Category Archives: Home Health Workers

Medicaid Home and Community-Based Waivers: CMS Should Encourage States to Conduct Mortality Reviews for Individuals with Developmental Disabilities

Source: Government Accountability Office, GAO-08-529, May 23, 2008

From the summary:
Deaths of individuals with developmental disabilities due to poor quality of care have been highlighted in the media. Prior GAO work has raised concerns about inadequate safeguards for such individuals receiving care through state Medicaid home and community-based services (HCBS) waivers. CMS approves and oversees these waivers. Safeguards include the review of, and follow-up action to, critical incidents–events that harm or have the potential to harm waiver beneficiaries. GAO was asked to examine the extent to which states (1) include, as a critical incident, deaths among individuals with developmental disabilities in waiver programs; (2) have basic components in place to review such deaths; and (3) have adopted additional components to review deaths.

Labor on the Home Front: Unionizing Home-Based Care Workers

Source: Eileen Boris and Jennifer Klein, New Labor Forum, Vol. 17, Issue 2, Summer 2008

Once known as “the invisible workforce,” the nation’s 1.4 million home health care aides and 1.8 million home child care providers are changing the face of organized labor. These frontline caregivers meet the personal needs of those requiring assistance, from children, to the elderly, to the disabled. Disproportionately African American, Latina, and immigrant women, these low-waged workers seized national attention in 1999 when 74,000 Los Angeles home health care aides voted to enter the SEIU, pulling off the largest successful union drive since the sit-down strikes of the Great Depression. Six years later, nearly 50,000 Illinois home child care providers followed in their footsteps. In less than a decade, hundreds of thousands of home-based care workers have entered into coalitions with parents, senior citizens, and disability activists. They poured into SEIU, AFSCME, and AFT, but also responded to community organizing efforts of ACORN, local grassroots groups, such as Brooklyn’s Families United for Racial and Economic Equality, and occupational associations, such as Milwaukee’s Providers Taking Action.

LABOR-MANAGEMENT PARTNERSHIPS: A New Approach to Improving Direct Support Jobs in California

Source: On the Move, Spring 2008
UC Berkeley Labor Center

The Oakland-based nonprofit, which provides an array of direct support services to people with developmental disabilities, recently entered an innovative labor-management partnership that Tom Heinz, executive director of East Bay Innovations (EBI), hopes will stabilize his staff of 100 and improve services to their 190 clients. Absent state action to address the staffing crisis on a sector- wide basis, creativity and innovation have had to emerge from the bottom-up. The Consumer Directed Service Network (CDSN) is a new initiative, whose design is largely based on the recommendations of Labor Center Senior Labor Policy Specialist Carol Zabin. CDSN incorporates a three-pronged approach to reforming the direct support DD service industry.

Building Bridges Radio: Domestic Workers Uniting – Your Home, My Work

Source: Mimi Rosenberg and Ken Nash, WBAI’s Building Bridges: Your Community and Labor Report, March 7, 2008

From the summary:
Domestic workers to tell their stories – of their pains, their pride and their efforts to organize. Women of color, from around the world work as domestic workers. Most are employed without a living wage, health care, and basic labor protections.

Laws of Care: The Supreme Court and Aides to Elderly People

Source: Eileen Boris and Jennifer Klein
Fall 2007

“There’s no place like home”–unless you’re one of the 1.4 million home aides who assist elderly and disabled people but whom the Supreme Court last June abandoned to the feudal manors of the past. In Long Island Care at Home v. Evelyn Coke, the justices unanimously determined that the Department of Labor had the authority to place providers of home care outside the labor law. For seventy years, the Fair Labor Standards Act (FLSA) has guaranteed minimum wage and overtime compensation to the nation’s workers, but somehow one of the fastest growing occupations of the twenty-first century doesn’t deserve the status and protection of formal employment.

Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

Source: Congressional Research Service

Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient.

Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the United States. As a result of increases in life expectancy, as well as the aging of the baby-boom generation, demand for family caregiving to the older population is likely to increase. However, demographic trends such as reduced fertility, increased divorce rates, and greater labor force participation among women may limit the number of available caregivers to older individuals, as well as the capacity for caregivers to provide needed care.

Although many family caregivers find caregiving for an older family member a rewarding experience, other life circumstances, in addition to caregiving, may increase caregiver stress. For example, family members may not live in close proximity to the care recipient, they may face the competing demands of child care and elder care, and they may have to manage work with caregiving responsibilities. As a result, family caregiving can lead to emotional and physical strain and financial hardship. These effects are more likely to be felt among those caring for persons with high levels of disability or cognitive impairment. Caregiver stress has been linked to nursing home admission for the care recipient, thus interventions that can reduce stress may also reduce nursing home placement.

Recognizing family caregivers as an important part of the nation’s long-term care delivery system, the federal government has established programs and initiatives that provide direct supports to caregivers, such as respite care, education and training, tax relief, and cash assistance. These benefits are targeted at family caregivers to reduce stress and financial hardship, and to improve caregiving skills, among other things. Other federal programs and initiatives provide home- and community-based long-term care services and supports to the care recipient. These programs can indirectly benefit caregivers in relieving caregiver burden by either supplementing the informal care they are providing or substituting with paid support.

Three sets of policies that would provide direct assistance to family caregivers to older adults are briefly discussed in the last section of this report. These policy issues, which have been the subject of discussion among federal policymakers and other interested stakeholders, include the following: caregiver services and supports, flexible workplace accommodations and income security, and additional tax credits.

CMS Announces Payment Changes for Medicare Home Health Services

Source: Centers for Medicare & Medicaid Services (CMS), 42 CFR Part 484, [CMS-1541-FC], RIN 0938-AO32, 2007

From press release:
The Centers for Medicare & Medicaid Services (CMS) today issued a final rule to refine and update the Home Health Prospective Payment System (HH PPS) for Calendar Year (CY) 2008. This final rule reflects the ongoing efforts of CMS to support beneficiary access to home health services and improve the quality and efficiency of care provided to Medicare beneficiaries through more accurate payments for services rendered. Refinements to the Medicare HH PPS as well as the annual update to the Medicare payment rates for home health services will disburse an estimated additional $20 million in payments to home health agencies in CY 2008.
Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008; Final Rule with comment period on display in the Federal Register on August 22, 2007
Fact Sheet

2007 National Home and Hospice Care Survey to Begin Including New Home Health Aide Supplement

Source: National Center for Health Statistics, Centers for Disease Control and Prevention, June 29, 2007

From press release:
The 2007 National Home and Hospice Care Survey (NHHCS) conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, will begin in August 2007 to collect information on this important segment of health care in America. The latest in a series of surveys about home health agencies and hospices, the 2007 survey will include a first-ever, nationwide survey of home health aides, the group that provides the majority of direct care to the Nation’s 1.5 million home health and hospice patients.

See also:
National Home and Hospice Care Data