22-05-2012, 03:47 PM
Health and Human Services
Direct-Care-Worker-Report-1-26-2010.doc (Size: 169.5 KB / Downloads: 47)
EXECUTIVE SUMMARY
The Direct Care Worker Task Force was convened by the Department of Health and Human Services (DHHS) to review LDs 400, 1078 and 1364; to recommend changes to direct care worker employment policies and training programs; and to gather information about a health insurance demonstration project for LD 1059. Worker and employer members agreed that deliberate and systematic changes are necessary to resolve the issues of too many different job titles, varied qualification and training requirements, financial barriers to training and health benefits, and training credentials that are not recognized or transferable across programs, inconsistent and inequitable wages and benefits. The Task Force reviewed DHHS personal care services, program rules, workforce titles, training and wages, and health insurance proposals and recommends that DHHS and the Legislature support steps to:
1. Develop a rational, equitable, clear framework for defining jobs, administering compensation, designing and delivering training, and ensuring a sufficient and quality workforce.
2. Set rates for all titles to include wages, benefits (including health insurance and workers’ compensation), training, travel, supervision, administrative costs (including but not limited to, liability insurance, recruitment costs, background checks, and motor vehicle violation checks) in order to establish and achieve wage levels, transparency, and parity across programs.
3. Ensure participation of direct care workers in the federal grant recently awarded to the Governor’s Office of Health Policy and Finance to provide affordable health insurance for uninsured low income direct care workers, part-time, and seasonal workers.
4. Establish a statewide job classification system of direct care and direct support job titles, focusing on personal care jobs within the DHHS home-and-community-based service programs
5. Develop a logical sequence of employment tiers, showing employment and training links among long-term care and acute care jobs – in both facility-based and home-based services;
6. Continue the work that’s been started in order to complete the development of the classification system (pursuant to LD 1078 and LD 400) and implement a systemic approach to Maine’s long-term care programs and policies. Consider creating a multi-departmental mechanism with the responsibility and authority to implement the recommendations.
CONTEXT
An estimated 22,000 people in Maine are currently employed in jobs to provide personal care, aide and support services to elders and people with disabilities living in their homes and communities, and in residential and nursing care facilities. The aging population, along with increasing demands for consumer-preferred, lower-cost, quality assured, home and community-based options are contributing to an increasing and long-term demand for direct care/support services. “Personal care,” defined generally as the broad set of personal care (ADL, IADL) and personal support (housekeeping, cooking) is currently a covered service, available to eligible consumer/clients, in over 25 different federal and/or state- funded programs administered through the Maine Department of Health and Human Services. The legislative and administrative processes that established these programs include rules to manage them, and these rules include staff specifications- such as job functions, qualifications, background check and training requirement. Since personal care services are provided by “unlicensed” personnel, there is no single universal title or standardized training credential required. The combined effect of these practices – the requirement for programs to identify job specifications, and the absence of standardized specifications for personal care job, has permitted personal care jobs to be defined by the programs that employ them, in a parallel job creation process, some with unique titles and others generally referenced as the “unlicensed assistive personnel”. An inventory of Maine’s publicly-funded long term care program illustrates the cumulative outcome: Within the 25 programs, mentioned above, more than 20 different job titles are used for the staff persons who perform “personal care services”. While this could be a diverse group of customized jobs, with unique functions and specialized skills, a closer comparison shows a different picture. Many of these titles have similar job functions and entry-level qualification requirements, but their titles, training requirements and training programs, wage rates and/or benefit options are different. (Excerpt from Scala presentation 11/30/09)
KEY ISSUES
Vague name for the workers: There are a lot of different names used to describe people/ workers who are employed to provide for personal care services (e.g. -Direct care, personal care, personal assistance, nursing aid, direct support workers, or direct service workers). As a result, vague, unclear, and even incorrect names are used to describe and/or represent this growing workforce.
Workforce planning or development: Many of the MaineCare and state-funded programs (> 25) cover personal care services and employ direct care staff with similar general qualifications to perform similar functions, yet they use different job titles (>20), require different training programs, have different wages and benefits, and their employers are reimbursed for their services using different methods and rates. As a result, there is confusion, miss-information, redundant or insufficient training offered/taken, there is a lack of transferability and employment flexibility/versatility for workers, employers, and consumers and undermine efforts to recruit and retain workers and to ensure a quality workforce.
Lack of competency-based information: Few of the personal care jobs have been assessed using a competency-based approach. Program and/or consumer-specific terms are used for job functions and training topics use unique and/or out-dated language/terms to describe comparable job functions, and the job information may not be updated to meet best practice and quality measures. As a result, a competency-based study should be conducted across programs so the jobs can be accurately defined, grouped and linked for workforce planning and development, and a more efficient training system. The process would help identify common and unique job functions and connect them to knowledge and skill requirements, and be the foundation of a salary administration/equity system.