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Everywhere I go, people are talking about how the high price of gas is affecting home care workers and agencies. Organizations are contacting me and my colleagues for ideas on how to deal with it, so I’d be very interested to hear from people in other parts of the country. How are employers and workers and clients dealing with it? Are any states planning a response to this crisis? If so, what’s being considered?
Four-dollar-a-gallon gasoline exacerbates all recruitment and retention problems, and I fear that it forces workers to make some very difficult choices. Employers are calling workers to offer them cases and having the workers do the gas calculations and say “I can’t afford to take this one.” Home care aides are seeing their co-workers go to other jobs where they don’t have such stressful transportation issues.
Here in Michigan, in the waiver program that funds home care for people who are eligible for nursing home services, I’m hearing that the only time a worker must be paid for transportation is when they’re driving the client, taking them shopping or the doctor or the pharmacy or something like that. People aren’t getting paid for all the driving they have to do just to get to their clients.
Norman DeLisle, MDRCNew York state has been “a national leader” in expanding health care coverage for home care aides and other workers, yet 30 percent of its home care workers lack insurance according to a fact sheet from PHI’s Health Care for Health Care Workers campaign.
Caregivers Without Coverage focuses on home care workers because they are the largest and fastest-growing segment of the state’s direct-care worker population. It explains the conditions contributing to the high rate of uninsurance among direct-care workers, including low wages that make it difficult to afford premiums and copays.
Among the facts it presents:
This analysis was sponsored by the Resolution Foundation and carried out by Deloitte & Touche LLP. It describes long-term care in England as a ‘mixed market’, made up of a combination of public and private funding and supply.
There is a widespread expectation that care provision is an integral part of the welfare state, but the reality is that long-term care is now almost entirely provided through private and third sector suppliers, and increasingly, is funded through private means.
The long-term care market does not function as a private market, because a series of intermediary processes such as means and needs testing that distort the interaction between supply and demand. These processes also have an impact on ‘self-funders’ who may face higher prices for similar services as a result of cross-subsidisation.
The analysis identifies key drivers of inefficiency and unfairness across the system, and tests the characteristics of supply, demand, and intermediary processes against indicators of a well-functioning market. This shows that whilst supplier profitability and entry and exit are stable, local markets and intermediary processes can distort outcomes for each individual, even for those who fund their care through private means.
The analysis indicates that the whole of the mixed market needs to be tackled, not just that part funded by the public sector. Innovation will be required by intermediaries, by the financial services sector, the supplier market as well as in the public sector.
Norman DeLisle, MDRC