Programs train welfare recipients for home health
Education requirements, scheduling a problem
Finding jobs for welfare recipients is high on the agenda for many states in 1997. Two states, though, already have taken the initiative and have led some of their recipients toward private duty and skilled home health. While some of the results have been promising, the programs also show the problems associated with transferring people from welfare rolls.
The Families First program in Tennessee is Gov. Don Sundquist’s 1996 legislative initiative for welfare reform. The temporary cash assistance program emphasizes work, training, and personal responsibility and is designed to help Tennessee’s Aid to Families of Dependent Children (AFDC) recipients become independent from government programs, says Merry McKenna, RNC, director of pediatric and perinatal services at Healthspan Services in Johnson City, TN.
When participants enter the program, case managers do an evaluation of their employment interests and experience, and the participants are given a functional literacy test, says David Calhoun, area manager for the Department of Human Services in Tennessee. Calhoun oversees the Families First program in Washington County. If the participants test at or above a ninth grade level, they are eligible to enroll in school or vocational training programs provided by the state. If not, they must attend adult basic education classes until they have reached the ninth grade literacy level.
Participants in the Families First program also must agree to enter into a performance-based personal responsibility plan that requires a work plan and the following:
• Teen parents must stay in school and live at home.
• Parents must ensure regular school attendance, including kindergarten.
• Children must receive immunizations and health checks.
• Parents, including teens, must attend life skills training.
In addition to the training opportunities, recipients receive transitional benefits such as child care assistance, rent and/or housing assistance, and transportation assistance. The limit for these services is 18 months at a time. The time limit "clock" does not start ticking for people enrolled in the adult basic education classes until they reach the ninth grade literacy level, Calhoun says.
The cap on the time a family can receive these services over a lifetime is five years. There are no limits as to family size, but if a recipient has another child after beginning the program, the recipient does not receive additional funds for the child. Aged, disabled, or incapacitated persons and those caring for a disabled relative in the home are exempt from having to participate.
Calhoun says he hopes to have the entire caseload of Washington County about 1,250 cases in all participating in Families First by the end of February, six months after the program’s start. More people have begun applying for AFDC since hearing of the new training programs, he says.
AFDC recipients only received $185 a month in government grants before the Families First program. "[Families First] is probably the best opportunity that AFDC folks have ever had or ever will have to become self-sufficient," Calhoun says.
Challenges for the program
One of the training options open to Families First participants is a CNA program. McKenna says she expected to see 10 to 20 certified nursing assistants (CNAs) coming to Healthspan from the Families First program "eager to work and pumped up from the course." Her role in the program is to try and provide employment opportunities for the CNAs in Healthspan’s private duty business. (For guidelines on how to match participants with the CNA training program, see p. 16.)
"In the ideal situation," she says, "they have completed their training and have their certification and have obtained [life skills training]. In essence, that’s supposed to make our jobs easier and make them more employable than say the average Joe that would walk in off the street."
Instead, McKenna has seen fewer than 10 CNAs from the program, and many of these people have scheduling problems. "People who have come to us have such limits to their availability, it’s been difficult to staff them," she says. "If they are single parents or divorced parents or [their children] have deadbeat fathers, their support services are limited. Finding child care for a single parent who is working a 3 p.m. to 11 p.m. shift can be difficult."
Calhoun admits that second- and third-shift child care has not been available to most participants. "There are only two, maybe three, child care centers that offer second-shift or third-shift child care. That’s a barrier."
Program coordinators, though, are already working to remedy the situation, says Calhoun. The 11-member Washington County Families First council made up of seven representatives from private industry, plus Calhoun, a program participant, a client advocate, and a clergyman is evaluating the need for second- and third-shift child care, he says. "We will review and approve grants for the most-needed day care."
Another problem possibly hindering the success of the program to date is the literacy level of the participants. "The vast majority of our folks have not tested at [the ninth-] grade level. We’ve only had a handful who tested higher. Some people are barely literate; some are not literate at all," says Calhoun.
A similar welfare-reform spawned home health aide training program was one of several training programs for different industries set up as part of a business partnership initiative by the Arizona Department of Economic Security, which is in charge of distributing welfare funds. The Sharon Smyth Educational Foundation in Tempe in association with the Arizona Association for Home Care, also in Tempe, received the home health contract. The foundation then subcontracted out parts of the contract, such as the training, background checks, and the screening, to see if the applicants were appropriate for the program, says Susan Brenton, executive director for the Arizona Association for Home Care.
The Department of Economic Security was responsible for doing a basic screening for interests and education, teaching communication skills, and making sure the applicants had a seventh-grade literacy level.
The first home health training class had nine students, Brenton says. The course included 185 hours of classroom and hands-on experience and then a four-week internship. During the internship, students spent time in a home health care agency, a nursing home, and an adult day care center. Students were provided with uniforms, shoes, watches, nursing bags, stethoscopes, thermometers, blood pressure cuffs, and books.
Two students dropped out of the class after one week. The other seven graduated in May, became certified as CNAs, and got jobs five working in home health agencies with intermittent care and two in adult day care centers. By completing training programs, most participants in the state program are eligible for up to two years of financial aid and assistance with child care and health care insurance, Brenton says.
The Department of Economic Security followed up with the students recently and found out that as a result of having passed the course, they were making about 50 cents an hour more than the "typical person off the street who had taken another [CNA] class," Brenton says. Funding for the program ran out before another class could begin. The foundation is negotiating a contract for this year, Brenton says.
Handling the paperwork for the contract was a problem, however, she adds. "We could not send them a bill on our form," she says. "It had to be sent on one of their special billing forms that did not correlate with our training program."
The contract itself was a 45-page document. "I made suggestions to the Department of Economic Security that if they wished to continue to work with private business in the future, they need to look into the amount of paperwork required," she says.
Ensuring the employees can make a living
Some providers are concerned that the students in these programs are getting into an occupation that, for the most part, gives them little pay and appreciation. "Are we taking them from their current life and squeezing them into the working poor?" asks Judy Clinco, RN, executive director of Catalina In-Home Services in Tucson, AZ. "We need to reevaluate how much we pay home health aides. These people should be making as much as workers on the assembly line at Ford."
To help the students, Clinco suggests expanding the training programs even more than the 185-hour program to make sure the students leave prepared and to allow them to work part-time so they can meet the needs of their families. Arizona law requires only 75 hours of training to be a home health aide or CNA.
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