1. Key Issues for the Long Term Care Workforce Alliance for Healthcare Reform Roundtable March 9, 2009

2. Markets Work Avg wage for direct care workers is $9.56, one-third less than all U.S. workers. Avg wage for direct care workers is $9.56, one-third less than all U.S. workers. Homecare: Homecare: Avg wage around $8/hour. Avg wage around $8/hour. Less than 10% earned more than $11/hour. Less than 10% earned more than $11/hour. 70% of only able to get part-time work; annual incomes w – around $17,340. 70% of only able to get part-time work; annual incomes w – around $17,340. Between 30-35% of homecare workers are single parents receiving Food Stamps. Between 30-35% of homecare workers are single parents receiving Food Stamps. Widespread shortage is a rational economic response to the labor market. Widespread shortage is a rational economic response to the labor market.

3. Raising Wages Requires public policy, public resources. Requires public policy, public resources. Revise reimbursement systems. Revise reimbursement systems. Require states to take greater responsibility for wages and traditional employer supports. Require states to take greater responsibility for wages and traditional employer supports. Use federal approval process for SPAs, waivers to ensure adequate wages. Use federal approval process for SPAs, waivers to ensure adequate wages. Need mechanism for accountability, particularly in PPS. Need mechanism for accountability, particularly in PPS.

4. Failure to Address the Wage Issue….

5. Expanding the Workforce Fixing the DRA to accelerate rebalancing, expand consumer-direction. Fixing the DRA to accelerate rebalancing, expand consumer-direction. Income eligibility. Income eligibility. Types of services. Types of services. Additional resources for state to invest in infrastructure, make structural changes necessary. Additional resources for state to invest in infrastructure, make structural changes necessary.

6. Improving Retention Encouraging providers to take the high road. Encouraging providers to take the high road. NY: Quality Care Committee NY: Quality Care Committee PA: Pennsylvanians for Quality Care PA: Pennsylvanians for Quality Care CA: HealthCare Workforce Development Program. CA: HealthCare Workforce Development Program. Amend WIA: Amend WIA: Allow greater state discretion, greater sectoral focus. Allow greater state discretion, greater sectoral focus. Expand WIA to allow for Taft-Hartley training funds and other labor-management joint ventures. Expand WIA to allow for Taft-Hartley training funds and other labor-management joint ventures. Standardize training, develop national certification. Standardize training, develop national certification.

7. New Models of Care DCWs can be the linchpin for improved care coordination for 8.8 million duals, but most need additional skills. DCWs can be the linchpin for improved care coordination for 8.8 million duals, but most need additional skills. Unanswered questions: Unanswered questions: Are there capitated payment models that produce better results for health outcomes, cost containment? Are there capitated payment models that produce better results for health outcomes, cost containment? Should we rethink the role of consumer choice? Should we rethink the role of consumer choice? Sharing savings with states? Sharing savings with states? SNP reauthorization as a vehicle? SNP reauthorization as a vehicle?

8. If we get health care reform but dont address workforce issues…