September: A Great Month for Geriatrics Education Advocacy on Capitol Hill

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September was an important month for geriatrics workforce education advocacy on Capitol Hill.  Between the introduction of the Geriatrics Workforce and Caregiver Enhancement Act (H.R. 3731), the inclusion of much of that bill’s language in Chairman Burgess’ bill The Empower Act (H.R. 3728), that would reauthorize several programs under Title VII, and multiple hearings in the House and Senate that included witnesses that lead GWEP efforts in Texas and Florida, September has been a blockbuster month showcasing all of the amazing accomplishments of those doing geriatrics education throughout the country. Continue reading September: A Great Month for Geriatrics Education Advocacy on Capitol Hill

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Workforce: It’s a Numbers Issue

By Katie Smith Sloan
President and CEO
LeadingAge

The theme of this years’ Older Americans Month is “Age Out Loud.” It is a clarion call to listen carefully to the voices of those who are in their later years.

This theme calls on us to think about what it means to grow old in America today. I believe it also calls on us – as providers, consumers, employers, and advLeadingAgeocates – to consider our role in ensuring a meaningful life for those in their later years.

One of the biggest challenges we face in achieving the objective of a meaningful life is an acute shortage of workers – at all levels – to provide services and supports to people as they age. While workforce challenges often come in cycles, our current challenges are here to stay for a while.

It’s a numbers issue.

In a recently released LeadingAge survey on workforce issues, 83.5% of LeadingAge members reported that an insufficient number of qualified applicants for vacancies is the number 1 of top 3 challenges facing providers. Well behind that number, at 65% and 63% respectively, are competitive wages and staff turnover. LeadingAge members also reported that the most difficult staff to recruit were registered nurses.

This should come as no surprise when we look closely at the numbers, as LeadingAge members are not immune from national – even international – trends.

In 2010, the ratio of caregivers to people needing care was 7:1; in 2030, it will be 4:1. While the population age 80 and older will increase by 44% between 2030 and 2040, the number of caregivers will only increase by 10%. The gap grows wider.

For the next 25 years, we will need to be intentional about attracting younger people to our field, redesigning jobs to accommodate phased retirement for older workers, and entering the immigration debate to ensure a steady supply of qualified workers. It is first and foremost about numbers and then about training and retraining, excellence in workplace cultures, and creating career ladders and lattices. Once recruited, retention is key.

We know that the time and attention required to cobble together creative solutions to these workforce challenges draws precious resources away from other priorities. While many of the barriers are specific to the characteristics of local markets, we believe that there is a critical role for LeadingAge to play in sharing what works: tools, strategies, partnerships, and promising ideas.

The LeadingAge Center for Workforce Solutions, launching in June, will be our platform for learning and exchange. It is my expectation that it will grow exponentially over the coming months as we hear from you and identify new resources. We are focusing heavily on recruitment and retention strategies.

To “Age Out Loud” we need the services, supports, and infrastructure to ensure all can age with choice and dignity. To that end, a quality workforce that is compassionate and caring is essential.

Join LeadingAge in promoting Older Americans Month. And let me know, how do you plan to Age Out Loud?

This post originally appeared on the LeadingAge website.

Help Older Adults Live Out Loud

By Jessica Nagro 
EWA Policy & Communications Manager

Each May, the United States recognizes the vital role of older adults by celebrating Older Americans Month. This year’s theme, “Age Out Loud,” is meant to give aging a new voice. In particular, the theme showcases how, more than ever before, older Americans striving for wellness, focusing on independence, and advocating for themselves and others. By highlighting the many ways that older adults engage in their communities, Older Americans Month creates opportunities to reflect on and celebrate what aging looks like today.Logos2

Older Americans Month is also a great time to recognize the individuals who support and care for older adults across the county. The eldercare workforce plays a critical role in enabling and promoting the ability for older adults to live out loud. From providing needed medical care to assisting with activities of daily living to offering comfort and companionship, the entire interdisciplinary team supports the health and well-being of our seniors. Together, health care professionals, direct care workers, and family caregivers contribute to the changing dynamics of aging and ensure that older adults are able to engage in their communities as they wish.

bubbleHowever, in order to have a well-prepared eldercare workforce, we as a country must invest in training. As our nation ages and life expectancy increases, more and more older adults will rely on critical eldercare services in medical settings, communities, and homes. We need a health care workforce that understands the unique needs of older adults, the importance of well-coordinated team care, and valuable role of family caregivers. The Geriatrics Workforce Enhancement Program (GWEP) is the only federal program that equips the primary care workforce with the knowledge and skills to care for older adults and builds community networks to address gaps in health care for seniors. Each program is designed to meet the unique needs of individual communities but all GWEPs share a goal of providing more coordinated and comprehensive care for older adults and their caregivers.

Right now, Congress is making critical decisions about the future of the program. The EWA GWEP Toolkitfunding for the GWEP is at risk each year and even more so in this political environment. However, you can help by sharing the value of this workforce and this program with your elected officials. Through our website you can send a pre-drafted email, find talking points to call your representatives, and information on how to set up meetings and site visits. EWA is also here to help so feel free to contact us if you need assistance. The more voices we can add to the conversation the stronger our eldercare workforce can be.

This Older Americans Month, help older adults live out loud by contacting Congress today!

 

 

The Home Care Workforce Crisis in Our States: How New York Has Responded

Allison Cook, MPH
New York Policy Manager, PHI

What would you do if your loved one needed home care and you couldn’t find anyone to provide it? This is the difficult reality for a growing number of Americans. The U.S. is facing a growing home care workforce shortage, especially in rural areas.

Home care is a critical support that helps older adults and people with disabilities age in the community, rather than in facilities. Unfortunately, we have not ensured that home care aides have quality jobs, which enable them to provide quality care. Because of low wages, inadequate training, and limited career advancement opportunities, these jobs have become noncompetitive, failing to attract and retain the workers necessary to meet the needs of our aging population. Aging advocates and media outlets around the country are sounding the alarm – workforce shortages are growing – yet federal and state governments are struggling to identify effective solutions.

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New York State is seeing the impact of the workforce shortage, especially in rural upstate. The state will need over 124,000 new home care aide jobs between 2014 and 2024, but doesn’t have sufficient workers to meet these needs. Testimony at a recent NYS Assembly hearing on the challenges facing the home care workforce illustrated how consumers are affected by the shortage. One person was stuck in a nursing home unnecessarily for months because they couldn’t find a home care worker. Many others told stories of routinely losing qualified aides because aides cannot make ends meet with such low wages.

Ahead of the curve, New York is addressing the workforce shortage by investing in home care aide job quality—a model that could also work for other states. Recent policy interventions include:

Despite these advances, there is room for improvement. New York—and other states—need comprehensive plans to address the workforce shortage. Thus far, most state interventions are focused solely on increasing wages. Arizona increased Medicaid funding this year to cover a minimum wage increase. Maine legislators made home care worker wages more competitive in 2015, but in 2016 the public voted to increase the minimum wage, resulting in the minimum wage catching up to home care wages. Most significantly, last year Washington state negotiated a collective bargaining agreement for “independent” or “consumer-directed” aides that raised their wages to $4 above the current minimum wage and $1.50 above the state’s new minimum wage in 2020. While wages are an important factor, solely increasing wages will not solve the shortage.

To build on this momentum and identify a range of solutions, PHI launched a two-year, national campaign to identify 60 policy and practice issues related to the direct care workforce. PHI is committed to finding solutions that improve the quality of care for older people and people with disabilities by improving the quality of direct care jobs– including providing better wages and benefits, creating advanced roles and training opportunities, reconfiguring how we finance and structure the long-term care system, and much more. Learn more at www.60caregiverissues.org.

Allison Cook is the New York Policy Manager at PHI, a research and consulting organization widely recognized as the nation’s leading authority on the direct care workforce.

EWA Urges Support for Critical Eldercare Workforce Programs

The Eldercare Workforce Alliance (EWA) released the following statement on President Trump’s America First: A Budget Blueprint to Make America Great Again:

The Eldercare Workforce Alliance is deeply concerned by the cuts proposed in the Budget BlueprintPresident’s budget blueprint. As offered, the blueprint drastically reduces critical health workforce training programs, cuts health research funding, and eliminates much-needed home- and community-based services for older adults across the county. At a time when our nation is rapidly aging, EWA urges Congress to provide adequate funding to ensure our eldercare system can provide high-quality care to older adults.

EWA is particularly concerned about the Title VII and VIII Geriatrics Workforce Enhancement Program (GWEP), given the administration’s intent to cut $403 million from the Department of Health and Human Services’ health professions and nursing workforce training budget. The GWEP is the only federally-funded program dedicated to training health professionals, family caregivers, and consumers in the unique needs of older adults. The community-based GWEPs aim to develop a health care workforce that maximizes patient and family engagement while improving health outcomes for older adults, providing a critical service in communities across the country.

In addition, EWA urges support for the vital health research activities conducted by the National Institutes of Health and National Institute on Aging, which increase our understanding of many of today’s most pressing health care challenges, including Alzheimer’s disease and related dementias. EWA also supports home- and community-based programs, like the services offered through the Community Services Block Grant, that allow older adults to receive high-quality care in their homes.

We appreciate the President’s proposal to provide additional funding to the Department of Veterans Affairs (VA). The VA plays a critical role in both providing high-quality care to our older veterans and training the geriatrics and gerontological health workforce. We look forward to working with President Trump and Congress to craft a full budget that recognizes the value of programs that train health care professionals, provides adequate funding for research into lifesaving medical advances, and supports programs that allow older Americans to live well in their homes and communities.

Keeping our Eyes on the Ball

By Amy York, EWA Executive Director

As we jump into 2017, this year is already about big transitions. We have a new President and Congress proposing substantial changes in many policy areas, including a major overhaul of our health care system. Many of our baby boomers are now 70 and will need significant care as we age. Workforce preparation for this care continues in a slow, piecemeal approach. At this point, it would be easy to get distracted.

To ensure we remain focused on workforce and family caregiving policies that advance a meaningful system of care with real choices for older adults and their families, EWA’s 2017 policy agenda will be focused on the following:

  • Support the Geriatric Workforce Enhancement Program (GWEP) reauthorization and increased appropriations. In 2015, the Health Resources and Services trainingAdministration (HRSA) funded 44 GWEP community centers in 29 states with a specific focus on ensuring that primary care clinicians have the skills and knowledge to care for older adults. We are encouraged by the program’s early successes but we know we need to expand its reach to meet the growing need. In our communications with Congress and the Administration, we will highlight the flexibility this program provides communities and urge geographic expansion of the program especially in rural areas where workforce shortages are more pronounced.
  • Support the recommendations in the 2016 Families Caring for an Aging America report by the National Academies of Sciences, Engineering, and Medicine (NASEM). Specifically, EWA will advocate for development of a national strategy to support family caregivers, additional funding for caregiver support programs, and training dollars for both the paid workforce and caregivers.
  • Develop and share information\data on how the proposed changes to our health system, such as repeal of the Affordable Care Act (ACA) and Medicaid block grants will impact the spectrum of workers who care for older adults. In particular, EWA will look at how these changes could affect the ability of our workfor
    ce to provide quality, coordinated care to older adults and their families. We will emphasize the importance of health care jobs, especially in rural areas, as key divers of economic growth and community stability.
  • Highlight innovative programs and models that provide high-quality, integrated care, especially those at the Department of Veterans Affairs. EWA will continue to share information about programs that recognize the unique needs of older adults and provide care through a team-based, patient and family centered approach.
  • Develop a State Based EWA Coalition Tool-Kit. EWA is working with Amanda Borer, a Health and Aging Fellow, to establish a North Carolina eldercare wokissing-forehead_000010309449mediumrkforce alliance. It will bring together GWEPs, EWA members, and other state advocates to discuss ways they can work together on state policy initiatives. Our hope is to use this example to draft a tool-kit to establish similar coalitions in other states.

The challenge for all of us is to fight for the programs that form the basis of our care system for older adults and launch new initiatives to advance and prepare our eldercare workforce. We are committed to raising concerns about how reforms could impact the workforce and those we care for, but at the same time, EWA must offer solutions to move beyond the status-quo.

As the voice of the eldercare workforce, we look forward to working with our coalition members, aging and health workforce stakeholders, and policy makers to build the eldercare system that our grandparents, parents, and ourselves deserve.

What President-Elect Trump Means for the Eldercare Workforce

By Jessica Nagro, MPA
Policy & Communications Manager
Eldercare Workforce Alliance

In November, the United States elected Donald Trump to serve as the 45th president. While this is a dynamic time for the transition, President-elect Trump has provided several signals for what his administration might mean for the eldercare workforce and America’s older adults.logo

Here is what we know so far:

Campaign Promises
Throughout the campaign, President-elect Trump made several statements on issues related to the eldercare workforce. For family caregivers, Trump has proposed to allow working individuals to deduct eldercare expenses from their federal income taxes. The deduction will be capped at the average cost of care for the state of residence. In addition, he wants to establish new Dependent Care Savings Accounts (DCSAs) so families can set aside extra money to offset eldercare expenses, including long-term care costs, for their parents or adult dependents.

More broadly, Trump has promised to “work with Congress to create a patient-centered health care system that promotes choice, quality, and affordability.” He also indicated he plans to block-grant Medicaid but promised to keep Medicare coverage intact.

First 100 Days
Shortly after the election, President-elect Trump released his plan for the first 100 days of his administration. The document outlines several ways he plans to work with Congress to alter the health care and eldercare systems. Trump urges Congress to fully repeal and replace the Affordable Care Act (ACA or Obamacare). He proposes to replace it with Health Savings Accounts, the ability to purchase health insurance across state lines, and more flexibility for states to manage Medicaid funds. The President-elect also hopes Congress will take up his Affordable Childcare and Eldercare Act that enacts his caregiving platform detailed above.

Federal Appointments
In late November, President-elect Trump announced his candidates for Secretary of Health and Human Services (HHS) and Administrator of the Centers for Medicare and Medicaid Services (CMS).

Trump nominated Congressman Tom Price (R-GA) to serve as Secretary of HHS. Congressman Price, an orthopedic surgeon, has served US House of Representatives since 2005 and currently serves as the Chairman of the House Budget Committee. In Congress, he is a leading conservative voice on health care and often advocates for more state and local control of health care policy administration. He supports Trump’s proposals to repeal and replace the ACA and block-grant Medicaid but Price has also spoken about making substantial reforms to the Medicare program.

President-elect Trump also nominated Seema Verma as CMS Administrator. Verma is a health care consultant who assisted Governor Mike Pence (now Vice President-elect) in designing Indiana’s Medicaid expansion under the Affordable Care Act. Her consulting company also assisted with other Medicaid expansion plans brought forward by Republican governors. Both Price and Verma are subject to Senate confirmation.

As our society continues to age, the coming years will be a critical time for eldercare issues. We look forward to working with our coalition members and interested stakeholders to ensure we have a health workforce prepared to care for our older loved ones.

#TalkBrainHealth: Starting the Conversation on Brain Health and Memory

As we age our brains do, too. If you are noticing changes in an adult in your life, it may be time to talk about brain health. Perhaps your loved one is having a hard time remembering things; they may act differently or struggle with everyday activities. To aid in starting a conversation about brain health and provide resources, the National Alliance for Caregiving and the Alzheimer’s Foundation of America created the #TalkBrainHealth Tool Kit. The Tool Kit can be used to gather information, find resources, and talk with family, friends, and health care professionals about the health and well-being of your loved ones.

tbhOften, the first time people notice these changes is during the holiday season—especially if we live some distance away from our loved ones. Because of this, many people may hesitate to have a conversation about it with their loved ones. But talking about brain health and memory concerns doesn’t have to be scary.

Here are some tips to consider in determining whether and how to start a conversation, ways to promote brain health, and next steps:

  1. Remember, it’s normal for our brains to change as we get older. Some changes associated with normal aging include changes in daily activities, such as driving less, occasional forgetfulness, or some difficulty understanding instructions and making decisions. If you notice changes beyond those listed above, it may be time to create a plan and help the person get the support they need.
  2. Adopt a brain healthy lifestyle. Join your loved one on a journey to promoting optimal health. Eat a diet rich in whole grains, Omega-3 fatty acids and antioxidants. Get moving! Start a regimen best-suited to your loved one’s need. Track your progress together. Also, be sure to get a good night’s sleep.talkbrainhealth_tool-kit-thumbnail-234x300
  3. Time to have a conversation? Be mindful of things like tone, word choice and body language. Keep in mind that there are a number of reasons someone could be having a memory problem, including vitamin deficiencies, thyroid problems, and depression. Using words like “Alzheimer’s” and “dementia” can be jarring. Keep in mind how your choice in words, body language, and tone will be perceived by your loved one. Be supportive and let the individual know that they are not alone.
  4. Caregivers, get help to follow through with your next steps. Managing brain health or memory issues, sometimes along with other health care needs, can seem daunting. Tap into your support system—family members, friends, community organizations—for help. Scheduling and going to appointments, managing follow-up visits, and monitoring any further changes in the individual are all tasks that can be assisted by others to ease the stress of caregiving.

For more details on these tips and additional information on how you can start a conversation on brain health this holiday season, download the Talk Brain Health toolkit at www.caregiving.org/talkbrainhealth.

#TogetherWeCare Update

This Labor Day, EWA asked partners to help us recognize, celebrate, and support the eldercare workforce.

Each year, on the first Monday in September, our country comes together to celebrate the contributions American workers have made to the strength of our nation. This year, we wanted to focus on the often over-looked eldercare workforce and reinforce the importance of the work they do each day. Whether it be health professionals, social workers, family caregivers, direct care workers, or others, these individuals play a critical role in keeping our loved ones healthy.

In order to join in the movement, we asked individuals to share their own care story. Many of us are providing care to an older adult but most of us don’t realize how many of our friends, neighbors, and colleagues are facing similar experiences. By putting a face on caregiving and the eldercare workforce, it reinforces that this isn’t an individual experience and ways to support this workforce are not an individual endeavor.

Here is a taste of the stories shared during the initiative.

LeadingAge President and CEO Katie Smith Sloan authored “Honoring Workers on Labor Day

Robert Espinoza, Vice President of Policy at PHI, weighed in with “Who Will Care For Us As We Age? New Research Raises Big Questions”

You can also find more eldercare workforce stories on the EWA website.

You can see a full recap of the stories shared via Twitter and please continue to share your care story using #TogetherWeCare! 

The Inextricable Link between the Eldercare Workforce and Family Caregiving

By Terry Fulmer, PhD, RN, FAAN
President, The John A. Hartford Foundation

Are you a caregiver? Sooner or later, caregiving touches us all.

According to a new report by the National Academies of Sciences, Engineering, and Medicine, Families Caring for an Aging America, nearly 18 million individuals currently provide care to an older family member, spouse, or friend. Millions more anticipate serving in a caregiving role in the future. Most of us, as we age, will eventually become care recipients.

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For individuals and for society as a whole, the preparation of our nation’s workforce to address caregivers’ needs should be of paramount concern.

Family caregivers are a large and absolutely critical component of our health care workforce. They are the primary providers of care for our nation’s older adults, yet they remain almost invisible. While they perform a host of vitally important activities, from meal preparation and house cleaning to complex medical tasks like wound care, they often do so with no training, limited support, and little recognition.

As the Academies’ report documents, our fragmented health care system and the demands it places on families often result in physical, emotional, and financial challenges for these heroic caregivers, which puts their loved ones at risk. This is unsustainable, dangerous, and wrong.

The good news is that health and social service professionals, as well as direct care workers such as home health aides and nursing assistants, are in a unique position to support family caregivers. To make that possible, we must work to create a health care system that is not just person-centered, but also family-centered, as called for in the report. The entire care workforce needs to be equipped with training and systems that support this transformative approach.

One key initiative is the Health Resources and Services Administration’s Geriatrics Workforce Enhancement Program (GWEP), which The John A. Hartford Foundation is proud to be a partner of through support for a national coordinating center. This important federal program is integrating geriatrics into primary care through 44 academic-community partnerships across the country. Through the GWEP sites, various members of the health care team are trained alongside family caregivers. This is a critical step to developing an inter-professional workforce that includes these caregivers.

kissing-forehead_000010309449mediumUnfortunately, as the report notes, the GWEP program does not have adequate funding to meet the range of training needs, or the proper geographic distribution to affect true systemic change. To fully support family caregivers and properly train the entire eldercare workforce, both paid and unpaid, programs such as the GWEP need to be valued and expanded.

In my own work as a geriatric nurse, and among my friends and family, I have seen the enormous strain on caregivers. I have seen how our system too often excludes them from important decision-making, yet assumes they are willing and able to do this very difficult job. I am so pleased the Academies have committed to shining a light on this often overlooked constituency and am optimistic that the report’s recommendations will catalyze change.

This report, and the work of organizations like the Eldercare Workforce Alliance, which we also proudly support, have the potential to move family caregivers into the forefront of health system reform and policy discussions. We owe it to family caregivers to prepare them to be full partners in the health care system, and to build that system so it can do more to care for the families caring for our aging America.