SOUTHERN MAINE LONG TERM CARE WORKING GROUP 

WEDNESDAY, MARCH 23 2005

  2PM – 4PM

 

PRESENT:  Debbie DiDominicus, SMAA; Bette Jewett, SMAA; Kate Dulac, SMAA; Amy Hatch, SMAA; Robyn Berry, Alzheimer’s Association; Arla Cohen, 75 State Street;    Rick Ewing; Bob Knowles, Good Neighbors; Suzanne Plourde, Kindred Healthcare; Cathi Reinfelder, Mercy Hospital; Terry Roy, Goodwill Bayside Neuro Rehabilitation; Maryann McGreehen, SMAA; Margy Gambell, RN, Home Instead; Cheryl Cheaugher, Sandy River; Michelle Matt, Goodall Hospital; Suzanne Plourde, Kindred Healthcare; Julie Vickers, HomePartners; Elise Scala, Muskie School; Mary Keefe, Kindred Health Care; Jackie Katz Austin, Legal Services for the Elderly.  

UPDATES  

Debbie reminded the group of our annual request for donations to underwrite the cost of administering the SMLTCWG meeting, please make any donations to SMAA I & A program.  

Debbie passed out flyers regarding The Maine Health Care Focus Group on Monday April 4, 2005 from 1:30 pm - 3:00 pm at The Trafton Senior Center, 19 Elm Street , Sanford Maine .  This focus group will include caregivers and consumers.  The focus group is sponsored by Goodall Hospital , Goodall Eldercare Services and MaineHealth.    There are focus groups all over the state.  There will be a Provider Breakfast focus group next Monday, March 28 2005 at Maine Medical Center .  

Bette announced the Southern Maine Agency on Aging Elders Day to be held on Tuesday, May 17, 2005, from 9 am -3 pm at the Portland Expo on Park Avenue in Portland .  This event is open to everyone and deals with senior issues. The Information & Advocacy program at SMAA is doing a community benefits outreach campaign which will start at Elders Day and take place every Tuesday through June as follows:

            AARP/SMAA Benefits Outreach Campaign  

5/17/05            Elder’s Day     Portland Expo

5/24/05            Bridgton Hospital                                10 –1

5/31/05            Springvale Library                              10 -12

6/7/05              Wells/Ogunquit Senior Center            10 -

6/14/05            Sacopee Valley Health Center            10 - 12

6/21/05            Freeport Elder’s Association              10 - noon

6/28/05            Standish Municipal Center                 10 - 1  

Kate Dulac, Family Caregiver Program, SMAA talked about the Best Friends trainings that are going on about Caring for your Elderly Parent which are being held in Bridgton, York, Sanford. These trainings will be held on April 2, April 11, April 29 and May 7 2005.  There are workshops held on the second Monday of each month from 5:30pm – 7pm at the Southern Maine Agency on Aging, 136 U S Route One, Scarborough Maine .  For more information on these workshops you can call 1-800-427-7411 or 1-207-396-6500. There are 27 billion informal caregivers nationally and 1.2million in the state of Maine .     

Debbie talked about the advocacy efforts of the Eldercare Issues Partnership to maintain a department of aging services.  Aging is not a disease and being merged with development disabilities and mental health needs would diminish aging as an issue in its own right.  The Office of Elders concept was presented to the Commissioner and was accepted; therefore, there is going to be an Office of Elder Services; an Office of Mental Health; an Office of Developmentally Disabled and an Office of Substance Abuse.  It is almost certain that this will happen.   

Debbie talked about the waiting list for home based care and the problem with access in southern Maine .  The problem is hidden in the fact that there is no money.  A regional allocation of funding could resolve the disparity in services.  It has been said that staffing issue is not the serious one but the real issue is the reimbursement.   

The Brain Injury Association of Maine will be holding their 15th Annual Professional Conference on Brain Injury on April 28 and 29 2005 at Verrillo’s Convention Center in Portland.  The Conference information will be attached and made part of these minutes.  The contact number is 1-800-275-1233.   

Bob Knowles, Good Neighbors, talked about reimbursement for billing through the state which is about six weeks behind. They are getting checks ranging from $111,000.00 down to $587.00 with no explanation for either. The payment received about a month ago turned out to be the 2002 average monthly billing.  The problem is with the 90 day rebilling clause.  If it goes over a year and it isn’t re-billed, it will be lost. The state has a new computer system which was outsourced to another country. There were problems with this system and now a Canadian company is sorting out the problem.     

Debbie talked about the new Medicare D program.  The five area Agencies on Aging, along with Legal Services for the Elderly, offer health insurance counseling to Medicare and MaineCare beneficiaries (SHIP program). Through CMS (Centers for Medicare and Medicaid Services) funding, each Agency on Aging has hired one Medicare D Specialist for the next 18 months.  Katlyn Blackstone, who is an Elder Advocate with the Southern Maine Agency on Aging, will be the Medicare D Specialist for Cumberland and York Counties .  Katlyn will be working with Carol Rancourt, who is the Medicare Coordinator at SMAA. Bette announced that Medicare D training is in process and it will probably be late spring, early summer before these trainings are offered to the community.  There is a six month window to enroll before a penalty will be incurred.  The Elders One number is 1-877-353-3771.  Our benefits sign up day on December 8 for the Medicare Prescription Drug Card was a huge success in spite of a snow storm.   Over 30 consumers were assisted and they saved $30,000.00 in medication bills.   

Bette explained that Medicare D is a prescription drug benefit which is being added to the Medicare program next year and will take effect January1, 2006.  There is a monthly fee of $37.00.  People will have to choose what benefit they want.  Right now it is not known what options will be offered in Maine .  Individual choice will depend on the financial circumstances and the meds taken because each program will have different formularies.  People who choose not to enroll by May 15, 2006, will be penalized for late enrollment at 1% monthly to enroll later.  It is the aim of our agency to educate everyone in Cumberland and York County over the age of 65 within that six-month window.  Katlyn Blackstone from SMAA will be mostly doing the Medicare D trainings.  People can call the Southern Maine Agency on Aging for information and help.  In the interim, there is a Medicare preferred drug card which can be used for the rest of the 2005 year.   

Question:  If a sign-up was in that six month period does a person have to start paying the $37.00.   

Yes they do.  Lower income individuals may be entitled to a waiver of the fee or a reduced fee.  The fee works like an insurance benefit, you pay as a preventive service whether or not you use the medications.  In order to be eligible for Medicare D you have to have Medicare A or B.   

ELISE SCALA, PROJECT DIRECTOR – MUSKIE SCHOOL OF PUBLIC SERVICE UNIVERSITY OF SOUTHERN MAINE AND INSTITUTE FOR HEALTH POLICY – PASA – DIRECT CARE WORKERS.  

Elise gave an overview of the Direct Care Workforce Initiatives – New Attention to Familiar Problems and what she has been doing and for the Muskie School of Public Policy – Instrument PASA (Maine Personal Assistance Service Association) for Direct Care Work Force and the recognition of long term care services and transfer care in facilities.  It has been fascinating process.  Elise has a background of human resources and some direct care work in medicine. A handout was passed out to the group, which outlined the Workforce Initiatives and which is made part of these minutes.  

A lot of the work that is being done is supported by CMS and grants.  The Workforce Initiatives are also funded by private foundations and family foundations recognizing the importance of what is being done regarding directcare workers.   

There are critical staff shortages in 40 states.  Demand for directcare workers has grown and the projection will be 34% based on the aging population and the expectation and demand for services.  The turnover rate of some agencies is over 150%.   The consequence of that is enormous.  The focus on the direct care staff is a paraprofessional group.  What is being heard is that 8 out of 10 hours of paid care received by a long term care client is provided by a ‘directcare’ paraprofessional – CNA, PCA/PSS or home health aide.  There was a study about nursing facilities and directcare workers.  The residents may see a staff member for 15 minutes a day and that would be a CNA over an eight hour period during that day.  This is an industry that has been well known for being dependent on a ready supply of women between the ages of 25 and 54 who are available to do care.   There has been a significant reliance on family members to do directcare but now there is a population shift. Women are working and no longer are able to care for family members. Maine has the oldest average age of 65 and older.  More people are elderly and the options for assistance are really important.  People are living longer healthier lives, thus want to be more independent and so their options for services are going to be more diverse.  People want to live in their own homes with policies supporting home and community based care rather than facility based. The range of services needed is widening and the quality of workforce needs to be there.   The availability of quality directcare and direct support workforce needs to be there. The staff shortages are at critical proportions.   There are significant challenges in the industry because it has structured itself on the assumption of a ready supply of low-income workers.  There is a population shift in Maine .  

Elise talked about an important report that was done two years ago by the Maine Center for Economic Policy called ‘Adult Care’ which has become an important reference document and is used to reach the legislature, raising their awareness on what is happening and what is needed in the workforce to provide services for the not only the aging population, but people under the Disabilities Act, who are choosing to live in their own community home settings.  The Department of Labors in Maine and nationally have some really interesting leads.  Three out of the top five jobs over the next twenty years in Maine are all health directed and as we all know they are not necessarily the jobs of choice.  There is a critical issue in Maine with a shortage of workers that, without intervention, will get worse over time.   

All 50 states have taken at least one step to control Medicaid costs during fiscal year 2002-2004 and either reduced or frozen payments to provider organizations.  35 states including Maine , reduced benefits.  34 states took steps resulting in reduced or restricted eligibility for services.  There were 32 states that increased consumer co-payments. There is a lot of competition for direct care workers. The quality of direct-care jobs is being questioned because the direct care worker does not have ability to do physically hard work and there is the competition between fast food restaurants and retail stores.  The aging population reduces the traditional pool of workers and increases the number of people needing services so in turn the worker is working with more clients with less hours.  There are too many jobs and also mileage is not allowed.  The impact of vacancies and turnover for consumers is lack of continuity, inadequate care or even denial of care so the quality of care suffers.  For the providers there is a high recruitment, retention costs and staff replacement.   For the workers there is a higher rate of injury, stress, frustration and a lack of training.  

Question:  What about the whole issue of freezing Medicaid.  Isn’t this a major factor in reimbursement for the direct care worker?  

It reduces the provider’s margin as they are trying to compete for workers.  There was a wonderful presentation for the Governor’s Staff where the Homecare Alliance of Maine and Maine Healthcare Association presented the new Call Center offering $10.00 an hour with benefits and will draw people away from the facilities.  There is no resource that these providers have to reimburse, so service hours for consumers are being cut.  We are hearing from workers that their hours are being cut and having more clients with few hours. These are workers who are on the front end and are rushing from one job to another.  In the northern part of the state there is the announcement that mileage is being cut.  One worker is dealing with 11 clients and spending more time in the car with no mileage!  The ripple effect from this is enormous.  The employer’s experience is that people are questioning the quality of jobs they are doing.  People, who years ago were in the market of doing directcare, are now looking elsewhere for jobs.   The competition is great for low wage workers when they see job alternatives with better benefits.  The aging population reduces the traditional pool of workers and increases the number of people needing services.   

There is another whole slide show on skilled nurses; another on lab technicians and another on radiology technicians.  This is really a tough situation. CMS is looking for some creative ways to get grants to identify what we are going to do about the issues.   

There is an impact of vacancies and turnover and a lack of continuity for consumers, which in turn leads to inadequate care or even denial of care, so quality of care suffers.  An example is of a woman who told her daughter that she was not taking off her nightgown for another worker again.  Providers and employers are trying to do orientation and training.  The recruitment and retention costs with the turnover, is $4,000.00 plus staff replacement, trainings and orientation.  People are considering leaving the profession all the time.  There are higher rates of injury, stress and frustration, less training and supervisory support.  As the data more attention is made to the workforce.  A lot of the industry is linking the workforce and quality for nurses and paraprofessional/frontline, direct care staff.  The workforce issues are generally an afterthought in the quality debate.  CMS has done several studies of staffing quality.  The turnover is a real issue which long term employers have to deal with.  They are managing within the realities of the labor shortages and restricted funding and are looking to external support such as CMS grants.  

The workforce factors influencing quality are the attributes the workers bring to work.  Some people are just really good at this and others it takes time to learn the skills.  There is development to be done through trainings and education.  The turnover is a real issue which the long term facility employers have to deal with.  They are managing within the realities of labor shortages and restricted funding and are looking to external support such as CMS grants.  Recruitment is only part of the problem.  There needs to be improvement with an eye on quality with participation in evaluation and outcome studies.  Some of the projects that are being done are really advocating positive changes in engaging directcare workers in that discussion and identifying the best practice.  Data helps to determine what are the best practices and supporting others to operate programs and implement those practices. This is something the Department of Human Services has done very well, looking at CMS and responding to grants that CMS has. Muskie School has been involved with a lot of these projects and what is done is see how the jobs are being ranked and get the information back and try to change some of the programs from what has been learned.  More advocacy activities are being organized regarding elder issues and providers who are saying they want to provide more quality services but yet there are not the resources to hire more people.  Catherine Cobb has been extremely helpful in having more resources and other federal and private foundation funding to be made available to states to bring more innovative programs. There needs to be more reimbursement for workers.  The providers should not be excluded.  There are demonstration projects to support recruitment and retention. The website is www.hhs.gov/news/press.  The Better Jobs Better Care website is www.bbc.org. There needs to be more reimbursement for workers.  There are a couple of groups who are working with the project; Susan Rovillard and Home Care for Maine , Home Care Alliance, Maine Health Association and working with the Direct Care Coalition. The Muskie School is working with the DirectCare Coalition.  What is happening is to start form groups to provide the opportunity to get together and gather this information and there are headways being made.   

Muskie School is doing a workforce grant and has had a chance to meet with individual administrators.  One of the questions was not understanding why people leave and why people stay. Another website is to refer to is www.nga.org/center.  

Elise has currently been working on a CMS grant which looks at a proposal trying to address on why people stay in a job for recruitment and retention and one of the concerns in home care field is benefits and Dirigo is looking at implementing health insurance to see if this helps recruit and retain staff which is called “Employer of Choice.”  This is a three year grant.  Dirigo provides an option for people who are low wage earners.  This would be an affordable healthcare for directcare workers.  

The second intervention that is being demonstrated is finding and keeping directcare workers and work with Paraprofessional Healthcare Institute looking at support of directcare workers.  They worked with the Catholic Health Association and put together a wonderful booklet that says what you should consider if you really want to recruit and retaining directcare workers.  There are 150 health care organizations and 30 who have agreed to participate.  There is more information needed to target homecare agencies and demonstrating peer mentoring.  Also looking at policy and see what is the best practice.   

Maine PASA – Maine Personal Assistance Services Association – recognizing and contributing to the professional development of the direct care and direct support workforce.  There are Department of Labor funds which include the following:  

·         Current project with American Network of Community

·         Organized Resources to assist with recruitment of direct Support professionals for MR programs/res care

·         Pathways to Retention (completed) CEI and PHI work with Glenridge and Home Care of Maine.

·         Direct Care Worker Coalition ( Augusta )   

The following is the website for National Provider Practice Database:

·         www.futureofaging.org

·         www.directcareclearninghouse.org  

There are two public policy trends:  

·         10 states reported they are collecting turnover data using uniform methodology.  This will be helpful for assessing the stability/instability of the workforce and the impact of interventions.

·         States’ interest/efforts to tie outcomes to provider reimbursement.  This strategy requires data/evaluation systems to verify that intended outcomes have occurred.  

Staying involved and informed –  

Opportunities to Stay Informed  

Provider/trade groups

Employee groups

Continuing education programs  

            Demonstration projects

            Evaluation projects  

Contact information can be found through Elise Scala, Project Director, Muskie School of Public Service, University of Southern Maine , P O Box 9300 , 96 Falmouth Street, Suite 509 Forest, Portland , Maine 04104 -9300 – scala@usm.maine.edu – 228-8423.  

Debbie thanked Elise for her presentation.  

The next meeting will be held on Wednesday, April 27 2005 2-4pm.

 

Respectfully submitted

Vivien Eisenhart

Administrative Secretary

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