-year old nonprofit organization headquartered in the South Bronx that focuses exclusively on paraprofessional employment with in the long-term care industry -- the work of home health aides, certified nurse aides and direct support workers. Mission: · To create decent jobs for low-income individuals. Especially women who are unemployed or transitioning from welfare to work; and · To provide high-quality health care to clients who are elderly, chronically ill or living with disabilities PHI serves this mission by helping to shape both day-to-day industry practice and long-range public policy. Direct Workforce Experience Worker-owned agency in the South Bronx Enterprise Development in NY, PA, NH, MI and AK Independence Care System PHI's primary background is on the long-term care side. We grew out of a worker owned home care agency in the South Bronx. Today that agency has over 650 workers and is part of a network of enterprises and training programs in New York, Pennsylvania, New Hampshire, Michigan and Arkansas. We have also had much experience working in facility-based settings. We also have experience in providing services and support to people living with disabilities. We are the prime sponsor of Independence Care System -- a Medicaid funded demonstration in New York City serving adults with significant disability or chronic illness who are nursing home eligible but are living in their own homes. We have also worked with various programs of independent living. Workforce Recruitment and Retention Project Purpose: Funded by CMS to identify for Systems Change Grantees Tools Resources Innovative practices ...in the recruitment and retention of personal assistant services workers. Last fall, PHI received funding for one year from CMS to conduct research on the adequacy and availability of personal assistance services for persons of all ages with a disability or long-term illness. Products: Fact Sheets/ Issue Briefs Supervisory Training Curriculum Return on Investment Analysis Final Report to Systems Change Grantees Specifically our goal is to serve the "Systems Change" grantees by identifying tools, resources, and innovative practices for recruitment and retention of personal assistance services workers. Resources will include: ·Fact Sheets on key elements in recruiting and retaining workers, ·Supervisory Training Curriculum, ·Return on Investment Analysis (net cost to states of increase in PAS worker wages) ·Final report to grantees on all our findings. Dissemination: Through the National Clearinghouse on the Direct Care Workforce and searchable web-based database : www.directcareclearinghouse.org This material will be made available through a searchable web-based database at www.directcareclearinghouse.org the website of the National Clearinghouse on the Direct-Care Workforce. We will be reaching out widely to collect this information. We see this meeting as the beginning of that process. While we are here today to share lessons learned from our years working on workforce issues, we also want to learn from you. We want to know what are your needs so that we can tailor our efforts on this project to meet them. And we want to know what you are doing. Because in many cases you may be involved in activities that others here can learn from. The Demographic Imperative States already reporting worker shortages Elderly population will double by 2030 The traditional personal assistance worker population is only expected to grow 7% Currently- the ratio of potential workers to consumers is: 2 : 1 In 2030 - the ratio is expected to be less than: 1 : 1 Through Systems change grants and other activities States are building home and community-based systems to give individuals choices of where and how to receive services. One of the big challenges states are likely to face in addressing the need for workers to provide these services. Systems Change will increase demand and is coming at a time when many states are already reporting a shortage of such workers. And not to paint too bleak a picture, demographic tends tell us that the situation will worsen in the decades to come. One way we dramatize this in terms of long-term care for the elderly is to compare the demand for care to the supply of caregivers. Over the next thirty years, the U.S. elderly population is projected to double while the "traditional" caregiving population -- woman between the ages of 25 and 54 -- is projected to rise by only seven percent. Overlay on this the increase in demand for home and community-based services for people with disabilities and the increase in the size of the younger population with disabilities and the gap between demand for services and the supply of workers widens even further. Which is just to say, that now is the right time to be looking at these issues before these demographic trends come to pass and we are faced with a crisis too big to come to terms with. It is very encouraging that so many are already gathering in response. Many sates have already identified workforce as an issue and are taking action. Many of you here have built it into your systems change grants. The federal government has taken notice and particularly Thomas Hamilton of CMS has been a leading voice. And it is not just government but all stakeholders, consumers, workers, providers coming together to craft solutions. Terminology Today, we'd like to share with you some of the lessons we've learned on recruiting and retaining direct support/direct care workers form our own work. As this project continues, we look forward to continuing this dialogue with you and sharing with you specific examples from the world of personal assistance services Before starting, I want to acknowledge the complexity of talking about this issue. Workers go by many names -- personal attendants, personal assistance service workers, direct support professionals, home health care aides. They can be hired through a number of different means -- directly by the consumer, through an agency, through a government registry. They may have very different levels of training and people here may have different perspectives on the desirability of training. They are funded by a wide variety of programs- Medicaid, Waiver programs, Older Americans Act, state programs. The Essentials of a Quality Job PHI has identified these elements as essential in creating a good job and a stable workforce: Wages and Benefits Recruitment Training Supervision Support Despite all these variables, there are five essential elements for creating a stable workforce that cut across all settings. 1. Competitive wages and benefits - family self sufficient wages health insurance plus 2. Recruitment - that screens for maturity, problem-solving skills, and desire to be a caregiver 3. Training - designed to adapt to individual consumer needs, adult centered, Stresses problem solving 4. Supervision - sets high standards of expectation, uses coaching approach 5. Support - Ongoing advice from peers, case management, maximizes public services There is sometimes a tendency to think of them as Wages and Benefits and Everything Else - [recruitment, training, support and supervision]. It is possible to get too caught up on wages and benefits. Improving wages is a necessary but not sufficient means for improving retention. Experience shows that while wages and benefits may initially attract workers to a position the other elements are critical to ensuring that they stay on the job and provide quality service. We have found is that you really need to approach this as a whole to permanently effect recruitment and retention of workers. Having just said that, I do not want to minimize the importance of wages and benefits either. I would like to spend the next few minutes talking about wages and benefits before moving on to spend most of the hour discussing the other elements. Wages and Benefits Wages and Benefits Direct care workers are a scarce resource but we don't value them as such. In 1999, the median wage of direct care workers was $7.97 per hour (and of all direct-care workers, Personal and Home Care Aides earn the least). $7.97 is one-third less than the median wage for all workers (11.87 per hour). Compare to other workers: Personal and Home Care $7.50/hr Home Health Aides $8.21/hr Production Workers $8.37/hr File Clerks $8.94/hr Receptionists $9.21/hr According to the U.S. General Accounting Office, Median income for all home-based direct care staff was $12,265 per year. 18 percent of home care aides have family income below the federal poverty level compared to 11 percent for all workers in the U.S. These workers are twice as likely to receive public benefits than other workers, more likely to be uninsured, more likely to depend on Medicaid for their health coverage, more likely to rely on food stamps to help put food on the table. This is a hidden subsidy taxpayers provide to those employing direct care workers. This is one of the reasons CMS has directed us to do a return on investment analysis to show that investments in wages and benefits may be offset by reductions in other costs as well as increases in tax revenues. We look forward to sharing those results with you when we have them. So it is no surprise that increasing wages can improve recruitment and reduce turnover significantly. Ø Research on the impact of an increasing wages and providing insurance to direct care workers in San Francisco showed a 35 percent increase in the number of workers after three years. Ø In September of last year, the state of Alaska increased wages from $12 an hour to $21 for personal assistants an hour as part the implementation of a consumer directed model for services. And they are now proposing a further increase to $25 an hour in an effort to improve worker recruitment and retention. Ø A recent study of the Wyoming Department of Health recommended almost a 50 percent increase in entry-level salaries for direct care staff to an average of $10.23 per hour from the current level of $6.92 to be competitive in the labor market. Video Clip Before turning the program over to Peggy Powell and Mary Ann Wilner, we thought we'd share with you a real life example of the workers we're talking about. Here is a brief clip from Heartwork a video produced by PHI in collaboration with Home Care Associates of Philadelphia which chronicles the development of an original theater piece performed by workers about their work and lives.