Advancing the Direct Care Workforce

Professionalizing the Field of Direct Care with House Memorial 37 Task Force

Frances Vescoso, a resident of Las Cruces, has been called a mother who truly feels the she will need to live another 67 years so she can take care of her son, one who was brain damaged at birth and who functions today at the level of a four or five year-old. Frances is worried that no else will be able to competently care for her son when she is gone. For this reason, Frances called state Representative Jeff Steinborn in early 2009 and asked that he sponsor a memorial to address her concern.

As a result, the House Memorial 37 Task Force (“Task Force”) was created during the 2009 Regular Session of the New Mexico legislature. The memorial requests a study to plan and implement a training and education program leading to credentialing of individuals who work as direct caregivers for individuals with disabilities and with elderly New Mexicans.

The topic is especially timely for New Mexico for several reasons, including predicted workforce shortages in health care and other fields, significant increases in the elderly population in the state, and an increased focus on consumer choice and home and community-based care.

Average wages for caregivers in the state of New Mexico are much lower for people in these occupations than for other occupations. In New Mexico, a home health aid worker earns approximately $8.00 per hour, $7.53 per hour less than that of an average New Mexico worker.1 And, while average hourly wages for direct caregivers increased ten percent from $6.62 (1999), these are wages at 150 percent of the Federal Poverty Level!

Occupational growth in the field of direct care is rapidly increasing. Personal and home health aides are the second fastest-growing occupation, both nationally and in New Mexico. The U.S. Department of Labor reports 21,520 New Mexicans were working as nursing assistants, home health aides or personal care/home care aides in 2006. Projected annual job openings for these occupations predict 6,190 additional job openings--an increase of 58 percent between 2006 and 2016!

High job turnover in the field of direct care occurs as a result of worker shortages, low wages, few to no benefits, little training and little recognition for the work performed. Persons who are elderly and disabled suffer the effects of direct care worker shortages and high turnover. The quality of care is compromised since employers are unable to meet the need for high-quality services to elders and people with disabilities. Read the full report here.
 

House Memorial 37 Legislative Task Force Recommendations:
  1. Define a core curriculum common to all direct care workers, building discipline-specific or sub-specialty training from that foundation. Direct caregivers undertake agency-specific have training depending on the setting and needs of the populations they serve. We recommend a foundational, or core, curriculum for all direct care workers regardless of work setting or needs of consumers served. A basic level credential would teach the skills common to all fields of direct care (elderly, physically, developmentally, psychologically, cognitive disabled). We recommend that advanced, discipline-specific curricula be developed once a crosswalk has been conducted (See Further Study Needed) and after a learner has mastered a foundation credential.
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  3. Direct care workers must be able to demonstrate skills acquired. Any direct caregiver, regardless of setting, must be able to demonstrate competence in skills acquired. And, for those individuals directing their own care, they too should be held accountable for demonstrating an appropriate level of training and competency of their caregiver.
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  5. Meet adult learners at their levels, reaching them through a variety of methods. There are many ways adults learn, just as there are a variety of learning resources, geographic settings and life circumstances of workers themselves. A focus on development of core competencies (rather than educational attainment) will result in mastery of the requirements needed for direct care workers as well as a learner’s identification of career pathways and transferable skills needed to transition among a variety of occupations within the field. A full menu of delivery mechanisms should be developed that includes classroom training, web-based/on-line learning and self-paced or independent study. Language adaptations may be required depending on the needs of the individual learners.
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  7. Educational credit should be granted to adult learners for experiential knowledge. When developing the core foundation curriculum and subsequent discipline-specific training, provide a way to grant educational credit for life experience and for training provided by state agencies and service providers.
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  9. Consolidate resources for educating and training direct caregivers. The range of state and Federal agency and service provider resources, tools and websites should be consolidated and made available to all direct caregivers. This clearinghouse would hold resources including education and training standards, workforce development tools and information on job/career advancement.
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  11. Remove barriers to granting wage increases for direct caregivers’ additional training. Existing obstacles to wage increases should be removed for those who obtain additional job training. For example, the Mi Via Waiver budget should be amended to grant wage increases (or benefits) for attendant care training.
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  13. Continue to involve consumers and direct care workers in development of a credentialing system. We strongly encourage continued involvement of consumers and direct caregivers so they may provide feedback to these recommendations and subsequent development of training, tools and resources.
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  15. Use Federal and state regulations to reinforce quality of care, asking that service providers, contractors and advocates re-draft certain rules. Consider additional documentation requirements as needed and by exception, employing these for clients who have ill-defined or more intensive clinical or behavioral needs. Government rulemaking generates attention to detail but not necessarily better quality of care. Further, there is a distinction between quality operating standards and regulations that reflect no more than a possibility of eliminating risk for vulnerable populations.
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  17. Promote a “duty to report” as an essential safety mechanism to protect consumers from abuse, neglect and exploitation, describing a policy and procedure for if and when a “self-directed” consumer loses his rights in self-directed care. The responsibility of the individual, family, community, service provider and government to provide oversight needs better definition and clarity. While we strive to promote individual liberty, there is a need to define the criteria for “involuntary termination” of a self-directed wavier when one’s own or another’s safety is threatened.
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  19. Improve and promote a positive image of direct care as a profession. There is a high degree of interest among direct caregivers, agencies and providers alike for gaining recognition, increasing the sense of professionalism and developing public awareness of the work of direct caregivers.
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  21. Develop and encourage adoption of a professional Code of Ethics that is daily demonstrated by direct caregivers across New Mexico. We believe that a Code of Ethics will help to promote a sense of professionalism and excellence.
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  23. Promote self-management and stress reduction skills to direct caregivers so they may deal with difficult work-related and personal care situations.