#TogetherWeCare – Advancing a Well-Trained Workforce to Care for Us as We Age
April 11, 2018 is the 10th anniversary of the Institute of Medicine’s (IOM) report Retooling for an Aging America: Building the Health Care Workforce. This seminal report led to the establishment of the Eldercare Workforce Alliance (EWA), a coalition of 31 organizations committed to developing practical solutions to strengthen our eldercare workforce and improve the quality of care. To recognize this anniversary over the next year, EWA will lead the #TogetherWeCare-Advancing a Well-Trained Workforce to Care for Us as We Age campaign to examine our progress since the report and share solutions for current and future workforce needs. EWA will collaborate with EWA members and other relevant partners to address specific topic areas each month. Below are themes for the next year that EWA will be addressing for the next year:
Every month we will be sharing blogs, infographics, and other material related to these important topics covered in the report at eldercareworkforce.org/togetherwecare . Please share our content, and feel free to share your own content around these topics with the hashtag #TogetherWeCare.
My first experience with caregiving came when I was eight years old. At the time, my grandmother had lung cancer which had spread to the rest of her body, including to her other vital organs. Even then, I remember it being clear to me that she was in the end-stages of her life. My family was fortunate enough to have the means to provide her with good quality care, including having an in-home hospice nurse to take care of the difficult tasks, like bathing her, where medical training was helpful, if not vital, in making sure that my grandmother did not get injured during what had once been her daily activities.
Beyond what we would’ve expected as her normal duties was where my grandmother’s hospice nurse truly shined. She played games with me to shield my mind from difficult decisions and my eyes from ugly sights. She comforted my grieving mother and grandfather. She explained exactly what she was doing to help my grandmother, so that we could replicate that aid overnight, if needed. She coached my family through the stages of death that were unfolding in front of us.
Most of us know what the experience of a death in the family is like; after all, aging and death are inevitable. When it is your loved one slipping away from you, it’s like there is an elephant sitting on your chest. The pressure of those days, weeks, or months is so intense that you feel like you’re abandoning your dying family member if you step away for even one minute. In-home hospice smoothed over the biggest potholes in my family’s caregiving journey. We were privileged to have that level of care for my grandmother, especially because my grandparents lived in Eagle Grove, a rural community in North-Central Iowa.
In underserved rural areas, caregiver support and quality geriatric care can be hard to come by. Geriatric Workforce Education Programs (GWEP) like the one at the University of Iowa are vital to ensuring that the rural health care workforce is trained in geriatrics. The University of Iowa’s three-year, $2.5 million GWEP grant is being used not only to provide clinical training in geriatrics to nursing and medical students, but also to create and promote innovative techniques for incorporating eldercare education into primary-care practices and community-based services and supports. The program has also introduced online distance learning tools for those employed in the geriatrics workforce.
The Geriatric Workforce and Caregiver Enhancement Act, introduced by Reps. Jan Schakowsky (D–IL), Doris Matsui (D–CA) and David McKinley (R-WV), would increase the funding for GWEP from its current level of about $39 million to $51 million per year. This modest increase in funding would allow at least 8 more communities to provide important training for the workforce and caregivers. Everyone deserves access to the level of care that was afforded to my grandmother and the rest of my family. By increasing GWEP funding, we can both provide better, more accessible care for the older adults in our lives today, and prepare a highly-trained geriatrics workforce for the future—an improvement that nearly every single American will reap the benefits of.
Willard West is currently interning at the Eldercare Workforce Alliance and is in his second year at American University majoring in journalism.
In this month’s Spotlight, Rep. Donovan (R-NY) discusses his role as caregiver for his mother, medical innovation, and the future of health care for older adults.
How has your experience as a caregiver influenced your work on health care policy?
“I was blessed to have my mother with me for 59 years of my life. Many people are much less fortunate. In the last decade of her life, though, she required extra care, and in the last few years she needed round-the-clock attention. I did my best to keep up for as long as I could, but when I was no longer able to provide her with the level of professional care she needed, I hired two incredible women as home health aides. Let me tell you this – those women cared for my mother like they were family. I will never forget what they did for her, and I’ll be eternally grateful. But they cost money, of course, and I drained my savings paying for my mother’s care. I don’t regret it for a minute and I’d spend it again tomorrow so she could be comfortable, but it’s just a fact. So when advocates meet with me to talk about those struggling to care for their elderly family members, I don’t just get it on an intellectual level – I lived it myself. It’s personal for me.”
Personal Care Aides in New York earned an average $10.85 per hour in 2015. With growing need and a shrinking supply of workers, family caregiving will become more strenuous and expensive. How should we address this problem?
“This is a problem that’s only going to get worse as the Baby Boomers get older. The challenges are two-fold: on the one hand, many families go into debt or exhaust all of their resources caring for a loved one. On the other hand, personal care aides barely earn enough to get by. It’s a catch 22 that requires a lot of thought. The first step is passing the RAISE Family Caregivers Act, which calls for a strategy to tackle this issue.”
What does the future of health care look like for older adults?
“The future of health care for our older generation will really depend on the policies we put in place now. Whether it’s legislation that incentivizes pharmaceutical innovation, proposals dealing with Medicare, or focusing our resources towards preventive care, the decisions we make now will transform our entire health system for decades to come.”
Where do you see innovation in health care for older adults and how do you plan to prioritize these programs in the future?
“Year after year, we see how numerous improvements in technology bring new cures to light and improve the health outcomes of people across the nation. We will continue to see advances in the quality of life of older adults as the understanding of health and disease continues to improve. Personalized care, smart devices, electronic health records, healthcare costs, preventive care and medical treatments and medicines, are all areas that are ripe with opportunity for innovation. Congress’ job is to ensure that policies that incentivize research and modernization within our health care system are put in place. I will continue to support legislation that addresses challenges and opportunities within our health system. An example of legislation I supported to improve health outcomes for years to come is the 21st Century Cures Act, which promotes medical innovation and aims to fast track the creation of cures for diseases like cancer and Alzheimer’s.”
The Geriatrics Workforce Enhancement Program (GWEP) is currently the only federal program that develops a health care workforce that maximizes patient and family engagement while improving health outcomes for older adults. With Direct-care workers providing an estimated 70-80% of the paid hands-on care for older adults or those living with disabilities or other chronic conditions in New York, how do you envision supporting these workers and those they care for in your home state?
“One option that has been floated is the ability for folks to deduct from their taxes the expenses associated with caring for a loved one. The problem is on both the family side and the health aide side. Families can’t afford to pay for constant care, and aides don’t earn enough to support themselves. We have to make sure insurance is part of the conversation as well.”
Congressman Daniel “Dan” M. Donovan, Jr. represents Staten Island and parts of South Brooklyn in the 11th Congressional District of New York in the U.S. House of Representatives. Dan was elected on May 5, 2015 during a special election and sworn in on May 12, 2015.
Dan serves as Chairman of the House Subcommittee on Emergency Preparedness, Response, and Communications. In that role, he exercises oversight of the federal government’s anti-terror and disaster response policies, issues critical to Staten Island and South Brooklyn. Dan also serves on the House Committee on Foreign Affairs.
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
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 advocates – 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?
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.
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.
However, 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.
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.
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.
Creating opportunities for career advancement: Last year, New York passed a law that created an Advanced Home Health Aide occupation. This will provide home health aides with a next step in their career, and will fill a care gap by allowing Advanced Aides to administer certain medications.
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.
The Eldercare Workforce Alliance is deeply concerned by the cuts proposed in the President’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.
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 Administration (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 workforce 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.
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.
Here is what we know so far:
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.
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.