Direct Care Workers: the Foundation for Community-Based Care

Terry Lynch

Wisconsin is one of many states establishing community-based managed care programs for older people and people with disabilities. These programs are gradually supplanting the home and community-based Medicaid waiver programs that have been the primary funding source for state alternatives to nursing home care.

As in other states, there have been long waiting lists for our Medicaid waiver programs. Many people have gone for years before being served. Many others have had no choice but to move to nursing homes, since there are no waiting lists for life in an institution.

Wisconsin is now expanding two managed care programs – Family Care and Partnership – that aim to eliminate waiting lists while helping consumers remain in their homes. Consumers who are Medicaid-eligible and at risk of nursing home placement are entitled to services in one or the other of these programs.

These programs are improving the lives of many consumers and family caregivers, but our economic crisis makes it difficult for Wisconsin to take them statewide. Meanwhile, another less visible crisis, the growing shortage of direct care workers, threatens these programs’ very survival.

Family Care provides long-term care services, which it coordinates with health care. Partnership provides health care as well long-term care.

Many of the consumers supported by Partnership are medically fragile and need ongoing health care management for chronic and acute care problems. They may have serious cardiac problems, dementia, independence-threatening physical disabilities, or other illnesses such as diabetes. Many are at constant risk of hospitalization.

Partnership supports each consumer with a team that includes not only social workers but also nurse practitioners and RNs. The team coordinates the consumer’s medical care with the person’s physician, who is also a member of the person’s support team. Partnership’s medical care is overseen by a medical services director, who is also an MD.

The outcomes are striking. Partnership consumers are often able to reduce the number of medications they are taking. Many either improve or maintain their ability to manage activities of daily living. Health crises diminish. Evaluations show that Partnership’s older members spend significantly less time in nursing homes and its members with physical disabilities spend less time in the hospital. Consumer surveys show substantial improvement in quality of life for the majority of Partnership’s members.

I recently had lunch with the executive director of one of the organizations that is administering Partnership in many counties. We discussed the dependence of many of its consumers on the skills of health care professionals and the creative coordination of health care services by each individual’s Partnership support team.

I asked her about the role of direct care workers in ensuring the best possible health outcomes for program consumers. “We couldn’t do it without them,” she said. But unless state funding for personal care services increases substantially, she added, the ultimate consequences for Partnership and its consumers will be “devastating.”

Devastating consequences are, of course, what the Direct Care Alliance and our allies are fighting to avert. Partnership gives us another eye-opening lesson in the urgency of building an even larger and stronger direct care workforce than the one we have now.

Our policymakers must understand that we cannot have successful health care reform until we give direct care workers the compensation, training, decision-making power, and respect they need and deserve.

Terry Lynch
Board Member
Direct Care Alliance