PHI is a not-for-profit organization that works to strengthen the direct-care workforce within Pennsylvania’s long-term care system. Our work is grounded in the philosophy that quality jobs for direct-care workers will lead to quality care for long-term care consumers. PHI recently began the Health Care for Health Care Workers Initiative, with the specific goal of advocating for affordable and accessible health insurance coverage for direct-care workers in nursing homes, assisted living, and in-home settings. Over the past year, PHI has been a member of the Governor’s Office of Health Care Reform’s Health Resources and Services Administration (HRSA) State Planning Grant for the Uninsured. We have provided input on how health insurance models explored in that process would affect the direct-care workers and their employers. We recently conducted a feasibility study of long-term care employers to better understand the current availability of health insurance coverage for direct-care workers and identifying the barriers that long-term care employers face in providing coverage to their workers. We also have brought together several focus groups of small and large employers throughout Pennsylvania to discuss their ability to provide health insurance for their workers. Soon, we will be surveying employees to learn more about the worker’s perspective.

There are an estimated 130, 000 direct-care workers in Pennsylvania. Nursing assistants, home health aides, and personal care attendants provide 70 to 80 percent of the hands-on long-term care services to elders and individuals with disabilities. We know that nationally, one in four nursing home workers and more than two out of five home care workers lack health insurance coverage. Given the challenges that direct-care workers and long-term care employers face in obtaining health insurance coverage we believe these national rates of non-insurance among direct-care workers are applicable in Pennsylvania. Direct-care workers lack insurance for two primary reasons: It is too expensive for them or it is too expensive for their employers. In Pennsylvania, home health aides and nursing home assistants earn an average of $9.00/hour. Studies show that almost half of direct-care workers live in households that are at or below the poverty line. In the instances when health insurance is available through their employer, these workers often cannot afford the average employee premium for individual or family coverage.

Difficulty recruiting direct care workers is a serious workforce problem which can be linked to a lack of health insurance.53% of 759 direct care providers surveyed in Pennsylvania reported either very serious or somewhat serious recruitment problems, and 42% reported serious or somewhat serious retention problems. The same report reveals that almost half of Pennsylvania consumers reported they have had more than one paid caregiver in the past week. Recent research also suggests that, for direct-care workers, health insurance is even more important than wages in reducing turnover, or in increasing the supply of direct-care workers and hours worked."

PHI has begun exploring a method of cost-sharing of benefit packages. We are interested in learning more about how long-term care employers can offer affordable health insurance. Low income workers are more likely to use and access health insurance when cost-sharing is below 5 percent of their income. Also, while we recognize the need to keep the cost of care at manageable levels, we find that direct care workers realistically need a solid benefit package, including prescription drugs, disease management/education services, and, given their high rate of on-the job injury, physical and occupational therapy services.

It is becoming increasingly difficult for health care provider agencies to provide employees in their industry with adequate heath insurance and other benefits.

With this in mind, the Paraprofessional Healthcare Institute (PHI), the Tri-County Patriots for Independent Living (TRIPIL Services), the Service Employees International Union, and the ICA Group have partnered to conduct research to explore alternatives that might make affordable employee benefits more widely available within the home and community based service sector in the Washington, Fayette and Greene County area. This effort is part of a larger project TRIPIL is undertaking with the financial support of the Pennsylvania Department of Labor and Industry, to create a Regional Workforce Center in southwestern Pennsylvania.

Our efforts have been focused on a survey that will explore the feasibility to develop a Professional Employer Organization (PEO) that could offer affordable health insurance for the long-term care sector in Southwestern Pennsylvania. The mission of the proposed PEO will be to establish a co-employer of record for agency-employed caregivers in the region for purposes of payroll, health insurance, and other benefits. The PEO offers an increasingly common solution to the escalating cost of health insurance for small and medium sized companies.

We believe the Governor’s Prescription for Pennsylvania is a great step in the right direction to provide health care coverage for all Pennsylvanians including those in the direct care workforce. We are pleased that the plan recognizes the need for subsidies for low-income families and small employers that employ the majority of the working uninsured in Pennsylvania.

We have learned a great deal about state reform and how subsidizing employer coverage can address the direct care workforce from our work in Maine with the state’s DirigoHealth reform plan since its launch in January 2006. There are lessons here that we want to share with you that we believe are relevant for Pennsylvania’s direct care workforce

These are just a few of the issues that are unique to the home care and home health arena and ones that could have a significant impact on improving access to the caregiving workforce.