Home and Community Based Care Lean Summary

as of December 30, 2009

The Home and Community Based part of Maine's Long-Term Care System has been put through a Lean process to make it more efficient, address inequality in services provided, and hopefully gain some cost savings that can be passed on to workers in the form of livable wages and benefits such as paid sick time and vacations and health care coverage.

The Lean process is the direct result of four pieces of legislation that came through this past legislative session. This legislation deals with worker issues in one form or another. The Department of Health and Human Services (DHHS) is charged with reporting back to the Legislature with the findings and recommendations coming out of the Lean process.

The actual Lean started up in early September. Five members of Maine Personal Assistance Services Association (Maine PASA); Dee Dee Strout, Ted Rippy, Cathy Bouchard, Julie Moulton and Helen Hanson, of which four are Voices Institute graduates (2008 and 2009) and three are Local 771 of MSEA-SEIU members, worked to position themselves to serve on the core team and two were successful in achieving seats on the team. The two that were successful were Julie Moulton and Helen Hanson. Cathy Bouchard became an alternate and she stepped up when Julie was not able to finish the Lean work. This is the first time workers have been involved at this level of working on system change.

The core team was charged with mapping out the system's current state in order to see where duplications and inefficiencies are happening.

The team then mapped out the system's future state with many ideals and values in mind, things that would improve service for Maine's elders and those with disabilities. From this map, we developed areas that need changing, the implementation plan.

One of the biggest changes is streamlining the system into three programs instead of seven. Along with this comes rule and policy changes, the different sections of MaineCare (Medicaid) and Office of Elder Services code getting rolled into one system that is easier to navigate, provides quality care, provides portability (a consumer can easily move from one program to another without the hassle of going through the assessment process again), and optimum choice for those needing home care or community based services.

With the mapping part of the Lean process over, the real work is now beginning. The core team has developed an implementation plan that has an aggressive timeline being driven by the legislation. There are activities in this plan around worker issues.

Where all four pieces of legislation driving the Lean process deal with worker issues, DHHS set up a Direct Care Worker Taskforce to address issues and make recommendations for change, as part of the report going back to the Legislature. This taskforce is made up of workers and providers and staff of DHHS.

Maine PASA Leadership Council members have identified seven activities surrounding the direct care workforce that we are actively involved in through the Taskforce.

1) Decide upon a single, inclusive title for caregivers – we have too many different titles

2) Encourage workers to work together as a team for the consumer, providing coverage for each other as needed, help with the fill-in problem

3) Provide higher incentives for DCWs: pay, benefits, mileage, pay differentials for nights/weekends, raise wages to $12.00/hour across all programs

4) Provide work stability for workers when a person in their care goes into the hospital or nursing home and the worker's hours are cut; make it easier for workers to pick up more work

5) Enhance opportunities for all direct care workers to receive training

6) Review training requirements and inequities, identifying how to make them more consistent and appropriate across program/modes of service and types of workers

7) Provide training for specialty equipment for clients/DCWs (equipment like mechanical lifts and oxygen apparatus)

These seven activities came out of the work of the core team, recommended changes to make to the system.

The Worker Taskforce has met three times so far. This work is ongoing through the winter and possibly into the spring. Maine PASA has five leader-members; Dee Dee Strout, Ted Rippy, Cathy Bouchard, Joyce Gagnon and Helen Hanson, as part of this taskforce. The seven activities identified as top priorities to work on are part of the work assigned to the taskforce.

We've had two meetings in December. The topic on the agenda at the first December meeting was the worker nomenclature. The second December meeting continued discussion around the nomenclature and starting discussion on what the State of Montana has done to gain health insurance coverage for its workers, with the possibility of implementing something similar here in Maine.

We've seen that worker education seems to define the title a worker has. What is not taken into account is that the core of the work performed by all the different titles in direct care work is basically the same.

We are looking into the possibility of developing three classes of workers. With this in place, it will be easier for workers have access to the training they need when they want to move up in their caregiving careers or move across programs that provide care. It will also identify core competency skills that those providing direct care should have, and help develop career pathways for when a worker wants to move up or move to a different work setting.

As a member of the Direct Care Worker Taskforce and recently completing my CNA training, I am in support of this three tier system of classification for workers. In the CNA training, the first part was training I had previously had as a Personal Support Specialist. I was able to use the same text I had in the PSS training. It would have been better if I could have proved my competency in these areas by testing out of them, or illustrating my skills somehow.

Where I've been working as a PSS for a few years, I possess those core skills, skills needed to bathe, dress, handling boundaries and abiding by them, ADLs, etc.

We workers met with DHHS, after the first December regular meeting, to talk about issues that we face in our day to day work with the people we serve. There were no providers present. This was an opportunity for workers to let the department know some of the challenges workers face and also provide feedback as to current policy and how it does or does not work. With no providers present, it meant that workers could talk freely without fear of reprimand from their employers. This was the workers' chance to shine.

At the second December meeting, DHHS had set aside time for workers to talk directly with them. No issues came up. I thought it was a good gesture on DHHS's part. Again, workers have not been involved at this level of policy making before, as far as I can tell. So, when workers get a chance to talk directly with DHHS, I encourage them to come and do so.

Now, the Department of Health and Human Services, with input from the Lean Core Team members and the Worker Taskforce, is preparing the report that is going back to the Maine Legislature in January. The report is on all this work we've been doing. Members of the Core Team let DHHS know that when the report is presented to the Legislature, we want to be there in support of Maine's Home Based and Community Care.

Maine PASA, through the work of it's Leadership Council; and Local 771, through its members that work with Maine PASA, have positioned themselves to be leaders on direct care worker issues as the Lean implementation plan gets worked through. Maine PASA and 771 leaders are working closely with DHHS in this process. This is a very exciting and encouraging time for PASA, 771, and the workers we are advocating for.

The Lean documents are available to the public online at: http://www.maine.gov/dhhs/reports/ltc-services-adults.shtml

Please check out the site and see what we've been working on. There's a lot on the site pertaining to workers.