1. Sites for affordable housing; 2. The Wisconsin Quality Home Care Commission

Today's Milwaukee County issues day!

Affordable Housing

On Wednesday, July 18, the Committee on Health and Human Needs of the Milwaukee County Board of Supervisors passed a resolution to “create a work group of County officials. . . to survey all county-owned land that potentially could be utilized for affordable, accessible, and supportive housing benefits for seniors and disabled citizens” and to prepare a list of appropriate sites.

The list will be sent to appropriate County Board committees and the Committee on Economic and Community Development. Authors of the resolution were Supervisors Holloway and DeBruin.

This may be an important step in locating affordable service-and-housing for those who need it most where they need it most—throughout the county.

* * *
Wisconsin Quality Home Care Commission

The second agenda item, a discussion of a report about the benefits and potential problems that might result from instituting the Wisconsin Quality Home Care Commission resolution (QHCC), was more controversial.

And trying to figure out what it all means has been an education! This is really long, but I wanted to share the fruits of my sometimes frustrating search for information. I'm counting on you to help me out if I'm off-base!

The Wisconsin Quality Home Care Commission is an intergovernmental entity, separate from the state or county, established in 2006 to provide services to consumers and providers of home care and personal care services. It promises to develop a provider registry, offer assistance for consumers in selecting providers from the registry, and serve in some capacities as the employer of record for private providers (those who aren’t affiliated with an agency) who want to be in the registry. Dane was the first county to sign the agreement, and the Commission is looking to Milwaukee County to sign on.

The Milwaukee County committee voted 5-1 endorsing the principle of the Commission. That’s different from actually signing an intergovernmental cooperation agreement, as Dane County and the Wisconsin Department of Health and Family Services (DHFS) have.

Presently, the Commission is only in the developmental stage. It has no continuing funding source, and it’s intended to “improve the quality and accessibility of supportive home care and personal care services” for clients with disabilities who receive medical assistance waiver services, not elderly people.

So why write about it here?
One of the reasons for looking at this proposal, according to Paper #436 (May 2, 2007), Health and Family Service—Disability and Elder Services, is the need to grow the pool of personal care workers in light of the expansion of Family Care, the nursing home diversion initiative, and other long-term care community program options. So it seems reasonable to follow carefully what unfolds here. It may be something in the future for home care providers for the elderly, too.

Who’s your boss?
If you are an independent personal care worker in a participating county, the Wisconsin QHCC could be a sort of Professional Employer Organization (PEO) for you.

With a PEO, you really have two employers--the person or organization that hires you and supervises you, and another entity that “assumes much of the responsibility and liability for the business of employment, such as risk management, human resource management, payroll, and employee tax compliance.” Training and orientation can also be PEO roles.

Because of the role of the Service Employees International Union (SEIU) in establishing the Commission, it would be a very new thing indeed—a union PEO. Traditionally, PEOs are “white collar” entities.

About the registry
A prototype registry already exists, and it’s expected that the provider registry of the Wisconsin Regional Training Partnership and the Service Employees International Union (SEIU) will be folded or developed into the QHCC registry.

Here’s what the provider registry form for Dane County looks like. Presently, it seems to be a list of skills and preferences, without a way to evaluate quality.

Back to the meeting
Corey Hoze, director of the Milwaukee County Department of Administrative Services, expressed reservations related to potential costs and limitations on consumer choice. Apparently, he’d expressed support for the objectives of the Commission but the same reservations at the previous meeting.

But the room was packed to overflowing with supporters, mainly from the Wisconsin Home Caregivers United for Quality Care, who spoke eloquently to the pressing need for quality home care--and support for the people who provide it.

I spoke to an organizer for Local 150 of the SEIU, who confirmed that the Wisconsin United people were from his organization.

Wherever you sit on the question of unions, there’s no question about the value of some of the points made by the supporters, especially about the need for better training and quality of care.

Ann Kruschke spoke to the lack of any but basic training for home care workers, compared with hospital employees who can upgrade their skills. “People are coming home in much more serious condition, with tracheostomies for example, and there’s no training for the people who take care of them. There should be at least one place they can go to learn more.”

Another woman, new to home care, talked about a gap she found in caring for older people. Formerly a childcare worker, she pointed out that part of the caring job with children was to provide cognitive, emotional, physical, and social stimulation. But there is nothing like that in the task list she receives from the agencies for which she works. “I’m afraid if I start a puzzle, sit down for coffee with my client, or take them for a walk, I’m stealing from the agency’s time. But I know how important those things are.”

A place for training for some
Important points, and we’d love to hear your comments on them. But there’s one place direct care workers who work with the elderly can go for free education and professional development.

The Milwaukee Aging Consortium's Caregiver Retention Project has been providing ongoing caregiver enrichment education since 2004. The next resource event, Thursday August 9, 5-7 pm at the Milwaukee Center for Independence, is providing skills and knowledge in dealing with people with disabilities and seated exercises home care workers can use with their clients.

Just what the Wisconsin United folks are looking for. Is this another place to develop partnerships?

Medicare: Universal health care for everyone?

With a genuine universal health care plan headed for the state assembly, Wisconsin’s abuzz with debate over the best ways to improve health care access and cut costs.

Some see salvation in the plan, which opens to all the system state employees use. Others see socialism and disaster. Business groups are divided, with many trade groups opposing the plan but some independent operators supporting it. Republicans have vowed to administer a swift death to the plan.

Wisconsin Democrats aren’t the only supporters of universal health insurance. The National Older Women’s League, OWL, is, too. In their Mother’s Day report for 2007, Give ‘em Health Revisited: Medicare for All, authors Joan Brodshaug Bernstein and Merton C. Bernstein say we’ve already got a system that works, so why not use it for everyone?

The Oregon Alliance for Retired Americans writes of the report:

Give 'Em Health, Revisited: Medicare-for-All illustrates the ways midlife and older women are especially at risk for lack of health care coverage. The report provides a scathing overview of what is wrong with the current health system including the one-third of total health care expenditures that go to pay for administration, the tripling of profits over five years of the top seven U.S. health care insurers, and the exorbitant salaries of pharmaceutical company CEOs. Yet 47 million Americans have no health insurance, including 15 percent of women age 60-64. OWL concludes the report by endorsing a Medicare-for-All plan that would provide health care insurance coverage to all Americans without requiring new taxes or fees.

Here’s one Tennessee woman’s response:

I am a registered nurse and health care administrator (recently retired). I spent a huge part of my 37-year career finding ways to get coverage for the medical needs of patients. If health care providers were freed from this laborious concern, there is no telling how much talent and skill would be freed up to care for patients—the impact would be wonderful and dramatic!

What do you think? Does dealing with insurance take your time away from more important tasks? Is universal health care important? Viable? Could Medicare be a good system for all? Who would benefit--and who would not?

USA Today series plunges into caregiving

USA Today is doing a great job helping people understand what’s involved in caregiving and longterm care for our elders.

If you’re a professional in aging, it may seem like an old story well told. But if you’re just starting to get an inkling, the series of articles Role Reversal: Your Aging Parents and You is an eye opener. You may want to share these articles with friends and clients.

To give an idea just how big the issue of caregiving is, not only personally but as a factor in the economy, consider these "average caregiver" facts from the AARP:

• The “typical” caregiver in the U.S. is a
46 year old female who works outside
of home and spends more than 20
hours per week providing unpaid care.
Caregivers often experience serious
economic losses due to changes in
work patterns, including lost wages,
loss of health insurance and other job
benefits, and lower retirement savings
and Social Security benefits.

• Almost one fifth of workers (19%) are
informal caregivers. Productivity
losses to U.S. businesses related to
informal caregiving are estimated to be
as high as $33.6 billion per year, more
than half the value of all productivity
losses due to common pain conditions,
such as arthritis, headache, and back
conditions.

In the USA Today series, “Becoming ‘parent” of your parent an emotionally wrenching process” is an especially eloquent account of the emotional aspects of the caregiving relationship.

Here’s the list of series articles that have appeared or will appear in the journal and its online counterpart. ABC news is running stories on the subject as well.

Monday
The burden of caring for elderly parents
A shift away from nursing homes
Valuable resources for caregivers

Tuesday
Coping with an aging parent: The emotional toll
Balancing work and caregiving
Claiming your parent as a dependent

Wednesday
Navigating sibling relationships
Re-emergence of multigenerational households
Avoiding scams that target your parents

Thursday
Long-term care insurance has its own risks
When a parent has Alzheimer's or dementia

Friday
Planning for retirement and elder care
How to spend down assets to pay for care

Tell your elder care story to ABC

ABC television news is planning a series on "the challenges of elder care." And they're looking for brief audio or video story clips from people who do the work.

Glenna Schumann, CWAG, who passed this information along, said the ABC folks are looking for "children caring for parents, role reversal and sandwich generation issues. . .They would like highlights of 1-2 things they experienced or challenges."

The deadline for uploading your video to their site is Friday, June 29--or sooner!

Press release with more information follows.

ABC News wants to know about your family, friends & loved ones. We want to hear your care giving stories-- from the difficulties and challenges you face caring for your elderly loved ones--to ways you've managed to make it all work.

Get your videos in by June 29th and you may have your story shown on ABC's special series "Role Reversal: Your Aging Parents and You!"

It's easy! Here's HOW:

Click here to directly send a VIDEO:
http://abcnews.go.com/US/BeSeenBeHeard/story?id=3279347

ABC News is specifically requesting 15-45 second video comments or photos highlighting one aspect of your story.

HOW TO SUBMIT VIDEOS:

1) Via cell phone
Record a 15-45 second clip and email it to: seenandheard@abcnews.go.com

2) Via the web:
http://abcnews.go.com/US/BeSeenBeHeard/story?id=3279347

NOTE: Deadline for submissions is Friday June 29th @ noon EDT.

We look forward to hearing from you & Thanks again for your participation!
- The "Talk Back" Team

Importing caregivers to look after the oldest old?

“Listening to the current bitter debates over immigration, I wonder whether those so eager to rid our nation of these immigrants have thought about what that will mean for the growing number of elderly in our nation.

"As one of four siblings who shared the burden of looking after my mother when she became too weak to care for herself in her late 80s, I worry about the heavier burden I will put on my two children, and panic at the thought of what the future may hold for them when they are very old, for neither of them has children. What makes their future care so problematic is that they are part of a growing trend—people who will live much longer and who are likely to have no or few children to care for them. “

This thought-provoking comment comes from Beverly Goldberg, a scholar with the Century Foundation and author of the new report Facing the Problems of Providing Long-Term Care for the Oldest Old.

The report “examines the demographic realities facing our nation as the boomers continue to age, the special needs of the oldest old, the costs of the long-term care necessary to meet those needs, and the challenge of developing a large enough cadre of health care workers who are trained in gerontology.”

Policy recommendations to “improve the care of the elderly while
containing costs for government and families include some creative and controversial workforce recommendations, including issuing visas for caregivers.

Among the recommendation are:

• establishing programs to train primary-care doctors, nurse practitioners, and others who provide nursing care in geriatrics;

• ensuring that drug trials include the elderly; that possible interactions between drugs used by the elderly are reported, studied, and information about them made available;

• covering long-term care through a social insurance mechanism like Medicare;

• encouraging the use of, and payments for, alternatives to nursing home placement;

• expanding the available tax credit for family caregivers or passing legislation providing direct cash payments to family members who provide such care;

• creating a civilian health service corps that will train people to provide basic home health care in return for funds for vocational training or community college education after a given term of service is completed;

• providing forgiveness for loans taken out to cover college tuition for nurses who work for a certain mandated time in nursing homes;

• increasing the pool of available home health care workers by increasing the number of visas for low-skilled workers; and

• encouraging businesses to provide programs aimed at easing the care-giving problem for workers, which would aid in retention, decrease absenteeism, and improve the
productivity of workers carrying such burdens.

Which recommendations strike you as most intriguing?

Congress and the caregivers: No overtime pay

On June 11, the Supreme Court ruled unanimously that home care workers are not entitled to overtime pay under federal law. This decision affects more than a million people in the United States.

From an editorial in the June 15 New York Times:

A retired home health aide who sued her employer for unpaid overtime lost big this week in the Supreme Court — and so did fairness and the health care system. A regulation that was ill-conceived and is cruelly applied is depriving an increasingly important group of health care providers of a decent living.

The story: for 20 years health aide Evelyn Coke, now 73, worked long hours and lots of overtime—sometimes, 24 hour days—for the people her home care agency assigned her to.
The Supreme Court upheld a law dating to 1975 excludes home health aides from overtime and other basic protections, including minimum wage.

More from the editorial:

But the justices were completely silent on the question of whether denying overtime to home health employees is good policy, let alone morally justifiable. Clearly it is neither. As the population ages, home health care has become one of the nation’s fastest growing occupations, with an estimated 650,000 aides currently employed — most of them by for-profit agencies. Most of them are low income, female and minority, a recipe for exploitation. The support of federal labor laws is crucial to ensure that the aides, entrusted with the care of the most vulnerable Americans, are treated with professionalism, fairness and dignity.

The editorial writers point out that “refusing to pay employees fairly for the work they do is not an acceptable way to keep costs down."

Congress has to reform the law to include home health employees. If that intensifies the pressure to find suitable ways to pay for the health needs of an aging population, fine.

Speaking on the other side of the story is Paul Hogan, founder of Home Instead Senior Care, which has 540 franchises in the United States with 41,000 full- and part-time caregivers.

Many seniors need long hours of companionship, even overnights. If the exemption is eliminated the cost of service would go so high it would drive many seniors into the gray market where they would be hiring home care workers directly. There would be no screening, no training, no supervision and no backup.

Your thoughts?

Won't you be my neighbor?

This weekend my neighborhood in Wauwatosa was shaken by a terrible event. A house exploded, probably owing to gas buildup, killing its owner and damaging other buildings nearby. I was walking my dog about a mile away when it happened, and a postcard from the woman I later learned had died fell out of the sky in front of me. It included a hand-written list of things she wanted to remember to discuss with her doctor.

I don’t know whether her age, 80, played any role in what happened. But I can’t help wondering whether she was doing well enough at home, whether she had the kind of long-term care help she might have needed from time to time to remain healthy and safe.

The day before I had attended “Won’t you be my neighbor,” a wonderful presentation on the Connecting Caring Communities (CCC) pilot program in helping Milwaukee County communities become “elder friendly.”

To make the communities more livable, the program connects older adults with people, organizations, and businesses in the area. And that’s an important part of what long-term care is about.

CCC is supported by the Robert Wood Johnson Foundation Community Partnerships for Older Adults Initiative, along with local support from the Helen Bader, Faye McBeath, and Greater Milwaukee foundations. The Milwaukee Aging Consortium is a CCC partner, and our Caregiver Retention Project is also part of the grant.

The program, organized by project director Stephanie Sue Stein, presented the first two Milwaukee neighborhoods, Layton Boulevard and Sherman Park, in which unique connections have been made, and introduced the next ones underway: Prospect/Farwell Corridor and West Allis-West Milwaukee.

But Connecting Caring Communities isn’t stopping there: everyone attending was asked to get involved in continuing the momentum in our own neighborhoods.

Milwaukee CCC has developed a guide to elder-friendly community development. It's called, of course, Won't You Be My Neighbor? A Guide to Connecting Caring Communities. If you’re interested in getting copies—or helping your own neighborhood become “connected”--contact Alice Kowalski, Milwaukee County Department on Aging, 414/289-5973.