Academic journal article Generations

Federal and State Policy Strategies for Developing a Quality Eldercare Workforce

Academic journal article Generations

Federal and State Policy Strategies for Developing a Quality Eldercare Workforce

Article excerpt

Forging a strong quality eldercare workforce will require a strategic team approach among all geriatric specialties to properly implement the Affordable Care Act.

With the passage of the Affordable Care Act (ACA), the paid and unpaid caregivers who serve and support elders achieved modest policy successes. For a workforce relatively unaccustomed to policy achievements, this is cause for considerable celebration.

Such targeted advancements-from enhancement of the Geriatric Academic Career Awards, to new training resources dedicated explicitly to the direct-care workforce-did not occur by chance. It required a series of thoughtful investments, starting years before the Obama Administration chose healthcare reform as its signature legislative initiative. These investments were then advanced through an unprecedented degree of cooperation among providers, professional organizations, consumer and family caregiver organizations, and direct-care worker advocates.

Shaping the Affordable Care Act

Early strategic decisions that eventually shaped the workforce elements of the ACA can be traced back to a wide array of "new models of care." This experimentation envisioned both different roles for eldercare staff, as well as interdisciplinary team structures cutting across the professions and caregivers. The new models were created in every type of setting where elders receive care and support. They included the Green House® Project (small-home models of nursing home care emphasizing self-managed teams), Cooperative Home Care Associates (redesigning the training and support of homecare workers), and the Geriatric Resources for Assessment and Care of Elders (home-based, integrated geriatric care).

All of these models shared a critical common characteristic: they each enjoyed significant philanthropic support from major health, aging, and workforce foundations. Indeed, while keeping strictly within their tax-exempt constraints of not directly influencing legislation, philanthropy's role of informing public policy was central to the eventual inclusion of key eldercare workforce policy innovations within the ACA.

Philanthropy's core role supporting the eldercare workforce is also reflected in the critical decision, dating back to 2006, of the John A. Hartford Foundation and The Atlantic Philanthropies to build a consortium of nine foundations, and of AARP to commission an Institute of Medicine report explicitly on the eldercare workforce. Prior to that, with support from the Hartford and the Robert Wood Johnson Foundations, the American Geriatrics Society produced a report on the Future of Geriatric Medicine that, among other things, called for the Institute of Medicine (IOM) to produce a workforce readiness report focused on the care of older adults (Besdine et al., 2005). The resulting report, Retooling for an Aging America, set a precedent when it defined the eldercare interdisciplinary team as including not only all professions, but also family caregivers and the direct-care workforce.

The IOM report documented strong evidence in support of "retooling" the eldercare workforce- drawing heavily on the various models of care already tested in the field. Rather than calling for significant additional research, the report made a strong plea for "fundamental reform," listing a dozen recommendations ranging from explicit support for well-tested models, to enhanced geriatric training. Nor was the report hesitant in requesting significant new investments in wages and benefits for low-paid direct-care workers, as well as for enhanced federal reimbursements to states for more robust eldercare services.

Still, the foundations that funded the IOM retooling report were well aware that a single document-even from a source as prestigious as the IOM-rarely is sufficient to spark policy change. In 2008, the Hartford Foundation and The Atlantic Philanthropies invested in the next strategic step, funding the formation of a coalition of twenty-eight national organizations called the Eldercare Workforce Alliance (EWA), a project of the Tides Center and The Advocacy Fund). …

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