Health and Disability

Caregiving is women’s work.

It is with that simple statement in mind that I went to the Raising Women’s Voices Conference last month, sponsored by the Avery Institute, Merger Watch, and the National Women’s Health Network.

I was invited to participate on the opening plenary panel to discuss voices that are traditionally left out of health care reform discussions. I talked about direct-care workers — and about Health Care for Health Care Workers and the broader work of PHI.

The conference brought together women’s health advocates, providers, and women in general to talk about health care issues and shape a women’s agenda for health care reform. There were the usual PowerPoint presentations and policy recommendations, but the way the organizers encouraged presenters to tell our stories made it clear from the start that this was no ordinary conference. Raising Women’s Voices lived up to its name, honoring the power of women’s voices and experiences as consumers and providers.

In my day-to-day work talking with policymakers, I have to show lots of facts and figures about direct-care workers not having health insurance and figure out how to “make the case” that this issue matters. At this conference, people listened intently when I opened my presentation with the story of Iya’ Negra, a direct-care worker in Maine. Iya’Negra was diagnosed with fast-growing fibroid tumors after she was kicked by a consumer with Alzheimer’s and the pain from the kicking did not subside. Because she had no health insurance, her health problem turned into a crisis for her whole family.

Sure, the fact that one in four direct-care workers is uninsured was a new and shocking statistic to many at the conference, but what struck them most was how that issue impacts the day-to-day lives of workers, the consumers they assist, and their families.

Providing health insurance makes consumer-directed home care workers more likely to stay, both on the job and in the field as a whole, according to a study from Washington state.

Evaluation of Interventions to Improve Recruitment and Retention (pdf) reports on a survey to evaluate a series of initiatives instituted by the Home Care Quality Authority (HCQA). The changes were aimed at improving recruitment and retention of the so-called individual providers (IPs) who participate in the state's consumer-directed home care program, many of whom are related to the people they care for.

The most expensive initiative - and the one the researchers expected would have the greatest effect - was subsidized health insurance. To qualify for the insurance, IPs had to have been working for the program at least 86 hours a month for at least three months. In general, though some exceptions were made, they also had to be ineligible for health insurance from any other source.

Researchers at Washington State University surveyed IPs and the consumers who employed them about their experiences from 2004, when the program began, to 2006. Among their findings:

* Average monthly turnover declined a statistically significant amount (from 1.53 percent to 1.27 percent);

Michigan’s innovative Kent County Health Field Collaborative (HFC), through its pilot Opportunity Partnership & Empowerment Network (OPEN) program, offers exciting potential to address the “care gap” - Michigan’s rapidly growing number of elders and people with disabilities and ever-shrinking pool of caregivers. The HFC consists of a group of employers working together - along with partners from government, educational institutions, and other not-for-profits - to solve recruitment and retention challenges in health care. Together they identified the challenges employers face now and in the future with growing the workforce.According to a new case study by PHI, a nonprofit organization that supports quality long-term care by improving the quality of direct-care jobs, the OPEN program has achieved impressive results with employee retention. The OPEN program, which the HFC based on a retention model developed by The Source (a coalition of Grand Rapids area manufacturers dedicated to collaborative approaches to employee retention and advancement), saw among its key results significant drops in the overall turnover rates of direct-care workers - those who provide services and supports to elders and people living with disabilities.