Direct Care Workforce

The availability of trained direct service workers is threatened by dramatic increase in population age 65 and older and the growing demand for long-term services and supports. This document explains why states and ADRCs need to focus on building their Direct Service Workforce to meet this growing demand.

The Office of Inspector General’s (OIG) body of work examining Medicaid personal care services (PCS) has found significant and persistent compliance, payment, and fraud vulnerabilities that demonstrate the need for Centers for Medicare & Medicaid Services (CMS) to take a more active role with States to combat the issues. This document summarizes OIG’s PCS work and, on the basis of the analysis of this work in the aggregate, offers recommendations to improve the integrity of Medicaid PCS.

Agency with Choice (AwC) is a model of Financial Management Services (FMS) in which an agency and a participant are joint employers of workers who provide service to the participant. This paper presents the benefits, challenges, and risks of AwC FMS and puts forth the National Resource Center for Participant-Directed Services (NRCPDS)’s list of key components for AwC FMS to be considered participant-directed, providing a model for consistency in future implementation of AwC FMS.

This critical essay examines how effectively the Patient Protection and Affordable Care Act (ACA) addresses prevailing deficiencies in the nation's long-term care system and whether the ACA will result in meaningful reform. This article also reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them, including incentives/options for expanding home- and community-based care and a number of research and demonstration projects.

This paper provides a brief overview of the direct-care workforce in the U.S. It uses PHI research to detail many of the issues facing the workforce, including low wages, inadequate benefits, and a lack of career advancement opportunities.

As technology continues to transform the workplace, demand is growing for the development, purchase, maintenance and use of information and communication technology (ICT) that is accessible to and usable by all applicants and employees, including individuals with disabilities. This paper provides a framework that can be used to develop technical assistance tools to help employers design, purchase, lease, maintain and use ICT that is accessible to & usable by people with disabilities and others.

This is the second “year in review” of developments in family caregiving, and there remains considerable room for improvement in how this nation supports the over 42 million family caregivers (and growing) who provide an estimated $450 billion in “free” care annually. The guide provides an overview of key developments in 2011. Two shorter versions, "45 Facts About Family Caregivers" and "27 Things You May not Know about Women and Caregiving" are also available.

Providing personal assistance services (PAS) in the workplace (WPAS) is one approach to support the employment of individuals with disabilities. This study examined the implementation of Medicaid WPAS by collecting & analyzing telephone interview data from key informants selected from county & public authority officials in California in 2010. The results showed that less than a fraction of 1% of individuals with disabilities who used Medicaid personal care services used the services at work.

The survey focused only on the Personal Assistant Workforce employed through the Center’s for Independent Living (CIL) Fiscal Intermediary (FI) programs at Disability Action Center Northwest (DACNW), Living Independence Network Corporation (LINC), and Living Independently For Everyone (LIFE). The major focus of this survey was to gather ideas and responses from personal assistants on ways to improve the retention rate in the FI In-home Personal Assistant (PAS) Workforce.

The goals of the survey, which was sent to direct-care workers serving participants using the MI Choice SD option, were to: collect baseline demographic information on workers in the SD option; understand the motivations, job satisfaction, and training needs of workers providing services and supports to self-directed participants; and,identify strategies to strengthen and support the recruitment and retention of workers in self-directed programs.