Letter to Committee on Health

The Honorable Christina Henderson, Chair
The Honorable Vincent C. Gray
The Honorable Charles Allen
The Honorable Brianne Nadeau
The Honorable Zachery Parker
Committee on Health
The John A. Wilson Building
1350 Pennsylvania Avenue, NW
Washington, DC. 20004

Dear Chairperson Henderson and Members of the Committee on Health:

On behalf of the Coalition on Long Term Care and the undersigned members and supporters, we are seeking your assistance to move the District of Columbia forward to enact needed training programs and legislative reforms that will help to alleviate the direct care workforce crisis. As you heard from multiple witnesses during oversight and budget hearings earlier this year, the direct care workforce crisis is affecting access to care for seniors and people with disabilities, driving up health care costs and impacting the ability of hospitals to safely discharge patients to aftercare. While the Department of Health Care Finance has provided some Medicaid providers with a supplemental payment to increase the wages of certain direct care workers to an average of 110% of the Living Wage this year, this alone is not a solution. In the face of a deepening crisis and increasing demand, we need action on the following items:

Medication Aide Training for Certified Nursing Assistants and Home Health Aide – Standards for Certification of Medication Aides were finalized by the Board of Nursing as part of the Nursing Assistive Personnel regulations in 2019. Employers want incumbent aides to receive this training and obtain the certification because it helps reduce the workload of nursing staff while advancing the skills and increasing the pay of direct care staff. Several schools applied to the Board of Nursing to offer this training, but these applications have been pending for many

months, including at least one since last year. What is taking so long when we know this certification is a real step in a career ladder that would help alleviate the workforce shortage and benefit workers, employers and consumers? See the Coalition’s 2021 survey.

Amendments to Health Occupations Amendment Act (HORA) – The Department of Health testified they anticipated transmitting legislation to the Council in May. We have heard nothing further. To help increase workforce participation and reduce the shortage of workers, we need your help to expedite legislative changes that we previously proposed. Specifically, we have proposed amendments to HORA to:

• Clearly define a direct care support worker as: Direct Support Professionals (DSP), Home Health Aides (HHA), Personal Care Aides (PCAs) and Certified Nursing Aides (CNAs) regardless of care setting.
• Lower the minimum age for all direct care workers to 16.
• Replace separate credentials and training programs for Home Health Aides and Certified Nursing Assistants with a single, universal credential.
• Allow those seeking to enter the health care workforce as Direct Care Workers to acquire skills through on-the job training through registered apprenticeship programs.
• Allow out-of-District Direct Care Workers and medication aides to work in the District of Columbia without additional certification.

Release the Recommendations of the Mayors Healthcare Workforce Task Force – Last summer, the Mayor established a Healthcare Workforce Task Force and charged it to develop recommendations quickly on strategies and investments necessary to address the workforce crisis so that they could be considered during budget formulation for FY 24. The Task Force and various subcommittees met on an expedited schedule and submitted its report to DC Health in late September of 2022. The Task Force reconvened to unanimously approve all the recommendations including a recommendation to establish a minimum wage for all Direct Care Workers equivalent to 120% of the District’s Living Wage. The Task Force’s report was never released to the public, and the Mayor has never responded to the report’s recommendations.

As we have previously stated in testimony before the Committee on Health, DC needs to fill thousands of direct care jobs to meet current demand and future needs. To have any hope of meeting this demand, we need focused, coordinated action across multiple agencies to address systemic and operational deficiencies, leadership to drive needed reforms and you, members of the Council, to hold agencies accountable.

Thank you in advance for your assistance.