CMS Intensive: Strategies for Addressing Barriers to HCBS Workforce Development HCBS Conference Arlington, Virginia September 13, 2012
Agenda About the DSW Resource Center and the Direct Service I. Workforce Barriers to Workforce Development II. Why Recruitment and Retention Matters III. Proven Solutions and Workforce Improvement Strategies IV. CMS Investment in DSW Development V. DSW-RC Key Activities 2012/2013 VI. VII. Strengthening the Workforce – How you can help! 1 www.dswresourcecenter.org
CMS DSW Resource Center www.dswresourcecenter.org Our mission is to support efforts to improve recruitment and retention of direct service workers who help people with disabilities and older adults to live independently and with dignity. Raising Awareness Building Consensus and Promoting Cross-Sector Partnership Disseminating Best Practices Providing Technical Assistance 2 www.dswresourcecenter.org
National Direct Service Workforce Resource Center Partners 3 www.dswresourcecenter.org
Members of the Direct Service Workforce Nursing facility aides - provide services and supports to individuals in nursing facilities and institutions; includes nursing aides, orderlies and attendants Direct support professionals (DSPs) – provide services and supports to individuals with developmental and intellectual disabilities, substance abuse challenges, and serious and persistent mental health issues Personal and home care aides (PHCAs) - provide services and supports to older individuals and people with physical disabilities. Increasingly provide services to nursing facility-eligible consumers in home- and community-based settings. Growing number are “independent providers” and/or paid family caregivers Home health aides (HHAs) - typically employed by Medicare-certified home health agencies and deliver more clinically-oriented services 4 www.dswresourcecenter.org
Workforce Barriers Impeding HCBS Development and Successful LTSS Balancing Characteristics of HCBS Jobs Isolation = limited supervision and limited peer support Limited availability of training/ credentialing systems Part-time work Lower wages and fewer benefits compared with NF/ Institutional jobs Higher transportation costs 5 www.dswresourcecenter.org
Workforce Barriers Impeding HCBS Development and Successful LTSS Balancing Industry Practice Cultures of Turnover Inadequate Training and Orientation Limited Advancement Opportunities Low Wages and Few Benefits Erratic Work Schedules 6 www.dswresourcecenter.org
Workforce Barriers Impeding HCBS Development and Successful LTSS Balancing Public Policy Inadequate funding to improve service quality/ job quality Wide variability of training standards Limited infrastructure to support workers (often family caregivers) and consumers in participant-directed model HCBS quality assurance systems are often underdeveloped and/or do not include workforce measures 7 www.dswresourcecenter.org
Background: Size of the Direct Service Workforce http://phinational.org/policy/states/united-states/ 8 www.dswresourcecenter.org
Background: Occupational Growth http://phinational.org/policy/states/united-states/ 9 www.dswresourcecenter.org
Background: Median Hourly Wages http://phinational.org/policy/states/united-states/ 10 www.dswresourcecenter.org
Background: Health Insurance http://phinational.org/policy/states/united-states/ 11 www.dswresourcecenter.org
Background: Public Assistance http://phinational.org/policy/states/united-states/ 12 www.dswresourcecenter.org
Why Improving HCBS Workforce Recruitment and Retention Matters Increasing demand for all LTSS, especially HCBS Supply of workers not growing fast enough to keep up with demand Unique barriers to workforce development in home and community-based service systems Quality of services depend on quality and stability of workforce Cost of turnover 13 www.dswresourcecenter.org
Why it Matters to People with Disabilities and their Families Three Rights to Care Families are permitted and helped to care for their family members Paid caregivers give high quality care without compromising their own well-being People who need care can get it - Deborah Stone, 2000 14 www.dswresourcecenter.org
Why it Matters to Workers Essential Elements of a Quality Job - PHI Compensation - Wages, health insurance, full-time hours Opportunity - Training, participation in decision-making, career advancement Support - Linkages to organizational and community, supervisors, owners and managers 15 www.dswresourcecenter.org
Why it Matters to CMS and States Access Quality State Medicaid programs are responsible for providing services in the most integrated setting possible and for ensuring services are available and of the highest quality. $$$ Reducing turnover saves public resources • Timely and adequate provision of HCBS can delay • or prevent more expensive institutionalization 16 www.dswresourcecenter.org
Outcomes of Improved Recruitment Increased number of qualified applicants for open positions More realistic understanding of direct service jobs among potential workers Fewer job vacancies Fewer and shorter gaps in care (less unmet need) experienced by consumers Greater public awareness, more positive image and more interest in the direct service field 17 www.dswresourcecenter.org
Outcomes of Improved Retention Greater continuity of care for consumers Fewer changes in support provider experienced by consumers Increased duration of time workers stay with individual consumers, with the same agency or in the field Increased worker satisfaction Increased opportunities for professional development and career advancement Greater number of experienced workers Reduced job turnover 18 www.dswresourcecenter.org
Proven Improvement Strategies and Solutions Industry Strategies Targeted Recruitment and Selection Culture Change Initiatives Participatory Management Multi-Employer Collaboratives Career Pathways Coaching Supervision Training Peer Mentoring Developing Business Case for Workforce Investment: ↑ Wage; ↓ Turnover Guaranteed Hours Sharing Across Settings Reimbursement of Transportation Costs 19 www.dswresourcecenter.org
Proven Improvement Strategies and Solutions Public Strategies (Medicaid) Provider Reimbursement/Rates Analysis Contracting Standards for Providers Incentive Awards for Workforce Outcomes Labor Market Analysis Workforce Data Collection Health Coverage Initiatives Competency and Training Development Universal Core Curricula Apprenticeship Programs Public Authorities Worker Registries Worker Associations 20 www.dswresourcecenter.org
Participant Discussion What kinds of workforce development initiatives are you in involved with? 21 www.dswresourcecenter.org
History of CMS Investment in DSW Development Real Choice Systems Change Grants, 2001 CMS Direct Service Workforce Demonstration Grants, 2003 and 2004 National Evaluation of DSW Demonstration, 2008 CMS Direct Service Workforce Resource Center, 2005- Present Intensive TA awarded on competitive basis to 15 states, 5 per year 2006-2008 Intensive TA to Money Follows the Person Demonstration programs 2008-Present Cross-Cutting Reports, Events and Special Projects 22 www.dswresourcecenter.org
DSW Grants: Summary of Approaches 2003 GRANTEES 2004 GRANTEES INTERVENTIONS DE LA ME NM NC AR IN KY VA WA X X X X X Health care coverage Enhanced training/ X X X X X X X X X education Career ladder, peer X X X X X X X mentorship, or other merit-based recognition Community building/ X X X worker registries Enhanced marketing or X X X X X X other recruitment strategies
DSW RC Intensive TA Focus Areas 2006 TA Recipients 2007 TA Recipients 2008 TA Recipients Focus Areas AZ LA NY SC TX GA NJ NC UT WI DE IN MI OH VT Strategic Planning and X X X X X X Partnership Disseminating Best Practices in X X X X X X X Recruitment and Retention Marketing/ Raising X X X X Awareness Data Collection X X X X X X System Design Market/Demand X X X Study Wage/Benefit X X Development
DSW RC Intensive TA Focus Areas 2006 TA Recipients 2007 TA Recipients 2008 TA Recipients Focus Areas AZ LA NY SC TX GA NJ NC UT WI DE IN MI OH VT Worker Training X X X X X X X Credentialing Consumer X X X Directed Training Worker X X Association
DSW RC Key Activities 2012/2013 Technical Assistance to Money Follows the Person Grantees Individualized TA and webinars/discussion groups for the 43 states and District of Columbia National Balancing Indicators Project Surveys of Independent Providers and Employer Organizations in 7 State Profile Tool Grantees (AR, FL, KY, MA, ME, MI, MN) Toolkit on DSW Data Collection for other states in development 26 www.dswresourcecenter.org
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