Category Archives: Home Health Workers

Localized Strategies for Addressing the Workforce Crisis in Home Care

Source: Allison Cook, PHI, Issue Brief, November 12, 2019

From the summary:
The United States is facing a home care workforce crisis that profoundly impacts older adults, people with disabilities, and family caregivers. While resolving the crisis will require concerted action at the state and national levels, there is also an important role for local governments and stakeholders to play. This issue brief presents a range of localized strategies for strengthening the home care workforce, along with real-world examples.

Key Takeaways:
• This issue brief presents a range of localized strategies for strengthening the home care workforce, along with examples.
• Local stakeholders are well-placed to identify and implement targeted strategies for strengthening the home care workforce.
• The home care workforce crisis reverberates across local regions, states, and the nation, and must be addressed at each of these levels.

5 Obstacles to Home-Based Health Care, and How to Overcome Them

Source: Pooja Chandrashekar, Sashi Moodley, Sachin H. Jain, Harvard Business Review, October 17, 2019
(subscription required)

One of the most promising opportunities to improve care and lower costs is the move of care delivery to the home. An increasing number of new and established organizations are launching and scaling models to move primary, acute, and palliative care to the home. For frail and vulnerable patients, home-based care can forestall the need for more expensive care in hospitals and other institutional settings. As an example, early results from Independence at Home, a five-year Medicare demonstration to test the effectiveness of home-based primary care, showed that all participating programs reduced emergency department visits, hospitalizations, and 30-day readmissions for homebound patients, saving an average of $2,700 per beneficiary per year and increasing patient and caregiver satisfaction.

There are tremendous opportunities to improve care through these home-based care models, but there are significant risks and challenges to their broader adoption. Let’s look at five key barriers to moving care to the home and explore potential solutions to overcoming these challenges.

Envisioning the Future of Home Care: Trends and Opportunities in Workforce Policy and Practice

Source: Kezia Scales, PHI, October 15, 2019

From the summary:
Envisioning the Future of Home Care: Trends and Opportunities in Workforce Policy and Practice
This report identifies opportunities for strengthening the home care workforce and improving home care access and quality. The report has three parts: Part I describes the current and projected home care landscape, focusing in turn on consumers, workers, and the sector, while Parts II and III begin building a vision for the future of home care services in the United States. The report culminates with recommendations for achieving this vision.

Key Takeaways
• Fifteen million adults living at home in the United States require some degree of personal assistance.
• Home care workers provide more paid support than any other segment of the HCBS workforce.
• What are the main factors impacting the home care delivery system and workforce in the United States?

U.S. Home Care Workers: Key Facts (2019)

Source: PHI, September 3, 2019

From the abstract:
This research brief provides the latest annual snapshot of the U.S. home care workforce, including key demographics and a variety of wage and employment trends. This year’s research found that nearly 2.3 million home care workers earn a median hourly wage of $11.52 and about $16,200 annually. One in six home care workers lives below the federal poverty line and more than half rely on some form of public assistance.

Key Takeaways:
– Nearly 2.3 million home care workers provide personal assistance and health care support to older adults and people with disabilities.

– From 2016 to 2026, the home care sector will need to fill 4.2 million home care worker job openings.

– With a median hourly wage of $11.52 and inconsistent work hours, home care workers typically earn $16,200 annually.

Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission

Source: California Future Health Workforce Commission, February 2019

From the summary:

California’s health system is facing a crisis, with rising costs and millions of Californians struggling to access the care they need. This growing challenge has many causes and will require bold action by the new governor, legislators, and a broad spectrum of stakeholders in the public and private sectors. At the core of this challenge is the simple fact that California does not have enough of the right types of health workers in the right places to meet the needs of its growing, aging, and increasingly diverse population.The California Future Health Workforce Commission has spent nearly two years focused on meeting this challenge, issuing a new report with recommendations for closing California’s growing workforce gaps by 2030…..

…..The Commission’s final report includes a set of 27 detailed recommendations within three key strategies that will be necessary for: (1) increasing opportunities for all Californians to advance in the health professions, (2) aligning and expanding education and training, and (3) strengthening the capacity, retention, and effectiveness of health workers. Throughout its deliberations, the Commission has focused on the need to increase the diversity of the state’s health workforce, enable the workforce to better address health disparities, and incorporate new and emerging technologies.

While advancing all 27 recommendations over the next decade will be important, the Commission has high-lighted 10 priority actions that its members have agreed would be among the most urgent and most impactful first step toward building the health workforce that California needs.

To make these proposals a reality, the Commission also recommended establishing statewide infrastructure, starting in 2019, to implement the recommendations in partnership with stakeholders, to monitor progress, and to make adjustments as needs and resources change. This statewide effort will need to be paired with strong regional partnerships to advance local workforce and education solutions.

The Commission’s 10 priorities for immediate action and implementation are:
1. Expand and scale pipeline programs to recruit and prepare students from underrepresented and low-income backgrounds for health careers….
2. Recruit and support college students, including community college students, from underrepresented regions and backgrounds to pursue health careers….
3. Support scholarships for qualified students who pursue priority health professions and serve in underserved communities….
4. Sustain and expand the Programs in Medical Education (PRIME) program across UC campuses….
5. Expand the number of primary care physician and psychiatry residency positions….
6. Recruit and train students from rural areas and other underresourced communities to practice in community health centers in their home regions….
7. Maximize the role of nurse practitioners as part of the care team to help fill gaps in primary care….
8. Establish and scale a universal home care worker family of jobs with career ladders and associated training….
9. Develop a psychiatric nurse practitioner program that recruits from and trains providers to serve in underserved rural and urban communities….
10. Scale the engagement of community health workers, promotores, and peer providers through certification, training, and reimbursement….

Together, the Commission’s prioritized recommendations will:
● Grow, support, and sustain California’s health work-force pipeline by reaching over 60,000 students and cultivating careers in the health professions.
● Increase the number of health workers by over47,000.
● Improve diversity in the health professions, producing approximately 30,000 workers from under-represented communities.
● Increase the supply of health professionals who come from and train in rural and other underserved communities.
● Train over 14,500 providers (physicians, nurse practitioners, and physician assistants), including over 3,000 underrepresented minority providers.
● Eliminate the shortage of primary care providers and nearly eliminate the shortage of psychiatrists.
● Train more frontline health workers who provide care where people live…..

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions

Source: Carolyn C. Foster, Rishi K. Agrawal, and Matthew M. Davis, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Historical Mismatch Between Home-Based Care Policies And Laws Governing Home Care Workers

Source: Lisa I. Iezzoni, Naomi Gallopyn, and Kezia Scales, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
Americans generally want to remain in their homes even if they develop chronic health problems or disabilities that qualify them for nursing home care. While family members or friends provide the preponderance of home-based support, millions of Americans use paid personal assistance services (PAS). Inexorable demographic trends are increasing the numbers of people who need paid home-based PAS, with this need rapidly outstripping the capacity of the paid PAS workforce. While many factors contribute to this widening discrepancy, its roots reach back more than eighty years to asynchrony among various policies affecting home-based supports for people with functional impairments and policies affecting home-based PAS workers. Finding solutions to the growing gap between demand for the services and the PAS workforce requires policies that cut across societal sectors and align incentives for consumers, workers, and other key stakeholders.

Related:
Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises
Source: Susan Jaffe, Health Affairs, Vol. 38, No. 6, June 2019

Care For America’s Elderly And Disabled People Relies On Immigrant Labor

Source: Leah Zallman, Karen E. Finnegan, David U. Himmelstein, Sharon Touw, and Steffie Woolhandler, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
As the US wrestles with immigration policy and caring for an aging population, data on immigrants’ role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants’ role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants’ role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2 percent of health care workers and 23.5 percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5 percent) of direct care workers and 30.3 percent of nursing home housekeeping and maintenance workers were immigrants. Although legal noncitizen immigrants accounted for 5.2 percent of the US population, they made up 9.0 percent of direct care workers. Naturalized citizens, 6.8 percent of the US population, accounted for 13.9 percent of direct care workers. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans.

Home And Community-Based Workforce For Patients With Serious Illness Requires Support To Meet Growing Needs

Source: Joanne Spetz, Robyn I. Stone, Susan A. Chapman, and Natasha Bryant, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
Home health and personal care aides are one of the largest groups of health care workers in the US, with nearly three million people providing direct care for people with serious illness living in the community. These home care workers face challenges in recruitment, training, retention, and regulation, and there is a lack of data and research to support evidence-based policy change. Personal care aides receive little formal training, and they experience low pay and a lack of respect for the skill required for their jobs. High turnover and occupational injury rates are widely reported. There is little research on the factors associated with higher-quality home care, the extent to which worker training affects client outcomes, and how regulations affect access to and quality of home care. Health care leaders should seek to fill these gaps in knowledge, support the establishment of training standards and programs, implement Medicaid reimbursement strategies that incentivize improvements in pay and working conditions, reform regulations that now prevent the full utilization of home care workers, and create sustainable career pathways in home care policies.

Conservatives Pushed a Strategy to Weaken Home Health Care Unions. The Trump Administration Bit.

Source: Rachel M. Cohen, Nick Surgey, The Intercept, May 31, 2019

Earlier this month, the Trump administration announced a new rule barring home health care workers from paying union dues through their Medicaid-funded wages. The new Department of Health and Human Services rule, which will impact more than 800,000 workers and was immediately met with a legal challenge, followed years of planning by anti-union activists to promote such measures in states across the country, and, more recently, on the federal level.

In anticipation of a crushing blow to public-sector unions by the U.S. Supreme Court last summer, conservative groups ramped up their efforts to bring the federal government’s attention to the issue of Medicaid-funded union dues, according to an audio recording obtained by The Intercept and Documented.

On an invitation-only call with donors last June, leaders with the State Policy Network — a corporate-backed umbrella group of right-wing think tanks across the country — raised the issue of directly deducting union dues from Medicaid-funded paychecks, what they call “dues-skimming.” Vinnie Vernuccio, a labor policy adviser to the State Policy Network told donors that its plan was to end this practice by getting “an administrative rule passed at Health and Human Services” and passing federal legislation with the assistance of Rep. Cathy McMorris Rodgers, R-Wash…..