The direct-care workforce, including nursing assistants, home health aides and personal care aides, is expected to be the nation’s largest workforce by 2020 according to a new PHI analysis. Direct-care occupations are projected to add an additional 1.6 million jobs to the economy over the next decade. Yet as the number of workers increases, the wages for these jobs continue to decrease and the number of workers without health care coverage has increased.

“It’s quite striking that probably the largest workforce ever produced by our economy is largely made up of women who struggle with inadequate conditions of employment as they try to make ends meet,” said Dorie Seavey, PHI Policy Research Director.

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Springtime is a season full of many events with family and friends – graduations, Memorial Day weekend, weddings and more. Many nursing home residents may be under the impression that they will lose Medicare coverage if they leave the facility to join their loved ones during these festivities; this is not true.

The Medicare Benefit Policy Manual states: “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.”

For more information, read the update on Center for Medicare Advocacy, Inc.’s website.

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This past Monday staff members from The Consumer Voice had the opportunity to attend a legislative Town Hall meeting sponsored by Caring Across Generations, entitled Transforming The Way We Care. Caring Across Generations is a national movement transforming the way people care by making sure that people with disabilities and seniors get the support they need to continue to live independently in their homes, that the workers who provide that support have quality jobs, and that the workers and consumers are treated with dignity and respect. The Town Hall meeting highlighted personal stories of constituents across the country who spoke about the importance of current long-term care funding supports and the need for a comprehensive legislative solution to the long-term care crisis. Mirla Nowla discussed her experiences as a direct care worker. Since her agency classifies her as an independent contractor, they do not have to pay her minimum wage, overtime, or worker’s compensation. Mirla believes direct care workers should be able to form unions to negotiate fair wages.

After highlighting these personal stories, Caring Across Generations then shared its five pillars of policy it advocates for the improvement of long-term care services. These policy initiatives focus on the importance of job creation and job quality for care workers, improving workers’ training and career development opportunities, providing immigrant care workers a more accessible path towards legalization, and better support for consumers and their families. More details about these policies can be found on the Caring Across Generations’ website, http://www.caringacrossgenerations.org.

Senator Tom Harkin of Iowa, who assisted with organizing the Caring Across Generations forum, has introduced S. Res. 453 in the Senate. This resolution calls for the need of a comprehensive approach to expanding and supporting a strong home care workforce, as well as making long-term services and supports affordable and accessible to elders and people with disabilities. S. Res. 453 is an important legislative step towards bringing greater Congressional attention to long-term care issues and is currently pending in the Senate Committee on Health, Education, Labor, and Pensions, of which Senator Harkin serves as Chairman.

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This summer Nursing Home Compare will get a redesign and new information required by the health care reform law, the Affordable Care Act. The Centers for Medicare & Medicaid Services say new features, which will go online in July or August, will modernize the 14-year-old site and make it easier for users to navigate its pages.

• Names of nursing homes’ owners.
• Links to facilities’ full survey reports (Form 2567) on the CMS website. As they become available, three years of survey reports will be provided.
• Quality measures for antipsychotic drug use.
•  Physical therapist hours per resident day.
• Quality measures changed to reflect the new MDS 3.0 resident assessments.

• Less text on pages.
• A format allowing users to click on tabs to compare homes’ general information (star ratings and nurse staffing and therapy hours); inspections and complaints; quality measures; and penalties.
• Graphs showing facilities’ relative performance on quality measures.
• A map allowing searches by geographic area.

The changes were unveiled by CMS and the contractor for the redesign, Abt Associates, at a meeting with consumer and provider groups May 16.

Although strongly welcoming the new information, advocates expressed disappointment at some details—for example, that ownership information will come, initially at least, from CMS’s PECOS system, and not from comprehensive disclosures required by the ACA. PECOS was criticized by the GAO [http://www.gao.gov/new.items/d10710.pdf] for inconsistency and incompleteness. The new system is off-schedule with final regulations not expected until December.

Information on survey reports will be redacted to protect privacy. Redactions in the examples provided, however, were confusing and withheld crucial information, such as the name of an improperly administered drug.

Consumer advocates were concerned about several other CMS proposals that are being considered:

• Excluding residents with certain mental health diagnoses from antipsychotics data. Advocacy groups are asking CMS to report the total number of residents who receive the drugs.
• Reporting “consumer satisfaction” surveys, potentially factoring them into the 5-Star Rating System.

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The new Aging Network Volunteer’s Collaborative created and funded by the U.S. Administration on Aging, the National Association of Area Agencies on Aging (n4a), the National Association of States United for Aging and Disabilities (NASUAD), AARP Foundation, the Corporation for National and Community Service (CNCS), and the Council for Certification in Volunteer Administration (CCVA) introduces the National Resource Center for Nonprofit Engagement in the Aging Network website, network, and resources.

The resource center website provides step-by-step guidance for starting an aging services volunteer program, enhancing a program and sustaining a successful aging services volunteer program. The resource center encourages individuals working in the aging services volunteer network to share their successful practices and learn from each other. The website also offers a resource library, blogs, space to post volunteer opportunities, registration to join the community and free training opportunities such as the recent 3-part series for Aging-Network Leaders and Volunteer Program Leaders.

The webinar series for Aging-Network Leaders titled, “Volunteers: A Theory of Organizational Abundance” offered three 45-minute webinars demonstrating how to expand an organization’s capacity by utilizing the experience of skilled volunteers.

The webinar series for Volunteer Program Leaders titled, “The New Human Capital: Mobilizing the Power and Potential of Today’s Skilled Volunteers” offered three 45-minute webinars addressing how to convince those in leadership that a volunteer program is worth the investment, how to craft effective recruitment messages and how to determine and maximize volunteer commitment by developing an “onboarding” process. 

Both tracks of the recent webinar series and additional resources are available on the resource center website: http://agingnetworkvolunteers.org/.

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CMS says there has been “a slight but consistent increase” in the proportion of nursing homes that receive the highest overall ratings on its five-star rating system. There has also been a drop in the proportion of nursing homes with one-star ratings, while the proportion of facilities in the middle—with two or three stars—has not changed significantly.

·         The proportion of facilities receiving overall five-star ratings increased from 11.8% to 15.9% and those receiving four stars increased from 23.4% to 27.4%.

·         1-star facilities declined from 23% to less than 16%.

·         There were upward trends in the staffing component of the ratings, with five stars increasing from 7.2% to 8.9% and for four stars from 31 to 39%.

·         Nursing homes with one star for staffing decreased from 23% to 14%.

·         CMS said there was “general improvement” in health inspection scores, and it called the improvement in quality measure ratings “quite dramatic.”

·         Non-profit and government-owned nursing homes continue to be higher-rated than for-profit homes. Fewer than 5% of for-profit facilities received five stars, and 17% received one star. However, almost 19% of non-profit and 24% of government-owned nursing homes received five stars, with only 5% receiving one star.

·         Small homes do better. Nearly one-third of facilities with fewer than 50 beds received an overall 5-star rating, compared to 18% with 50-99 beds, 11% with 100-199 beds, and 7% with more than 200 beds.

·         There is a strong relationship between facilities’ health inspections and their staffing.

 CMS is modifying the way it calculates quality measure and staffing data as it transitions to data from the new MDS 3.0 resident assessment system. It says the majority of nursing homes will see changes in their ratings even though the overall distribution of the ratings will remain the same.

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