Home Care Month 2018: Building a Workforce for the Future

November 2, 2018

Today marks the start of Home Care Month. This is the first of several blogs post reflecting on the current issues impacting the industry.

Every day in this country, 10,000 baby boomers turns 65. This new generation of “elders” are unlike any other to come before it. Economists suggest that these baby boomers control 70% of all US disposable income, yet a large percentage are not well prepared financially for retirement, with savings far below what they are projected to need to “sustain their quality of life.” Thanks to medical advances, these aging boomers should have a longer life expectancy than even the generation before them. They are more educated. They are accustomed to speaking up about their health care needs and they are technologically savvy. And without a doubt, they will be looking for a long-term care delivery system that meets their needs, allows them to age in place with some degree of financial security and with little dependence on their children (whom many boomers are still supporting!).

In short, they will want a high-quality, cost-effective, technologically-advanced home care delivery system. As we celebrate home health care month in Massachusetts and around the country, let’s look at some of what we need to do to make sure we have that in place.

Starting with Workforce Issues

This chart from a recent report from global health care consulting firm, Mercer, depicts what many have written about: There is a huge gap between the availability of a home health aide/personal care workforce and patient need. Massachusetts is among the states expected to feel it the most, and the graphic speaks to how much has to be done in this area.

Home health agencies – dependent on heavily regulated Medicare and Medicaid funding for most of their services – are increasingly unable to offer wage and benefit packages that allow them to compete within the health-care or service-delivery sectors. Added business costs such as the state’s EMAC assessment and mandated paid sick leave make it harder for private home care companies to keep costs affordable and attract workers. Already, many report more demand than they have the workforce to meet.

To ensure an available, productive, and healthy workforce we support:

  • Repealing the onerous EMAC assessment on agencies whose workers access public insurance (Medicaid);
  • Providing premium assistance or pooled purchasing of health insurance for direct care workers;
  • Adequately adjusting Medicaid reimbursements to cover living wages and benefits; and
  • Investing now in the creation of a meaningful, long-term care workforce training, with nurse and aide training funds.

Looking at Technology

There are many who think some of the workforce demand can be offset with the new technologies emerging to support aging at home. These include sensor devices that can detect a multiplicity of conditions and situations including missed meals or medications, a problematic change in weight or blood pressure, or a fall. According to a recent report by the MA state Auditor’s office:

The potential for technological change to impact the labor requirements for home health/direct care workers is considerable. As low cost technologically-based products become available it is likely that these emerging products and services will serve as both substitutes for and complements to home health/direct care occupations.

Most of these technological devices require a receiver to get and act on the collected data. While in some cases this may be a family member, it should also be noted that home care agencies are appropriately poised to be the monitor of remotely transmitted systems, sending a nurse or aide to visit only as indicated. As workforce issues intensify, we would like to see and support:

  • More insurance coverage, including Medicare and Medicaid for remote monitoring devices
  • More modeling of partnerships between private home care companies and technology vendors to test the market for, and price, care extender technologies as part of a private home care plan of care.

Home Care Month is a time to honor the contributions of home health workers who are the lifeline to health care for some many home-bound elders, for isolated and struggling families and for the disabled. Let’s also use this opportunity to listen to and respond to their needs.

Return to www.thinkhomecare.org.


MA Legislative/Regulatory Preview for 2018

January 11, 2018
On Wednesday January 3rd , the Massachusetts Legislature returned for the second year of its two-year session. After a seven-week recess, the body is looking at a traditionally busier second half than the first. The nearly 170 bills that passed in 2017 marked the lowest total in twenty years.

Lawmakers have until July 31 to complete all substantial legislative debate. In addition, all 200 members are up for election in 2018, which is expected to be a distraction from normal legislative work as a result of a polarized political landscape. Here’s what the Alliance will be focused on in 2018:

Workforce Issues:

Prior to the Holiday break, the Alliance met with its ‘Enough Pay to Stay’ partners to strategize coordinated efforts to attain wage relief for direct care workers and ASAP case managers. The coalition has pending legislation which would take steps toward this initiative, but we will pursue other legislative vehicles to fight for our workforce.

Worker Registry:

In November, Governor Baker signed into law the Home Care Worker Registry. This law will establish a worker registry that requires agencies contracting with ASAPs to submit workers’ private information to the state. The law is enacted and subject to regulations. The Alliance and its partners are in active communication regarding next steps toward protecting our members and their workers’ rights.

Licensure:

The FY 2018 State Budget included language that will establish a licensure process for home health agencies providing skilled services. It is unclear at this point when the process to promulgate regulations will begin, but the Alliance will be providing input to the Department of Public Health as these parameters are developed. In addition, Alliance-sponsored legislation that would license private care agencies is still making its way through the legislative process. Under procedural rules, the legislature has until February to report legislation out of committee. The Alliance will continue to advocate for passage of this legislation.

Continuous Skilled Nursing:

In late 2017, MassHealth announced two rate increases for the Continuous Skilled Nursing (CSN) program that totaled nearly 11 million. This was welcomed news, but there remains work to be done. The CSN provider/parent coalition will continue to advocate for the CSN Bill of Rights legislation that would mandate bi-annual reviews of the workforce to ensure safeguards against future crises.

MassHealth Rates:

The Alliance has been informed that MassHealth will conduct a long-overdue review of rates for per-visit nursing, therapies, and home health aide services.  The Alliance will be working to gather data to demonstrate that the current low rates are interfering with agencies’ ability to attract and retain enough workers to meet the demand for services.

MassHealth Reorganization:

MassHealth’s initiative to enroll the majority of members into managed care programs this coming spring will dramatically change the way MassHealth members access home health services, and disrupt many existing provider referral relationships.  The Alliance will continue to work to ensure that MassHealth members retain access to needed home health services, and that agencies are adequately reimbursed for those services.

House of Representative Health Care Bill:

Late last year the Senate passed a health care cost containment bill aimed at curbing costs while maintaining access. It has long been rumored that the House will be embarking on similar initiatives. Though the details are scarce, this legislation could be a vehicle for many of the Alliances priorities in 2018 and we will continue to advocate where necessary.

If you have any questions about the year ahead for advocacy or would like to get involved, reach out to Jake Krilovich, the Alliance’s Director of Legislative and Public Affairs.


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