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CMS Intensive: Strategies for Addressing Barriers to HCBS Workforce Development HCBS Conference Arlington, Virginia September 13, 2012 Agenda About the DSW Resource Center and the Direct Service I. Workforce Barriers to Workforce

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CMS Intensive: Strategies for Addressing Barriers to HCBS Workforce Development

HCBS Conference Arlington, Virginia September 13, 2012

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www.dswresourcecenter.org

Agenda

I.

About the DSW Resource Center and the Direct Service Workforce

II.

Barriers to Workforce Development

III.

Why Recruitment and Retention Matters

IV.

Proven Solutions and Workforce Improvement Strategies

V.

CMS Investment in DSW Development

VI.

DSW-RC Key Activities 2012/2013

  • VII. Strengthening the Workforce – How you can help!

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www.dswresourcecenter.org

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CMS DSW Resource Center

www.dswresourcecenter.org

Our mission is to support efforts to improve recruitment and retention of direct service workers who help people with disabilities and older adults to live independently and with dignity.

  • Raising Awareness
  • Building Consensus and Promoting Cross-Sector Partnership
  • Disseminating Best Practices
  • Providing Technical Assistance
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National Direct Service Workforce Resource Center Partners

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Members of the Direct Service Workforce

Nursing facility aides - provide services and supports to individuals in nursing facilities and institutions; includes nursing aides, orderlies and attendants

Direct support professionals (DSPs) – provide services and supports to individuals with developmental and intellectual disabilities, substance abuse challenges, and serious and persistent mental health issues

Personal and home care aides (PHCAs) - provide services and supports to older individuals and people with physical disabilities. Increasingly provide services to nursing facility-eligible consumers in home- and community-based settings. Growing number are “independent providers” and/or paid family caregivers

Home health aides (HHAs) - typically employed by Medicare-certified home health agencies and deliver more clinically-oriented services

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Workforce Barriers Impeding HCBS Development and Successful LTSS Balancing

Characteristics of HCBS Jobs

Isolation = limited supervision and limited peer support

Limited availability of training/ credentialing systems

Part-time work

Lower wages and fewer benefits compared with NF/ Institutional jobs

Higher transportation costs

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Workforce Barriers Impeding HCBS Development and Successful LTSS Balancing

Industry Practice

Cultures of Turnover

Inadequate Training and Orientation

Limited Advancement Opportunities

Low Wages and Few Benefits

Erratic Work Schedules

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Workforce Barriers Impeding HCBS Development and Successful LTSS Balancing

Public Policy

Inadequate funding to improve service quality/ job quality

Wide variability of training standards

Limited infrastructure to support workers (often family caregivers) and consumers in participant-directed model

HCBS quality assurance systems are often underdeveloped and/or do not include workforce measures

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Background: Size of the Direct Service Workforce

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http://phinational.org/policy/states/united-states/

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Background: Occupational Growth

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http://phinational.org/policy/states/united-states/

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Background: Median Hourly Wages

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http://phinational.org/policy/states/united-states/

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Background: Health Insurance

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http://phinational.org/policy/states/united-states/

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Background: Public Assistance

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http://phinational.org/policy/states/united-states/

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Why Improving HCBS Workforce Recruitment and Retention Matters

Increasing demand for all LTSS, especially HCBS

Supply of workers not growing fast enough to keep up with demand

Unique barriers to workforce development in home and community-based service systems

Quality of services depend on quality and stability of workforce

Cost of turnover

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Three Rights to Care

Families are permitted and helped to care for their family members

Paid caregivers give high quality care without compromising their own well-being

People who need care can get it

  • Deborah Stone, 2000

Why it Matters to People with Disabilities and their Families

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Essential Elements of a Quality Job - PHI

  • Compensation - Wages, health insurance, full-time hours
  • Opportunity - Training, participation in decision-making, career

advancement

  • Support - Linkages to organizational and community, supervisors,
  • wners and managers

Why it Matters to Workers

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Why it Matters to CMS and States

$$$

  • Reducing turnover saves public resources
  • Timely and adequate provision of HCBS can delay
  • r prevent more expensive institutionalization

Access Quality

State Medicaid programs are responsible for providing services in the most integrated setting possible and for ensuring services are available and of the highest quality.

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Outcomes of Improved Recruitment

Increased number of qualified applicants for open positions

More realistic understanding of direct service jobs among potential workers

Fewer job vacancies

Fewer and shorter gaps in care (less unmet need) experienced by consumers

Greater public awareness, more positive image and more interest in the direct service field

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Outcomes of Improved Retention

Greater continuity of care for consumers

 Fewer changes in support provider experienced by consumers  Increased duration of time workers stay with individual consumers,

with the same agency or in the field

Increased worker satisfaction

Increased opportunities for professional development and career advancement

Greater number of experienced workers

Reduced job turnover

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Proven Improvement Strategies and Solutions

Industry Strategies

 Targeted Recruitment and Selection  Culture Change Initiatives  Participatory Management  Multi-Employer Collaboratives  Career Pathways  Coaching Supervision Training  Peer Mentoring  Developing Business Case for Workforce Investment: ↑ Wage; ↓ Turnover  Guaranteed Hours  Sharing Across Settings  Reimbursement of Transportation Costs

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Proven Improvement Strategies and Solutions

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Public Strategies (Medicaid)

 Provider Reimbursement/Rates Analysis  Contracting Standards for Providers  Incentive Awards for Workforce Outcomes  Labor Market Analysis  Workforce Data Collection  Health Coverage Initiatives  Competency and Training Development  Universal Core Curricula  Apprenticeship Programs  Public Authorities  Worker Registries  Worker Associations

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Participant Discussion

 What kinds of workforce development initiatives are you in

involved with?

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History of CMS Investment in DSW Development

Real Choice Systems Change Grants, 2001

CMS Direct Service Workforce Demonstration Grants, 2003 and 2004

 National Evaluation of DSW Demonstration, 2008 

CMS Direct Service Workforce Resource Center, 2005- Present

 Intensive TA awarded on competitive basis to 15 states, 5

per year 2006-2008

 Intensive TA to Money Follows the Person Demonstration

programs 2008-Present

 Cross-Cutting Reports, Events and Special Projects

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DSW Grants: Summary of Approaches

2003 GRANTEES 2004 GRANTEES INTERVENTIONS DE LA ME NM NC AR IN KY VA WA

Health care coverage

X X X X X

Enhanced training/ education

X X X X X X X X X

Career ladder, peer mentorship, or other merit-based recognition

X X X X X X X

Community building/ worker registries

X X X

Enhanced marketing or

  • ther recruitment

strategies

X X X X X X

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DSW RC Intensive TA Focus Areas

2006 TA Recipients 2007 TA Recipients 2008 TA Recipients

Focus Areas

AZ LA NY SC TX GA NJ NC UT WI DE IN MI OH VT

Strategic Planning and Partnership

X X X X X X

Disseminating Best Practices in Recruitment and Retention

X X X X X X X

Marketing/ Raising Awareness

X X X X

Data Collection System Design

X X X X X X

Market/Demand Study

X X X

Wage/Benefit Development

X X

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DSW RC Intensive TA Focus Areas

2006 TA Recipients 2007 TA Recipients 2008 TA Recipients

Focus Areas

AZ LA NY SC TX GA NJ NC UT WI DE IN MI OH VT

Worker Training Credentialing

X X X X X X X

Consumer Directed Training

X X X

Worker Association

X X

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DSW RC Key Activities 2012/2013

  • Technical Assistance to Money Follows the Person

Grantees

Individualized TA and webinars/discussion groups for the 43 states and District of Columbia

  • National Balancing Indicators Project

Surveys of Independent Providers and Employer Organizations in 7 State Profile Tool Grantees (AR, FL, KY, MA, ME, MI, MN)

Toolkit on DSW Data Collection for other states in development

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DSW RC Key Activities 2012/2013 (continued)

  • Toolkits and Resources for States (in development)

 Review of Proposed Models to Integrate Medicare and Medicaid

Design Contracts for evidence of workforce infrastructure

 Development of a toolkit for State Medicaid Agencies on

implementation of training costs within Medicaid rate development as outlined in the July 2011 CMS Bulletin

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Participant Discussion

 How does your state pay for and support training for DSWs?  How can states promote workforce development within managed

LTSS models?

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DSW RC Key Activities 2012/2013 (continued)

  • Special Projects to Support DSWs and Family

Caregivers

 DSW Core Competencies Road Map Project  Building Capacity for Participant-Direction  Policy Options for Increasing Wages

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Why are Core Competencies Important?

A set of DSW HCBS core competencies will help to:

 Establish best practices across sectors  Influence state training policies  Enable more efficient investment in training and workforce

development

 Facilitate ongoing interagency collaboration  Create a clear career path for workers  Help workers to better meeting consumers’ individual needs

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Road Map of Core Competencies for the Direct Service Workforce

Phase III: DSW Core Competency Validation and Synthesis

Modified Delphi process with leader/expert panel to determine core competencies

Phase II: DSW Competency Analysis

Content analysis completed among 7 nationally-recognized competency sets

Phase I: DSW Competency Inventory

Across LTSS sectors: Aging, Behavioral Health, Intellectual and Developmental Disabilities, and Physical Disabilities services

22 sets inventoried:

14 established, 8 in development (6 PHCAST)

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Based on content from the following resources:

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DSW Core Competency Areas Draft List for Review

  • 1. Communication
  • 2. Facilitation of Individualized Services
  • 3. Assessment
  • 4. Participant Crisis Prevention and Intervention
  • 5. Professionalism and Ethics
  • 6. Participant Empowerment
  • 7. Advocacy
  • 8. Documentation
  • 9. Community Living Skills and Supports
  • 10. Supporting Health and Wellness
  • 11. Safety
  • 12. Community and Service Networking
  • 13. Cultural Competency
  • 14. Education, Training and Self-Development

 Addiction Counseling Competencies (TAP 21)  Adult Psychiatric Rehabilitation/Recovery-Oriented Mental Health Services for Adults Competencies (CPRP , USPRA)  Alaskan Core Competencies  Community Residential Core Competencies (CRCC)  Community Support Skills Standards (CSSS)  Competency Standards for Physical Health and Aging (CNA, HHA, and HSS)  National Alliance for Direct Support Professionals Competencies (NADSP)

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Core Competency Next Steps

 Stakeholders completed and submitted review form – July 2012.  In-person Summit held in conjunction with NASUAD HCBS

Conference in Arlington, VA on Sept. 10

 DSW RC disseminates modified Core Competency Set for final

review and approval by all stakeholders – November 2012/2013

 Plan for validation and testing stage and final publication - 2013

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Participant Discussion

 What skills and competencies would you most want to see

included in basic or “core” training for HCBS direct service workers?

 What areas do you think are lacking in current training programs?

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Strengthening the Workforce – How you can help!

1) Talk to state leaders, employer associations, and advocates about

the importance of direct service workforce development, especially HCBS development.

2) Consider workforce capacity as you develop new initiatives and new

service models (e.g., integrated care, managed care).

3) Insist on cross-setting, cross-population approach to workforce

development initiatives.

 Review your state’s workforce policies (e.g., service rates, training

programs, quality improvement initiatives) – are they consistent across populations and programs? Are inconsistencies causing disincentives to rebalancing?

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Strengthening the Workforce – How you can help! (Continued)

4) Include workers, consumers, and family members as

stakeholders/advisors in workforce development initiatives.

5) Support and participate in data collection activities that help

states assess workforce status and measure outcomes (e.g., NBIP and PHI State Data Center).

6) Review and provide feedback on draft DSW Resource Center

products (e.g., core competencies).

7) Let us know about your workforce development activities. 8) Remember that CMS makes free technical assistance available to

states through the DSW Resource Center.

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Kathryn King CMS, CMSO, DEHPG, DCST Kathryn.king@cms.hhs.gov Carrie Blakeway The Lewin Group carrie.blakeway@lewin.com 703-269-5711

The Lewin Group | Health care and human services policy research and consulting | www.lewin.com

3130 Fairview Park Drive, Suite 800 • Falls Church, VA • 22042 From North America, call toll free: 1-877-227-5042 • inquiry@lewin.com

Direct Service Workforce Resource Center Contacts

www.dswresourcecenter.org info@dswresourcecenter.org 1-877-822-2647