Members of the PCA Reform Coalition are passionate about changing laws affecting Minnesota’s Personal Care Assistance (PCA) program. The group consists of disability advocates, PCA agencies, and other human services providers in Minnesota. They propose several changes to Minnesota law that would increase reimbursement rates for personal care workers to reflect the difficulty of the work and the cost of providing the service, as well as creating a system of accountability within the industry to ensure the highest quality of care.

A PCA is a direct support staff person who provides medical and health-related services, assistance with activities of daily living, and assistance with instrumental activities daily, such as cooking and cleaning, in an individual’s home or workplace.

The service is critical in supporting the independence and inclusion of Minnesotans with disabilities and older adults, but The Olmstead Report on Recommendations to Expand, Diversify, and Improve Minnesota’s Direct Care and Support Workforce highlights the many challenging aspects of working in this profession.

For instance, the prominent perception is of a low-wage, dead-end job that is difficult, unreliable and sometimes dangerous. In addition, according to PCA Reform Coalition data, there has been very little change in rates since 2008. The rate of change since October 1, 2008 has been 1.642 percent.

This impression is not lost on the recipients of care. “It is disheartening to see fast food workers being paid better than my caregivers. For example, my full-time caregiver has more than 30 years of experience and is paid $11.27 per hour. Her salary has increased only 77 cents per hour in the past 10 years,” said Carla, a Minnesotan with a disability.

This slow rate of wage increases has exacerbated the direct support workforce crisis within the PCA program. And, while staffing shortages are a cross-sector crisis affecting businesses and industries, the stakes for Minnesotans with disabilities are literally life and death. Some Minnesotans with disabilities have died in their homes due to the PCA staffing shortage – demonstrating the significant public health crisis faced today. Others have been forced to transition into more costly congregate settings in order to receive the support they need – despite their ability to live independently with just a little bit of help.

Despite being one of the most cost-effective ways of supporting seniors and individuals with disabilities living and working in their communities, PCA services have never been reimbursed by the state in a way that reflects the actual costs of providing care. Past attempts to remedy this disparity have failed due to absence of hard data to determine and explain what the reimbursement rate should be. That is why the PCA Reform Coalition hopes to work with the Minnesota legislature to establish a cost-based, data-driven methodology for calculating fee-for-services PCA rates.

The proposed rate-setting framework uses Bureau of Labor Statistics’ (BLS) information to establish a wage that is competitive with other jobs requiring similar skills, and then adds a competitive work force factor to bring wages more in line with other jobs that require similar education, training, and experience as PCA staff.

It’s crucial to address both the reimburse rate and wage issues to contribute to solving the PCA workforce shortage crisis. Minnesota must assure that we can attract and retain job seekers to the role of a PCA. To do so will reduce the current PCA job gap which number in the thousands of unfilled job openings. Most importantly people with disabilities who rely on PCAs to live the lives they lead will be assured the continued quality of life they seek and enjoy, and have the right to enjoy with a sustained PCA workforce.

A rate increase and framework will:
*Help ensure the long-term sustainability of the PCA program by increasing PCA and supervisor wages.
*Help alleviate the workforce shortage to ensure that more Minnesotans with disabilities can hire and retain high-quality PCA staff.
*Help provider agencies cover costs for which they currently don’t receive reimbursement.

In addition to a higher rate of pay, a plan is being drafted to create a system of accountability for the personal care industry to ensure that all PCA agency providers are operating in a way to safeguard public funds, while also ensuring high quality services. The PCA Reform Coalition seeks to implement greater enrollment standards and financial reporting for PCA providers to improve the quality of care and maintain integrity within the program.

Currently, the requirements to enroll as a provider are minimal. There is no requirement that providers demonstrate business competence or have the financial stability to administer this program.

 

Greater provider standards will:
*Reduce and prevent fraud, waste and abuse.
*Help ensure recipients are receiving quality services.

In the end, this legislation is critical to address the public health crisis currently impacting Minnesotans with disabilities and older adults in our communities. According to the Olmstead Report, if nothing changes by 2030, the current crisis is expected to deepen, based on a significant drop in the prime working-age population of Minnesota residents.

(Editor’s note: The commentary is authored by the PCA Reform Coalition. Its members prepared the recent workforce report submitted to Minnesota’s Olmstead Subcabinet. A story about the report is on page one.)