Direct Care Workforce

This week, the Senate Finance Committee released the language and summaries of legislation to help nursing home efforts to stop the spread of COVID-19. The Act would call on nursing homes to ensure that a portion Federal relief funds, made available on or after July 1, for responding to COVID-19 would be used for personal protective equipment (PPE) and COVID-19 testing in long-term care facilities. The Act also has language for expanding resources for elder justice activities.

This report looks at the changes states implemented to their Medicaid or other publicly-funded consumer directed home care programs in order to comply with the 2013 FLSA Home Care Rule. The report includes perspectives from various stakeholders and describes issues raised in interviews. It provides an overview of early implementation efforts, an environmental scan of state policies and procedures, and a case study examination of states with well-documented hardship exceptions.

This brief focuses on how providers can recruit and retain a direct care workforce. Considerations include inclusive hiring practices, cultivating an organizational environment of inclusivity, and providing appropriate training. Companion briefs in this series discuss direct care worker training and organizational cultural competence.

This brief highlights how providers can train their workforce in cultural competency. Key recommendations include establishing formal policies, focusing on the elements most relevant for LTSS, using adult learner-centered methods of training, and identifying which programs work best for your organization's setting. Additional briefs in this series focus on organizational cultural competence and recruiting and retaining a diverse direct care workforce.

This brief describes how LTSS providers can build cultural competence within their organization. It covers key considerations including identifying areas for improvement, supporting diversity across the organization, addressing linguistic competence, and engaging community partners. Other briefs in this series provide specific considerations for training, recruitment, and retention of direct care workers.

The Home and Community Based Services (HCBS) Conference is hosted annually by ADvancing States (formerly known as NASUAD). This event highlights best practices from across the country in home and community-based services. The conference includes federal, state, and local policymakers as well as those who administer, manage, and deliver waiver and other HCBS programs. This link contains all of the slide presentations from the 2019 HCBS Conference.

The Centers for Medicaid & Medicare Services released a report that profiled the 10 states with the greatest change in Long-Term Services and Support (LTSS) system balancing. The report highlights characteristics of the 10 states and compares their change in LTSS system balancing with other states and provides a national overview on LTSS system balancing. State profiles consist of characteristics and strategies states utilized in their progress towards rebalancing their LTSS systems.

The report provides an overview of the expected increased need for direct care workers and a breakdown of the current direct care workforce. In each description of barriers facing the direct care workforce, PHI includes program and policy recommendations. Challenges and recommendations in this report include areas regarding: wages and benefits, training, advanced roles, supervision, recruitment and retention, data collection, decision-making, family caregivers, and matching service registries.

This report is the third in a series of publications from the MLTSS Institute. The report identifies the challenges and promising practices in addressing the mismatch between supply and demand for direct care workers in long term services and supports programs, all viewed through the lens of MLTSS programs. This report is co-authored by ADvancing States and Sage Squirrel Consulting, LLC.

While faced with new challenges, reduced budgets, and growing populations requiring more services, states are stronger than ever, and the work they do is more effective than ever in reaching individuals and addressing their needs. The National Home and Community Based Services (HCBS) Conference 2018 highlights these achievements, allowing states to share best practices, present unique partnerships, and recognize the work of their peers.