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Source: Susan Reinhard, Enid Kassner, Leslie Hendrickson, and Robert Mollica, AARP's Public Policy Institute, The Commonwealth Fund and The SCAN Foundation, May 2012

The State Long-Term Services and Supports Scorecard ranked states on 25 indicators that comprise the key dimensions of a high-performing system. The Scorecard is designed to help states raise the performance of their long-term services and supports (LTSS) systems by targeting opportunities for improvement. While the Scorecard started a discussion about state LTSS performance, it did not explain why states ranked high, low, or somewhere in between. Therefore, the AARP Public Policy Institute, with support from The Commonwealth Fund and The SCAN Foundation, undertook a series of case studies to provide a deeper context for understanding state performance for the baseline Scorecard. This paper presents an overview of the findings from the case studies.

We studied three states to learn more about the factors that distinguish a high-ranking from a lowranking state. We conducted site visits to the top-ranked state (Minnesota) and to a middle-ranked state (Idaho, ranked 19th) and a low-ranked state (Georgia, ranked 42nd). While three states were intentionally selected to examine the differences among them, the characteristics of one state do not necessarily pertain to those of other, similarly ranked states. For example, two states may have similar ranks, yet achieve them in quite different ways. Figure 1 illustrates the different dimension ranks achieved by North Dakota (ranked 18th overall) and Idaho (ranked 19th overall).

Nevertheless, in the overview of the three case study states, it is apparent that significant factors differentiate a high-ranked state from a low-ranked one. These factors include state policy decisions and administrative structure, as well as features over which the private sector and consumers, rather than the state, have control. Such features include private pay rates for LTSS, the supply of home care workers, nursing home staff turnover, and measures of life satisfaction. Poverty and disability rates also can affect the challenges that states face. Notably, both Minnesota and Idaho have substantially lower than average rates of disability.

Source: Jennifer M. Hitt, Eva Tatum, Mary McNair, Marilyn Harrington, Sandra D. Stanton, Rebecca Askew, Susan Lofton, Jean T. Walker, Amy Robertson, Home Healthcare Nurse, Vol. 30 no. 5, May 2012
(subscription required)

From the abstract:
Ergonomics provides a broad framework for home healthcare nurses to improve their individual physical, psychological, cognitive, and spiritual well-being through application of models for self-care planning. As the individual becomes stronger, more resilient and work hardy, the benefits to the individual, along with the work organization and ultimately the clients, grow exponentially. This article seeks to explore the relevant ergonomic domains and assist home healthcare nurses to develop self-care planning practices that lead to healthy lifestyles and improved quality of life.

Source: Denise Gammonley, Michael Mason, Home Health Care Management Practice, Vol. 24 no. 3, June 2012
(subscription required)

From the abstract:
The history of long-term home health care (HHC) for aging persons in the United States is one of alternating successes and of dashed hopes for persons wishing to remain in their own homes during their last years. Personal issues and public policy issues are woven into a maze of challenges faced by individuals and families wrestling with the difficult choice of elder health care options. Some of the elements of choosing home health care options are presented, and a suggestion of fundamental reform that puts Medicare and Medicaid on the table is suggested as a means to develop a new framework for social work services in home health care.

Source: Irena Kenneley, Home Healthcare Nurse, Volume 30 - Issue 4, April 2012
(subscription required)

From the abstract:
The number of home healthcare clinicians who have acquired an infection as the direct result of patient care is not known. How clinicians practice infection prevention and control in home healthcare is also unknown. To describe infection prevention and control policies and practices in the home healthcare setting, an exploratory study in the form of a 22-question survey was conducted. Findings confirm the presence of occupationally acquired infections among home healthcare clinicians and that infection prevention and control practices vary widely across agencies.

Source: Franchise Business Review, 2012

From the abstract:
Franchise Business Review's special report Senior Care Franchises offers a high-level look at the senior care/home care franchising sector. We explore what services the sector provides, what's involved from an investment standpoint, what the "typical" franchisee looks like, and how franchisee satisfaction in the sector has fared in the past year. We also identify the top senior care franchises based on our franchisee satisfaction research.

To compile the data this report, we surveyed 1,348 franchisees from the senior care sector and researched more than 30 brands. We also talked to CEOs at some of the top senior care franchises for their in-the-trenches take on the industry.

Source: Geoffrey J. Hoffman and Steven P. Wallace, UCLA Center for Health Policy Research, Health Policy Fact Sheet, April 2012

In 2009, an estimated six million caregivers in California provided care to a family member or friend with a long-term illness or disability. Of these caregivers, a significant number - 450,000 persons - were paid for the care they provided. Nearly two-thirds of these paid caregivers, or 290,000, aided a family member or friend receiving Medi-Cal (paid Medi-Cal caregivers). Many of these paid Medi-Cal caregivers more than likely worked for California's In-Home Supportive Services (IHSS) program. Despite being compensated, paid caregivers - and paid Medi-Cal caregivers in particular - fared much worse on a number of economic security indicators.

Source: Genworth Financial, 2012

From the summary:
For the ninth consecutive year, Genworth has surveyed long term care service providers across the country. Genworth's survey includes 437 regions that cover all Metropolitan Statistical Areas defined for the 2010 U.S. census.

Looking back at the past five years of survey results, Genworth recognizes emerging trends across the long term care services landscape. Overall, the cost of care among facility-based providers has steadily increased. For example, in 2007 the median annual rate for a private nursing home room was $65,700, compared with the 2012 median annual rate of $81,030. This means that Americans can expect to pay approximately $15,330 more per year today for a nursing home than they had to pay in 2007. This increase represents a 4.28 percent compound annual growth rate over that period.
In contrast to facility-based care, rates charged by home care providers for "non-skilled" services have remained relatively flat over the past five years. For example, whereas the national hourly private pay median rate charged by a licensed home health agency for a home health aide was $18 in 2007, the 2012 hourly rate has only slowly crept up to $19. The historical compound annual growth rate for this type of care service has been only 1.09 percent over a five-year period. Home care rates have remained flat in part because of increased competition among agencies and the availability of unskilled labor, and because the companies that provide these types of services do not incur the costs associated with maintaining stand-alone health care facilities.
See also:
interactive map

Source: PHI (Paraprofessional Healthcare Institute), August 2011

The State Chart Book On Wages For Personal Care Aides, 2000-2010, prepared by PHI, provides information on the wages received by Personal Care Aides (PCAs) in all 50 states, the District of Columbia and the nation over a decade-long period.

This updated resource provides a state-by-state look at trends in wages for PCAs, the fourth fastest-growing occupation in the country, and a key job title within the direct-care workforce. Prepared as a resource guide on wages for advocates and policymakers concerned with the direct-care workforce, the data underscore the problem of low wages for PCAs, factors which contribute to workforce instability and near-poverty incomes for this high-demand workforce.

Source: SCAN Foundation, 2010-2012

From the summary:
The Long-Term Care Fundamentals series highlights and describes the organization and financing of long-term care in California. Briefs will review different aspects of the organization of long-term care services and providers in California, as well as consider current policy and alternatives that can help to build a strong infrastructure of services and support for individuals and their families.
Articles include:
- Long-Term Care Fundamentals No.1: An Overview of Long-Term Care in California, November 9, 2010
- Long-Term Care Fundamentals No. 2: Organization of Long-Term Care in the Government, November 9, 2010
- Long-Term Care Fundamentals No. 3: The Financing of Long Term Care, November 9, 2010
- Long-Term Care Fundamentals No. 4: Who Needs and Uses Long-Term Care?, November 9, 2010
- Long-Term Care Fundamentals No. 5: Implementing Olmstead in California, January 13, 2011
- Long-Term Care Fundamentals No. 6: The Aging Network, March 22, 2011
- Long-Term Care Fundamentals No. 7: Residential Care Facilities for the Elderly, March 22, 2011
- Long-Term Care Fundamentals No. 8: What is a Medicaid Waiver?, August 4, 2011
- Long-Term Care Fundamentals No. 9: Medicaid-Funded Home- and Community-Based Services, August 4, 2011
- Long-Term Care Fundamentals No. 10: Nursing Facilities in California, January 30, 2012

Source: Dorie Seavey, PHI (Paraprofessional Healthcare Institute), PolicyWorks Blog,15 March 2012

During the past two months, private-duty trade associations have produced three different studies designed to bolster their position that narrowing the overtime exemption would have serious negative consequences for home care companies, clients, and workers. Yet each of these studies presents serious flaws.

In two surveys of their membership, these associations had the opportunity to acquire solid industry data on the employment patterns of home care workers: how many work overtime, and how often; how many work part-time and would like to work more; and how much they are paid. This kind of information could have usefully complemented the U.S. Department of Labor's (DOL) analysis, which relied on all the nationally representative, statistically valid data available on these questions. So, what do the new studies tell us?
Related:
- 2012 Companionship Services Exemption Survey
Source: Private Duty Homecare Association (PDHCA) an affiliate of the National Association for Home Care & Hospice (NAHC), and the National Private Duty Association, January 23, 2012
- Economic Impact of Eliminating the FLSA Exemption for Companionship Services
Source: IHS Global Insight, February 21, 2012
- Estimating the Economic Impact of Repealing the FLSA Companion Care Exemption
Source: Jeffrey A. Eisenach, Kevin W. Caves, Navigant Economics, March 6, 2012