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Plan to Join Us!! VOR 2007 Annual Meeting and Washington Initiative. See -
http://www.vor.net/VORAnnualMeeting2007.htm for complete details, including
a registration form.
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VOR is the only national organization advocating for a full range of
residential and support options for people with mental retardation,
including Medicaid-certified Intermediate Care Facilities for the Mentally
Retarded (ICFs/MR) and home and community-based care. VOR supports choice.
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VOR Weekly E-Mail Update
For March 30, 2007 and April 6, 2007
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1. CMS awards second round technical assistance grants to enhance direct
care workforce in 5 states GA, NJ, NC, UT and WI
2. Foundation Issues New Primers On The Medicare and Medicaid Programs
3. Justices to Hear Case on Wages of Home Aides
4. Arizona: A fair answer to wage woes
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1. CMS awards second round technical assistance grants to enhance direct
care workforce in 5 states GA, NJ, NC, UT and WI
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Source: Direct Services Workforce Resource Center Newsletter
Winter 2007
CMS is pleased to announce that Georgia, New Jersey, North Carolina, Utah,
and Wisconsin were selected on February 16, 2007 to receive the second
round of individualized intensive technical assistance (TA) from the
National Direct Service Workforce Resource Center. Applications for the
2008 round of Intensive TA will be available in late summer 2007.
Georgia: Intensive TA will support the Georgia Office of Developmental
Disabilities to:
* conduct a study that will provide recommendations and assistance to align
Georgia's Direct Support Professional certificate program with proposed
national standards
* develop a sustainable instructor training material production and expand
options for workers to access national DSP certificate programs
* study the various data collection systems in GA in order to provide
recommendations to coordinate info or data elements in a manner that will
allow analysis for decision-making in the ongoing development of a
sustainable direct support workforce
New Jersey: The New Jersey Division of Medical Assistance and Health
Services will use intensive technical assistance to support the following
tasks:
* designing a Career Path for a statewide service delivery system
* assisting provider agencies, DDD, and Medicaid to explore sources of
funding or ways to change current funding practices to find the funds to
implement and support a career path
* assisting provider agencies to develop creative management strategies
related to recruitment and retention.
North Carolina: The Office of the Secretary of the Department of Health and
Human Services will use technical assistance to support their Frontline
Worker Initiative. The goals of this initiative include:
* developing a cross-population, cross-divisional, statewide stakeholder
group
* identifying the positions comprising workforce across agencies and
populations, gaps and needs, and trends
* identifying successes and evidence-based practices
* determining core competencies for training and assistance in coordinating
venues for training
* implementing social marketing campaign
* developing a broader public education/marketing strategy about the NC New
Organizational Vision Award (NC NOVA)
Utah: The Utah Division of Services for People with Disabilities will use
intensive TA to further their Workforce Augmentation and Integration
Taskforce initiative. Utah's goals are to:
* develop and implement web-based training
* expand their web-based system to permit free or low-cost professional
development
* conduct market comparability studies on DSW wages and the broader market
to determine adequate levels of compensation
* provide assistance to providers and families to devote greater resources
toward workforce development
Wisconsin: The Wisconsin Division of Disability and Elder Services will use
TA to aid in implementing their "Meeting the Demand for Quality Direct Care
Workers Resulting from Managed Long-Term Care Expansion" project. Wisconsin
plans to:
* develop a methodology for projecting the demand for direct care workers
* develop training materials for self-directed consumers and workers
* explore incorporating DSW quality measures into Family Care CMO contracts
with long-term care providers
* support the implementation of the College of Direct Supports
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2. Foundation Issues New Primers On The Medicare and Medicaid Programs
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Kaiser Family Foundation
Monday, March 19, 2007
Together, Medicare and Medicaid provide health coverage to about 90 million
Americans. To help explain the two programs, the Kaiser Family Foundation
today issued a new primer on the Medicare program and an updated version of
its primer on the Medicaid program. Prepared by Foundation staff, the
primers provide an overview of the programs, who they serve, how the
programs work, and how they are financed.
Medicaid: A Primer, available at http://www.kff.org/medicaid/7334-02.cfm,
provides an overview of the basic components of the nation's largest health
coverage program which covers 55 million low-income individuals (including
families, people with disabilities and the elderly) and is the dominant
source of the country's long-term care financing. The primer examines the
structure of the program, who it covers, what services it provides, and
spending. Because Medicaid is jointly financed by the federal and state
governments and the states administer the program within broad federal
guidelines, programs vary across states. Tables examining the
state-to-state variation in eligibility, enrollment, and spending for
Medicaid enrollees are included in the primer.
Medicare: A Primer, available at http://www.kff.org/medicare/7615.cfm,
explains key elements of the program that now provides health coverage to
nearly 44 million people including about 37 million people age 65 and
older and another 7 million younger adults with permanent disabilities. It
looks at the characteristics of the Medicare population, what benefits are
covered, how much people with Medicare pay for their benefits and the
program's overall costs and future financing challenges. It also provides
information about the Medicare Advantage program and the Medicare drug
benefit, and includes detailed tables showing the number of Medicare
beneficiaries in each state, broken out by age, income level, source of
drug coverage, and by enrollment in Medicare Advantage plans.
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3. Justices to Hear Case on Wages of Home Aides
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Summary: The Supreme Court is scheduled to hear arguments in a case that
questions whether federal labor laws relating minimum wage and overtime pay
should apply to home care workers. The stakes in this case are
considerable, not least because home care attendant is one of the nation's
fastest growing occupations. There are expected to be nearly two million
aides by 2014, as the elderly population grows and government pushes for
the elderly to be cared for at home rather than in nursing homes, where
costs are high. Providers worry that if overtime and minimum wage laws
apply to home care workers, they'll be forced out of business due to
reimbursement rates too low to cover the increase in labor costs that would
result. Others think that if fair labor standards apply to home care
workers, the government will be forced to increase reimbursement rates to
cover the increase and home care workers will more fairly compensated, in
light of their demanding work.
March 25, 2007
By Steven Greenhouse
Source: The New York Times
Evelyn Coke sat in her wood-frame home in Corona, Queens, a hobbled figure,
not realizing that this is supposed to be her moment in the spotlight.
For 20 years, she had cared for clients in their homes, bathing them,
cooking for them, helping them dress and take their medications. But now,
suffering from kidney failure, she is too ill to work.
Her mind and memory are not what they once were, she acknowledges, and as a
result she is hazy about the important events that will take place on April
16. On that day, the Supreme Court of the United States is scheduled to
hear oral arguments in a case in which Ms. Coke, a 73-year-old immigrant
from Jamaica, is the sole plaintiff.
She is challenging Labor Department regulations that say home care
attendants, who number 1.4 million, are not covered by federal minimum-wage
and overtime laws.
"I loved my work, but the money was not good at all," Ms. Coke said in a
whispering voice, noting that she often worked three or four 24-hour days a
week, sleeping at a client's home, while hardly ever receiving
time-and-a-half pay for overtime.
The stakes in her case are considerable, not least because home care
attendant is one of the nation's fastest growing occupations.
There are expected to be nearly two million aides by 2014, as the elderly
population grows and government pushes for the elderly to be cared for at
home rather than in nursing homes, where costs are high.
Ms. Coke's lawsuit has attracted powerful supporters and opponents.
The nation's largest health care union, the Service Employees International
Union, is backing Ms. Coke's effort because a victory for her could mean
larger paychecks for hundreds of thousands of home care aides, many of whom
live in poverty.
AARP plans to file a brief backing Ms. Coke, arguing that the increased pay
that would result from requiring overtime coverage would reduce turnover
among home care aides and help prevent a shortage.
The federal government and the Bloomberg administration have lined up
against her, arguing that a victory for Ms. Coke could greatly increase
Medicare and Medicaid costs, perhaps causing a budget shortfall that could
leave many of the elderly without home-care aides.
In a friend-of-the-court brief, the Bloomberg administration, joined by the
New York State Association of Counties, argued, "In the worst cases, some
clients, especially those with high hour needs, might no longer be able to
be serviced in their homes and might have to be institutionalized."
The Bloomberg administration said a victory for Ms. Coke could force the
city, state and federal governments, which all finance home care through
Medicaid, to pay $250 million more a year to the 60,000 home attendants who
work in the city.
Some advocacy groups have criticized the city's position, saying it
conflicts with Mayor Michael R. Bloomberg's push to reduce poverty because
keeping these aides exempt from overtime coverage would hold down their
pay.
The defendant in Ms. Coke's case is Long Island Care at Home, which is
based in Westbury and employs 50 aides.
MaryAnn Osborne, Long Island Care's vice president, said that a defeat in
court could put her agency out of business because, with many aides working
60 or 70 hours a week, it might face huge overtime costs. Her agency pays
aides $8 to $11 an hour, but a defeat in the Supreme Court would require
the agency to pay time and a half, meaning $12 to $16.50 an hour, for
overtime.
"This would be horrendous for the entire industry because the reimbursement
rate we get won't cover that type of money," she
said.
But supporters of Ms. Coke's lawsuit say that if she wins, the government
would most likely increase reimbursement rates to compensate for the
overtime costs.
Ms. Coke said that Long Island Care made a lot of money off her, saying she
earned just $7 an hour when she last worked there in 2001.
Moreover, she said, she did not get paid overtime for her 24-hour stints at
homes in Great Neck, Roslyn, Manhasset and other communities.
She said she stopped working because she was hit by a car, injuring her
shoulder, and she later had colon and kidney problems. "The job didn't even
give us health insurance," said Ms. Coke, who goes to a dialysis clinic
three times a week.
The Supreme Court agreed to hear her case after the United States Court of
Appeals for the Second Circuit overturned Labor Department regulations that
exempted home care aides from federal minimum-wage and overtime coverage,
saying the exemption conflicted with Congress's intent.
Before 1974, home care aides were generally covered by minimum-wage and
overtime laws if they were employed by agencies. (Aides hired directly by
families were not covered and will remain exempt from overtime regardless
of the outcome of Ms. Coke's case.)
In amending the Fair Labor Standards Act in 1974, Congress extended
minimum-wage and overtime coverage to household workers like maids and
cooks but said that baby sitters and "companions" for the elderly and
infirm would be exempt.
When the Labor Department first proposed regulations to enforce the changes
in the law, it said that home care workers employed by agencies should
continue to get overtime. But the department reversed itself in 1975,
saying Congress had not intended to allow those workers overtime when it
created the exemptions the year before.
But the Court of Appeals, sitting in Manhattan, wrote, "It is implausible,
to say the least, that Congress, in wishing to expand F.L.S.A. coverage,
would have wanted the Department of Labor to eliminate coverage for
employees of third-party employers who had previously been covered."
Those urging the Supreme Court to overturn that ruling say the Court of
Appeals failed to show proper deference to the Labor Department's
decision-making authority.
Even with the exemption, few home care workers receive less than the
federal minimum wage of $5.15 an hour. But many do not receive any overtime
premium even when they work more than 40 hours a week. (Under federal
rules, workers who sleep in are generally paid for all extra hours on the
job, less eight hours' sleep time.)
Natasha Maye, a home care aide in Philadelphia who is part of a separate
suit concerning the minimum wage, is rooting for Ms. Coke. She said that
she earned, in effect, less than $5.15 an hour at her former agency because
she was not paid for the two hours spent each day traveling between her
three clients' homes. Including travel time, she said, she often put in 60
hours a week and earned $300.
"I don't think that's fair," she said. "We should be entitled to overtime
and travel time."
The Clinton administration, in its next-to-last day in office in 2001,
proposed regulations that would restore minimum-wage and overtime
protections to home care aides employed by agencies, arguing that the 1975
exemption clashed with Congressional intent.
But in 2002, the Bush administration scrapped that proposal, concluding the
revised rules would have a severe economic impact on clients, government
budgets and home care agencies.
In its brief, Long Island Care at Home argued that exempting aides who
worked for agencies was consistent with Congressional intent because some
lawmakers back in 1974 voiced concerns about holding costs down. "The need
to restrain costs in the case of third-party employees has only become more
acute as agencies provide an increasing amount of needed care," Long Island
Care said.
But Craig Becker, the chief lawyer for Ms. Coke, argued that legislative
history showed that the exemption to minimum wage and overtime laws was to
apply only to baby sitters and companions who were employed directly by
families and were not regular breadwinners.
"In its exemption for baby sitters and companions Congress had in mind the
quintessential neighbor-to-neighbor relations," Mr. Becker said.
"Increasingly this is not a casual form of work akin to baby-sitting but a
full-time regular type of employment."
Ms. Coke became a plaintiff through unusual circumstances. After she was
hit by the car six years ago, she hired a lawyer, Leon Greenberg. When
seeking to determine her economic losses, Mr. Greenberg learned that she
sometimes worked 70 or more hours a week without receiving any overtime
premium.
He invited her to bring a test case challenging the federal exemption. Ms.
Coke agreed. Mr. Greenberg is no longer involved in the case; her current
legal costs are being paid by the service employees union.
And because of her condition, Ms. Coke now has her own, unpaid, home care
aide: her son Michael, a computer technician.
She said she brought the lawsuit to help hundreds of thousands of home care
workers like her for years to come. But she also said there was another
reason. "I just hope I get some money from this," she said.
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4. Arizona: A fair answer to wage woes
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Summary: As a follow-up on a story sent out weeks ago - it appears
rationality remains an option in Arizona.
Mar. 22, 2007
The Arizona Republic
We choose to call them workers.
They will not be "workers," per se. Rather, they will be "trainees," who
work not for a wage but for an educational stipend.
But after three grim months of struggling to overcome the failure of
Arizona's new minimum-wage law to exempt developmentally disabled workers,
those undaunted workers should feel confident soon that their jobs will
stay secure.
The Arizona Industrial Commission is scheduled today to consider a
hard-fought compromise that effectively will allow disabled workers to
stay on the job. They can keep that job, even if it pays less than the
$6.75 per hour stipulated in Proposition 202, which voters passed last
November.
Until now, uncertainty about their status under the new minimum-wage law
forced many work centers employing the disabled to shut their doors.
Now, most caregivers, parents and work-center operators feel assured that
the disabled - many of them with severe cognitive, physical and emotional
infirmities that preclude employment outside a highly structured, secure
environment - will be safe in their jobs.
The policy is a tribute to the art of compromise. Most of the public
clearly was not aware prior to this distressing, unnecessary battle over
the wages of disabled workers that supporters of the developmentally
disabled long have been riven into two camps.
On one side were those parents and work-center operators who accepted the
need for sub-minimum wages for developmentally disabled workers, at least
until the workers can gather the needed skills and confidence to face
employment in the "real world."
On the other side, however, were developmentally disabled "advocacy"
groups, which celebrated the passage of Proposition 202 as written, since,
in their view, everyone is deserving of a minimum wage, even if no one can
afford to pay it.
Odd as it seems, then, these advocacy groups - groups firmly committed to
mandating a minimum wage for the disabled - abandoned their ardently held
notions of pay equity and came to the table to help negotiate this
compromise.
For that much, they should be commended. Still, it remains a puzzle why
organizations committed to the best interests of the developmentally
disabled failed to foresee the train wreck Proposition 202 posed for their
charges. To a group, they claim complete ignorance of its ramifications,
even though national advocacy groups contributed to the language of
Proposition 202.
But for helping fix it, we give them their due.
Above all others, however, the staff and members of the little-known state
Industrial Commission deserve enormous credit.
Since early December, according to Director Larry Etchechury, commission
staff has been "jumping out of windows" as they struggled to keep the
disabled on the job.
They've managed it.
Well done.
Technically, the law may say the developmentally disabled are but
"trainees."
But, in fact, they are workers. Earning what they get, and gaining the
gratification of a wage hard-earned in the process.
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Tamie Hopp
REFERRAL/MEMBERSHIP/CONTRIBUTION FORM
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TO REFER SOMEONE TO VOR: Use the form below, including the additional
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Mail the completed form (if joining or contributing) with payment to:
Voice of the Retarded
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Rolling Meadows, IL 60008
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