While important issues like the elder abuse cases are sweeping media attention, there are other major concerns that directly affect vulnerable populations in Minnesota. Currently there is a direct care workforce shortage affecting thousands of individuals with disabilities. In July of 2016, the Minnesota Department of Human Services hosted a Direct Care Workforce Shortage Conference attended by over 180 individuals to begin addressing the problem. The result of this conference was a DHS report in November of that same year summarizing issues relevant to the the workforce shortage, with one of the major themes being the work of personal care assistants.
Personal care assistants (PCAs) help people with their most basic needs, working through day-to-day activities in the homes and communities of those they serve. Without qualified PCAs, many individuals would struggle with everything from eating to getting dressed. As a consequence of the current PCA shortage in Minnesota, many people are understaffed and not getting the care they need. Some endure uncovered shifts, are forced to stay in bed for prolonged periods, or even sleep in their wheelchairs overnight. Without adequate care people with complex needs can develop severe health complications that require costly hospitalizations. Left completely unattended some individuals cannot survive and more and more deaths are occurring due to a lack of trained and available workers.
This shortage of workers can in part be explained by a deficiency in adequate funding. Our state sets the rate and reimburses providers who compensate the PCA’s. Currently PCS’s earn as little as $10 to $12 per hour and receive few benefits. The pay scale has not kept up with the marketplace and workers can find better paying jobs in most industries. Additionally, the same level of pay applies to all PCA’s, whether the client has basic needs or complex needs dis-incentivizing PCA’s to take a harder position requiring the administration of more intense services.
On Monday March 12th, 2018, a hearing was held in the Minnesota Senate for a bill to begin addressing the problems around the workforce shortage. The Critical Need for Enhanced Rate for PCA Services, otherwise known as the Complex Care Bill (HF481/SF393) is legislation that asks for a higher reimbursement rate for PCA’s that work with individuals needing ten or more hours of PCA services per day (generally the more complex cases). Under this bill the PCA wage would be at least 10% higher than the typical PCA wage. These PCAs would also undergo more training, similar to Nursing Assistants or Home Health Aides.
There is an urgent need to pass bills like the Complex Care in order to improve availability of support staff for those in the disability community. Enhancing the rate for PCA’s that serve individuals with more complex needs is an essential part of meeting the needs of people with disabilities in general and beginning to address the overall workforce shortage.
More information on this bill can be found on the policy page of this website.
By Jenna Ogle / U of M
25 million Americans suffer from bladder and bowel incontinence which can lead to a daunting range of health and lifestyle implications. Incontinence is a major factor in long-term care admissions, and the methods by which patients and caregivers are able to manage this condition seriously affects a person’s quality of life.
When the Department of Human Services (DHS) approached Minnesota legislators, during special session negotiations, with a proposal that would save money by decreasing what is spent on incontinence products by 35% it was included in the final Omnibus Bill without much question. When the disability community got wind of it they felt blindsided. This legislation, known as the Medicaid Preferred Incontinence Product Program (MPIPP) was passed during special session last May without public notice, debate, or awareness. There was no vetting process or input from stakeholders who actually use these products. Even the Governor was unaware of the implications of this bill.
The 14,000 Minnesotans who currently rely on these products are mostly unaware of this bill as well, but organizations that advocate for them are aware, and they immediately took action for its' repeal. One of DHS’s aims and initiatives is to work with Minnesotans to help them meet their basic needs so they can live as part of the greater community, yet the MPIPP does not support that. Currently, Medicaid recipients receiving incontinence products have a choice of products that best fit their needs. With MPIPP, the new program which includes a competitive bidding process, products are only covered if they fall on the MHCP Incontinence Products List. This significantly limits a patient’s options for their most personal and important needs.
ActivStyle, a home delivery medical supplier is just one of the many companies that would be affected without repeal of this bill. With the MPIPP’s "one-size-fits-all" distribution model, qualified Medicaid recipients will no longer be able to receive products through their original distributor. This will result in substantial job layoffs across the state for medical supply businesses. Additionally, through the MPIPP’s new distribution process, product recipients who live far from the Metro area will likely not be able to continue receiving products. While medical supply companies specialize in product delivery, it will become increasingly difficult for the new distribution model to reach individuals in rural or northern regions.
Incontinence is a challenge in and of itself. This narrowing of options is unlikely to save DHS’s projected 35% in costs as more product is used when quality goes down. The MPIPP is a similar single-vendor model to ones that have been implemented in twelve other states. However, seven of those states have had to abandon their programs after deeming them “corrupt.” The experience in other states further supports the fact that this model will not serve patients in Minnesota in a way that is sound and sustainable. Without proper access to needed products, individuals will become further isolated from their communities. In general, the MPIPP should be repealed and the existing incontinence program, which has been considered an exemplar nationally, should continue.
Jenna Ogle / Graduate Student U of M
The Minnesota Consortium for Citizens with Disabilities (MNCCD) is a broad based coalition
of advocacy and provider organizations working to change public policy to improve the lives of people with disabilities through building awareness, providing education, and engaging the community.