Key Issues for Key Issues for the Long Term the Long Term Care WorkforceCare Workforce

Alliance for Healthcare Reform Alliance for Healthcare Reform RoundtableRoundtable

March 9, 2009March 9, 2009

Markets WorkMarkets Work

Avg wage for direct care workers is $9.56, Avg wage for direct care workers is $9.56, one-third less than all U.S. workers.one-third less than all U.S. workers.

Homecare:Homecare: Avg wage around $8/hour.Avg wage around $8/hour. Less than 10% earned more than $11/hour. Less than 10% earned more than $11/hour. 70% of only able to get part-time work; annual 70% of only able to get part-time work; annual

incomes w – around $17,340. incomes w – around $17,340. Between 30-35% of homecare workers are Between 30-35% of homecare workers are

single parents receiving Food Stamps.single parents receiving Food Stamps. Widespread shortage is a rational economic Widespread shortage is a rational economic

response to the labor market. response to the labor market.

Raising WagesRaising Wages

Requires public policy, public Requires public policy, public resources.resources.

Revise reimbursement systems. Revise reimbursement systems. Require states to take greater Require states to take greater

responsibility for wages and traditional responsibility for wages and traditional employer supports.employer supports.

Use federal approval process for SPAs, Use federal approval process for SPAs, waivers to ensure adequate wages.waivers to ensure adequate wages.

Need mechanism for accountability, Need mechanism for accountability, particularly in PPS.particularly in PPS.

Failure to Address the Failure to Address the Wage Issue….Wage Issue….

Expanding the WorkforceExpanding the Workforce

Fixing the DRA to accelerate Fixing the DRA to accelerate rebalancing, expand consumer-rebalancing, expand consumer-direction.direction. Income eligibility.Income eligibility. Types of services.Types of services. Additional resources for state to invest Additional resources for state to invest

in infrastructure, make structural in infrastructure, make structural changes necessary. changes necessary.

Improving RetentionImproving Retention Encouraging providers to take the “high Encouraging providers to take the “high

road.”road.” NY: Quality Care CommitteeNY: Quality Care Committee PA: Pennsylvanians for Quality CarePA: Pennsylvanians for Quality Care CA: HealthCare Workforce Development Program.CA: HealthCare Workforce Development Program.

Amend WIA:Amend WIA: Allow greater state discretion, greater sectoral Allow greater state discretion, greater sectoral

focus.focus. Expand WIA to allow for Taft-Hartley training Expand WIA to allow for Taft-Hartley training

funds and other labor-management joint ventures.funds and other labor-management joint ventures. Standardize training, develop national Standardize training, develop national

certification.certification.

New Models of CareNew Models of Care

DCWs can be the linchpin for improved DCWs can be the linchpin for improved care coordination for 8.8 million duals, but care coordination for 8.8 million duals, but most need additional skills.most need additional skills.

Unanswered questions:Unanswered questions: Are there capitated payment models that Are there capitated payment models that

produce better results for health outcomes, cost produce better results for health outcomes, cost containment? containment?

Should we rethink the role of consumer choice? Should we rethink the role of consumer choice? Sharing savings with states?Sharing savings with states? SNP reauthorization as a vehicle?SNP reauthorization as a vehicle?

If we get health care If we get health care reform but don’t address reform but don’t address

workforce issues…workforce issues…