Strengthening the Direct Care Workforce
for Long-Term Services and Supports
Suggested Approaches From a National Panel of Experts
Title V of the Patient Protection and Affordable Care Act (2010) is intended to encourage innovations in health workforce training, recruitment, and retention. One area of focus is direct-care workers who provide long-term-care services and supports, as exemplified by the enumeration of a core set of 10 competencies for personal or home care aides. Six states will be awarded funds totaling up to $5 million a year from 2010-2012 to demonstrate approaches to training that will advance these core competencies and to develop training protocols (Justice, 2010). The latter will include a certification test for home care aides who complete this training, and the impact of the training on aides' job skills will be evaluated.
A National Health Care Workforce Commission is going to be established in the latter part of 2010, and it will serve as a resource for Congress and the President. Panelists suggested that, upon request, AoA should provide information to the Commission regarding development, dissemination, and application of evidence-based, best-practice programs designed to advance the training, support and retention of DCWs and informal caregivers. If the Commission makes recommendations regarding the establishment of a national credentialing program for personal care workers, those could be considered by AoA.
Demand for HCBS and the direct-care workers who provide such services is expected to increase as a result of the CLASS Act, the purpose of which is to facilitate community living services and supports. It establishes a new public-private approach to financing long-term services and supports, and gives enrollees flexibility in how to use their cash benefits. In such an environment, the growth of consumer-directed care programs is also likely, which again has implications for family caregivers. For example, there is potential for paid family caregivers to be unionized. In addition, one panelist noted that increased demand in the market for these services could create upward pressure on DCW compensation. Others suggested that AoA could collaborate with CMS on infrastructure grants designed to build the capacity of AAAs for the expansion of HCBS, for serving a private pay market and administering managed care programs.
Patient-centered medical homes, as described earlier, will be established under a federal grant program, and must contract with primary care providers for support services, including care coordination, chronic disease management and care planning. Panelists also suggested that AoA could take a leadership role in promoting evidence-based practices and the involvement of family caregivers in the care of older adults served by medical homes. In addition, AoA could collaborate with CMS to continue investing in ADRCs and/or AAAs; they could play a significant role in care coordination and care transition models in which family involvement and education around anticipated changes in caregiving tasks and demands are critical. They could also provide counseling and education about the use of the benefits under the CLASS Act, although there are still many unanswered questions remaining about the specifics of its implementation.
Approaches Related to Health Care Reform and the CLASS Act
7.1 Provide information upon request to the National Health Care Workforce Commission regarding development, dissemination, and application of evidence-based, best-practice programs designed to advance the training, support and retention of DCWs and informal caregivers.
7.2 Consider recommendations made by the National Health Care Workforce Commission regarding the establishment of a national credentialing program for personal care workers.
7.3 Have AoA take a leadership role in promoting the involvement of family caregivers in the care of older adults served by medical homes and evidence-based practices that medical homes should use to communicate, educate and coordinate care with family caregivers.
7.4 Collaborate with CMS on investing in ADRCs and/or AAAs so that they have a significant role in care transition and care coordination models that emphasize family involvement and education around anticipated changes in caregiving tasks and demands.
7.5 Collaborate with CMS on investing in ADRCs and/or AAAs to provide counseling and education about use of benefits under the CLASS Act.
7.6 Collaborate with CMS on infrastructure grants designed to build the capacity of AAAs for the expansion of HCBS and for serving a private pay market and administering managed care programs.
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