As Terry Lynch pointed out in his most recent blog post, the popular – and federally mandated – trend of using Medicaid to pay for less nursing home care and more home care cannot continue unless states can attract and keep more home care workers. A pair of recent papers from New Hampshire looks at just what that means for the state of New Hampshire.
In Home Care Workers: Keeping Granite Staters in Their Homes as They Age, (PDF) Kristin Smith of the University of New Hampshire’s Carsey Institute profiles home care workers. The 12-page policy brief provides a demographic and economic overview of the state’s licensed nursing assistants, personal care service providers, personal care assistants (PCA), and homemakers and companions. It also discusses the implication of low pay and high turnover among direct care workers for those who rely on their services.
After outlining the dismal state of affairs, which includes median wages of less than $10 an hour, the brief concludes: “If New Hampshire is serious about its desire to reduce turnover among the home care workforce, meet the projected needs of the aging population, and provide the quality care necessary to help keep Granite Staters in their homes as they age, then the road map is clear and adeptly articulated by the home care workers themselves: increase wages, increase hours, increase access to health insurance and paid leave, and increase opportunities for advancement.”
Strategies to Invest in the Future of the Direct Care Workforce (PDF) builds on that foundation by recommending strategies that state agencies, employers, and other stakeholders can adopt to build and support a stable home care workforce. Its recommendations:
- The state should establish “a rational rate setting and reimbursement process” that allows home care agencies to pay their direct care workers “a livable wage.”
- Stakeholders should work with their elected representatives to create federal reimbursement for the training of home and community‐based workers, like the funding now provided to train nursing home CNAs.
- Home care agencies should implement a steady work week, create loan repayment programs, and improve the quality of staff supervision for their direct care workers.
The paper was published by the New Hampshire Coalition for the Direct Care Workforce.
Direct Care Alliance