[Joint House and Senate Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
CARE FOR OUR COMMUNITIES: INVESTING
IN THE DIRECT CARE WORKFORCE
=======================================================================
JOINT HEARING
BEFORE THE
SUBCOMMITTEE ON
HEALTH, EMPLOYMENT,
LABOR, AND PENSIONS
AND THE
SUBCOMMITTEE ON
HIGHER EDUCATION AND
WORKFORCE INVESTMENT
of the
COMMITTEE ON EDUCATION AND LABOR
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, JULY 20, 2021
__________
Serial No. 117-23
__________
Printed for the use of the Committee on Education and Labor
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via: edlabor.house.gov or www.govinfo.gov
___________
U.S. GOVERNMENT PUBLISHING OFFICE
46-174 PDF WASHINGTON : 2022
COMMITTEE ON EDUCATION AND LABOR
ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman
RAUL M. GRIJALVA, Arizona VIRGINIA FOXX, North Carolina,
JOE COURTNEY, Connecticut Ranking Member
GREGORIO KILILI CAMACHO SABLAN, JOE WILSON, South Carolina
Northern Mariana Islands GLENN THOMPSON, Pennsylvania
FREDERICA S. WILSON, Florida TIM WALBERG, Michigan
SUZANNE BONAMICI, Oregon GLENN GROTHMAN, Wisconsin
MARK TAKANO, California ELISE M. STEFANIK, New York
ALMA S. ADAMS, North Carolina RICK W. ALLEN, Georgia
MARK DeSAULNIER, California JIM BANKS, Indiana
DONALD NORCROSS, New Jersey JAMES COMER, Kentucky
PRAMILA JAYAPAL, Washington RUSS FULCHER, Idaho
JOSEPH D. MORELLE, New York FRED KELLER, Pennsylvania
SUSAN WILD, Pennsylvania GREGORY F. MURPHY, North Carolina
LUCY McBATH, Georgia MARIANNETTE MILLER-MEEKS, Iowa
JAHANA HAYES, Connecticut BURGESS OWENS, Utah
ANDY LEVIN, Michigan BOB GOOD, Virginia
ILHAN OMAR, Minnesota LISA C. McCLAIN, Michigan
HALEY M. STEVENS, Michigan DIANA HARSHBARGER, Tennessee
TERESA LEGER FERNANDEZ, New Mexico MARY E. MILLER, Illinois
MONDAIRE JONES, New York VICTORIA SPARTZ, Indiana
KATHY E. MANNING, North Carolina SCOTT FITZGERALD, Wisconsin
FRANK J. MRVAN, Indiana MADISON CAWTHORN, North Carolina
JAMAAL BOWMAN, New York, Vice-Chair MICHELLE STEEL, California
MARK POCAN, Wisconsin JULIA LETLOW, Louisiana
JOAQUIN CASTRO, Texas Vacancy
MIKIE SHERRILL, New Jersey
JOHN A. YARMUTH, Kentucky
ADRIANO ESPAILLAT, New York
KWEISI MFUME, Maryland
Veronique Pluviose, Staff Director
Cyrus Artz, Minority Staff Director
------
SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS
MARK DeSAULNIER, California, Chairman
JOE COURTNEY, Connecticut RICK W. ALLEN, Georgia
DONALD NORCROSS, New Jersey Ranking Member
JOSEPH D. MORELLE, New York JOE WILSON, South Carolina
SUSAN WILD, Pennsylvania TIM WALBERG, Michigan
LUCY McBATH, Georgia JIM BANKS, Indiana
ANDY LEVIN, Michigan DIANA HARSHBARGER, Tennessee
HALEY M. STEVENS, Michigan MARY E. MILLER, Illinois
FRANK J. MRVAN, Indiana SCOTT FITZGERALD, Wisconsin
ROBERT C. ``BOBBY'' SCOTT, Virginia VIRGINIA FOXX, North Carolina
(ex officio) (ex officio)
SUBCOMMITTEE ON HIGHER EDUCATION AND WORKFORCE INVESTMENT
FREDERICA S. WILSON, Florida, Chairwoman
MARK TAKANO, California GREGORY F. MURPHY, North Carolina
PRAMILA JAYAPAL, Washington Ranking Member
ILHAN OMAR, Minnesota GLENN GROTHMAN, Wisconsin
TERESA LEGER FERNANDEZ, New Mexico ELISE M. STEFANIK, New York
MONDAIRE JONES, New York JIM BANKS, Indiana
KATHY E. MANNING, North Carolina JAMES COMER, Kentucky
JAMAAL BOWMAN, New York RUSS FULCHER, Idaho
MARK POCAN, Wisconsin MARIANNETTE MILLER-MEEKS, Iowa
JOAQUIN CASTRO, Texas BOB GOOD, Virginia
MIKIE SHERRILL, New Jersey LISA C. McCLAIN, Michigan
ARIANO ESPAILLAT, New York DIANA HARSHBARGER, Tennessee
RAUL M. GRIJALVA, Arizona VICTORIA SPARTZ, Indiana
JOE COURTNEY, Connecticut JULIA LETLOW, Louisiana
SUZANNE BONAMICI, Oregon VIRGINIA FOXX, North Carolina
ROBERT C. ``BOBBY'' SCOTT, Virginia (ex officio)
(ex officio)
C O N T E N T S
----------
Page
Hearing held on July, 20 2021.................................... 1
Statement of Members:
DeSaulnier, Hon. Mark, Chairman, Subcommittee on Health,
Employment, Labor, and Pensions............................ 1
Prepared statement of.................................... 3
Allen, Hon. Rick, Ranking Member, Subcommittee on Health,
Employment, Labor, and Pensions............................ 4
Prepared statement of.................................... 5
Wilson, Hon. Frederica S., Chairwoman, Subcommittee on Higher
Education and Workforce Investment......................... 6
Prepared statement of.................................... 7
Murphy, Hon. Gregory F., Ranking Member, Subcommittee on
Higher Education and Workforce Investment.................. 7
Prepared statement of.................................... 8
Statement of Witnesses:
Burani, Paul, Head of Business Development in North America,
Udacity.................................................... 25
Prepared statement of.................................... 28
Espinoza, Robert, Vice President of Policy, PHI.............. 9
Prepared statement of.................................... 11
Fay, Hon. Jessica, State Representative, Maine House of
Representatives............................................ 34
Prepared statement of.................................... 36
Torres, Zulma, Home Health Aide, Cooperative Home Care
Associates................................................. 19
Prepared statement of.................................... 21
Additional Submissions:
Questions submitted for the record by:
Chairman Scott........................................... 135
Response to question submitted for the record by:
Rep. Fay................................................. 136
CARE FOR OUR COMMUNITIES: INVESTING
IN THE DIRECT CARE WORKFORCE
----------
Tuesday, July 20, 2021
House of Representatives,
Subcommittee on Health, Employment,
Labor, and Pensions,
Subcommittee on Higher Education and Workforce
Investment,
Committee on Education and Labor,
Washington, DC.
The subcommittees met, pursuant to notice, at 10:17 a.m.,
via Zoom, Hon. Mark DeSaulnier (Chairman of the Subcommittee on
Health, Employment, Labor and Pensions) presiding.
Present: DeSaulnier, Wilson, Courtney, Bonamici, Takano,
Norcross, Jayapal, Morelle, Wild, McBath, Levin, Stevens,
Fernandez, Manning, Mrvan, Bowman, Pocan, Castro, Sherrill,
Espaillat, Scott (ex officio), Murphy, Allen, Walberg,
Grothman, Banks, Fulcher, Miller-Meeks, Good, McClain,
Harshbarger, Spartz, Fitzgerald, Letlow, and Foxx (ex officio).
Staff present: Phoebe Ball, Disability Counsel; Ilana
Brunner, General Counsel; Rasheedah Hasan, Chief Clerk; Sheila
Havenner, Director of Information Technology; Eli Hovland,
Policy Associate; Carrie Hughes, Director of Health and Human
Services; Ariel Jona, Policy Associate; Andre Lindsay, Policy
Associate; Richard Miller, Director of Labor Policy; Max Moore,
Staff Assistant; Mariah Mowbray, Clerk/Special Assistant to the
Staff Director; Lorin Obler, GAO Detailee; Kayla Pennebecker,
Staff Assistant; Veronique Pluviose, Staff Director; Banyon
Vassar, Deputy Director of Information Technology; Cyrus Artz,
Minority Staff Director; Rob Green, Minority Director of
Workforce Policy; Amy Raaf Jones, Minority Director of
Education and Human Resources Policy; Dean Johnson, Minority
Legislative Assistant; Georgie Littlefair, Minority Legislative
Assistant; Hannah Matesic, Minority Director of Operations;
Audra McGeorge, Minority Communications Director; Chance
Russell, Minority Legislative Assistant; Mandy Schaumburg,
Minority Chief Counsel and Deputy Director of Education Policy;
Michael Davis, Minority Operations Assistant; and Taylor
Hittle, Minority Professional Staff Member.
Chairman DeSaulnier. The Subcommittee on Health,
Employment, Labor, Pensions, and the Subcommittee on Higher
Education and Workforce Investment will come to order. Welcome
again, everyone. I note that a quorum is present.
The subcommittees are meeting today for a joint hearing on
Care for Our Communities: Investing in the Direct Care
Workforce.
This is an entirely remote hearing, and, as such, the
Committee's hearing room is officially closed. All microphones
will be kept muted as a general rule to avoid unnecessary
background noise.
Members and witnesses will be responsible for unmuting
themselves when they are recognized to speak, or when they wish
to seek recognition.
If a Member or witness experiences technical difficulties
during the hearing, please stay connected in the platform. Make
sure you are muted and use your phone immediately to call the
Committee's IT director, whose number was provided in advance.
Should the Chair experience technical difficulty or need to
step away, Chairwoman Wilson or another majority Member is
hereby authorized to assume the gavel in the Chair's absence.
In order to ensure the Committee's five-minute rule is
adhered to, staff will be keeping track of time using the
Committee's remote timer, which appears in its own thumbnail
picture. Members and witnesses are asked to wrap up promptly
when their time is expired.
Pursuant to Committee Rule 8(c), opening statements are
limited to the Chairs and Ranking Members. This allows us to
hear from our witnesses sooner and provides all Members with
adequate time to ask questions.
I now recognize myself for the purpose of making an opening
statement.
Today, we will be hearing about the valuable work performed
by America's direct care workforce and the urgent care and need
to expand these services for aging Americans and Americans with
disabilities.
Direct care makes it possible for millions of Americans to
live independently in their homes and their communities. The
degree to which these vital services enhance the quality of
life for aging and disabled Americans cannot be overstated.
They enable individuals who need assistance with activities
of daily living to live healthy and productive lives and remain
active participants in their communities. We know that people
want to stay at home, and they want to stay in their
communities as long as possible and as much as possible. Direct
care workers are a crucial part to ending the unnecessary
segregation and advancing the civil rights of individuals with
disabilities as outlined in the Supreme Court's 1990 Olmstead
decision.
Unfortunately these services are often unaffordable and
inaccessible for those who need them most. Private insurance
and Medicare often provide only limited coverage for home-and
community-based services, forcing family Members and friends to
care for loved ones, or, alternatively, to pay out of pocket
for those services until their resources are depleted enough
for Medicaid to kick in.
The demand for direct care is also rapidly outpacing the
growth of the direct care workforce, and, unfortunately,
individuals who need home-and community-based services often
find it impossible to access the support they need.
The direct care sector is expected to add more than 1.3
million jobs between 2018 and 2028. Yet the number of people
who will need direct care continues to exceed the number of
workers who can provide it. To address this shortage, we must
understand the causes.
Direct care workers, disproportionately women of color, are
chronically undervalued and overworked. Medicaid is, by far,
the largest funding source for direct care services, and
Medicaid reimbursement rates have not allowed wages to increase
as fast as those in these occupations.
Today, roughly one in six in direct care workers lives in
poverty, one in six of these workers lives in poverty. The
turnover rate for direct care workforce in 2018 was 82 percent.
And that was before the pandemic, which forced more than
200,000 direct care workers to leave their jobs.
Today, we will discuss the need to ensure access to direct
care services for those who need them, and also support the
worker force that delivers these services.
The American Jobs Plan calls for robust investments to
expand access to home-and community-based services for Medicaid
and to strengthen the workforce through higher wages, better
benefits, and sector-based job training and supports.
The Direct Creation, Advancement, and Retention of
Employment Opportunity Act, or Direct CARE Opportunity Act,
also expands workers' earning potential and provides the
financial assistance for transportation, childcare, and housing
that workers need to stay in their jobs.
Our society and our economy depend on direct care workers.
They deserve better, as do their clients. We are committed to
that goal.
I now recognize the distinguished Ranking Member of the
Subcommittee on Health--I am sorry. I now recognize the
distinguished Ranking Member of the Subcommittee on Health,
Employment, Labor, and Pensions for the purpose of making an
opening statement.
[The statement of Chairman DeSaulnier follows:]
Statement of Hon. Mark DeSaulnier, Chairman,
Subcommittee on Health, Employment, Labor, and Pensions
Today we will be hearing about the valuable work informed by
America's direct care workforce, and the urgent need to expand these
services for aging Americans and individuals with disabilities.
Direct care makes it possible for millions of people to live
independently in their homes and communities. The degree to which these
vital services enhance the quality of life for aging and disabled
Americans cannot be overstated. They enable individuals who need
assistance with activities of daily living to live healthy and
productive lives and remain active participants in their communities.
We know that people want to stay at home, and they want to stay in
their communities as long as possible and as much as possible. Direct
care workers are a crucial part to ending the unnecessary segregation
and advancing the civil rights of individuals with disabilities, as
outlined in Supreme Court's 1999 Olmstead decision.
Unfortunately, these services are often unaffordable and
inaccessible for those who need it most.
Private insurance and Medicare often provide only limited coverage
for home and community-based services, forcing family members and
friends to care for loved ones or, alternatively, pay out-of-pocket for
these services until their resources are depleted enough for Medicaid
to kick in.
The demand for direct care is also rapidly outpacing the growth of
the direct care workforce. And unfortunately, individuals who need home
and community-based services often find it impossible to access the
support they need.
The direct care sector is expected to add more than 1.3 million
jobs between 2018 and 2028. Yet, the number of people who will need
direct care continues to exceed the number of workers who can provide
it. To address this shortage, we must understand the causes.
Direct care workers--disproportionally women of color--are
chronically undervalued and overworked.
Medicaid is, by far, the largest funding source for direct care
services, and Medicaid reimbursement rates have not allowed wages to
increase as fast as those these occupations. Today, roughly 1 in 6
direct care workers lives in poverty. 1 in 6 of these workers lives in
poverty.
The turnover rate for the direct care workforce in 2018 was 82
percent. And that was before the pandemic, which forced more than
200,000 direct care workers to leave their jobs.
Today, we will discuss the need to ensure access to direct care
services for those who need them and also support the workforce that
delivers these services.
The American Jobs Plan calls for robust investments to expand
access to home and community-based services from Medicaid and
strengthen the workforce through higher wages, better benefits, and
sector-based job training and supports.
The Direct Creation, Advancement, and Retention of Employment
Opportunity Act of 2021, or Direct CARE Opportunity Act also expands
workers' earning potential and provides the financial assistance for
transportation, child care, and housing that workers need to stay in
their jobs.
Our society and our economy depend on direct care workers. They
deserve better-as do their clients. We are committed to that cause.
I now recognize the distinguished Ranking Member of the
Subcommittee on Health, Employment, Labor and Pensions for the purpose
of making an opening statement. Mr. Allen, good morning.
______
Chairman DeSaulnier. Mr. Allen? Good morning.
I think you might be muted, Mr. Allen.
Mr. Allen. All right. There we go.
Chairman DeSaulnier. There you are.
Mr. Allen. You got me?
Chairman DeSaulnier. We got you.
Mr. Allen. Hey, thanks, Mr. Chairman. I thought I was right
on schedule. I couldn't get in the hearing room, so I finally
got in here. But we're here, and I want to thank my colleague,
Dr. Murphy, for joining us in his role on his Subcommittee.
I do find it ridiculous that, even unelected bureaucrats
are back to working in person before Democrats in Congress, the
Workforce Investment and Opportunity Act, WIOA, provides an
important source of funding for State and local workforce
development systems that are tasked with addressing needs of
the community.
The Federal Government does not have the knowledge or
foresight required to dictate what States need. I believe we
should err on the side of flexibility when designing and
funding workforce development systems with taxpayer dollars.
Direct care workers are an important part of the healthcare
workforce and care for our most vulnerable patients. Their work
is often difficult and unrecognized, but our healthcare workers
are valuable and should be recognized for the sacrifices they
have made, especially during the COVID-19 pandemic.
We know there is an incredible amount of turnover in the
labor market for direct care workers. We also know that most
direct care workers did not pursue additional education after
high school.
As Ranking Member of the Subcommittee on Health,
Employment, Labor, and Pensions, I hope today's hearing can
shed light on how Congress can help all workers, including
direct care workers, gain the skills they need to improve their
upward mobility, and sustain a fulfilling career.
New technologies and practices developed in the private
marketplace are revolutionizing the healthcare field. We must
ensure workers are not left behind. The Federal Government has
an interest in sustaining a workforce pipeline that recruits,
retains, and assists individuals interested in finding the
right career for them, including careers within the healthcare
workforce. But Congress cannot fall into the trap of having
hundreds of different programs, each devoted to one particular
occupation.
This is why I advocate for apprentice-style programs.
Combining structured on-the-job learning, and classroom-based
instruction gives individuals a low-risk option to determine if
a job is a good fit for them. In the same way, earn-and-learn
programs are another way to help folks find that rewarding
career.
I look forward to working with my colleagues on both sides
of the aisle to find innovative solutions to address the
healthcare workforce challenges facing our Nation, and I look
forward to hearing the witnesses' testimony today.
And, with that, Mr. Chairman, I thank you, and I yield
back.
[The prepared statement of Mr. Allen follows:]
Statement of Hon. Rick Allen, Ranking Member,
Subcommittee on Health, Employment, Labor, and Pensions
Thank you, Chairman DeSaulnier.
And thank you to my colleague Dr. Murphy for your remarks.
I find it ridiculous that even unelected bureaucrats are back to
working in person before Democrats in Congress.
The Workforce Investment and Opportunity Act (WIOA) provides an
important source of funding for State and local workforce development
systems that are tasked with addressing the needs of the community. The
Federal Government does not have the knowledge or foresight required to
dictate what states need. I believe we should err on the side of
flexibility when designing and funding workforce development systems
with taxpayer dollars.
Direct care workers are an important part of the health care
workforce, and care for our most vulnerable patients. Their work is
often difficult and unrecognized, but our health care workers are
valuable and should be recognized for the sacrifices they have made,
especially during the COVID-19 pandemic.
We know there is an incredible amount of turnover in the labor
market for direct care workers. We also know that most direct care
workers did not pursue additional education after high school.
As Ranking Member of the Subcommittee on Health, Employment, Labor,
and Pensions, I hope today's hearing can shed light on how Congress can
help all workers, including direct care workers, gain the skills they
need to improve their upward mobility and sustain a fulfilling career.
New technologies and practices developed in the private marketplace are
revolutionizing the health care field. We must ensure workers are not
left behind.
The Federal Government has an interest in sustaining a workforce
pipeline that recruits, retains, and assists individuals interested in
finding the right career for them, including careers within the health
care workforce. But Congress cannot fall into the trap of having
hundreds of different programs, each devoted to one particular
occupation.
This is why I advocate for apprenticeship-style programs. Combining
structured on-the-job learning and classroom-based instruction gives
individuals a low-risk option to determine if a job is a good fit for
them. In the same way, earn-and-learn programs are another way to help
folks find a rewarding career.
I look forward to working with my colleagues on both sides of the
aisle to find innovative solutions to address the health care workforce
challenges facing our Nation. And I look forward to hearing the
witnesses' testimony today.
Thank you and I yield back.
______
Chairman DeSaulnier. Thank you, Mr. Allen.
I now want to recognize the distinguished Chairwoman of the
Subcommittee on Higher Education and Workforce Investment for
the purpose of making an opening statement.
Chairwoman Wilson?
Chairwoman Wilson. Thank you, Chair DeSaulnier.
I want to add my thanks for our distinguished witnesses'
time today. In addition to low pay and difficult working
conditions, the direct care sector lacks the training and
career pathways that workers need to join and remain in this
profession.
Direct care is hard work. It is physically and emotionally
demanding, and also requires knowledge of complex health
conditions, such as Alzheimer's disease and dementia. Yet,
training for entry level direct care workers varies widely, and
is not reimbursed by Medicaid or Medicare, leaving many workers
unprepared to safety--to safely provide quality, long-term
care.
In addition, these workers often do not have the required
education, qualifications to enroll in training programs, and
would offer professional growth. Without these pathways, direct
care workers often become stagnant without the opportunity to
advance into higher-paying positions.
In most professions, workers can increase their pay as they
increase their skills and experience. Direct care workers
should have that same opportunity.
The American Jobs Plan dedicates resources to improve the
lives of direct care workers. This mirrors the Direct CARE
Opportunity Act, which invests in recruiting, retaining, and
advancing the direct care workforce pipeline. Those resources
will allow States and local organizations to pursue the best
solutions in their regions, from training programs and
registered apprenticeships to mentorship opportunities, to make
direct care a more sustainable career.
Supporting a well-paid and well-trained direct care
workforce is vital. It is vital for aging Americans; it is
vital for individuals with disabilities.
In 2015, in my home State of Florida, 6,000 people died
while waiting for home care services according to the
Department of Elder Affairs. Sadly, this underscores the
desperate need for increased investment in the direct care
sector.
Strengthening this workforce pipeline is not only the right
thing to do to support our Nation's direct care workers; it is
also the smart thing to do. With the right investments, the
direct care field will be able to offer millions of good-paying
jobs with lower barriers to carrying--to entry, and ample
opportunities for career growth.
As we recover from the pandemic, which erased millions of
jobs, enhancing the direct care workforce would help people get
back to work immediately, and secure quality long-term care for
those who need it most.
I look forward to our discussions today, and I now yield to
the Ranking Member, Mr. Murphy--Dr. Murphy, for his opening
statement.
[The prepared statement of Chairwoman Wilson follows:]
Statement of Hon. Frederica S. Wilson, Chairwoman, Subcommittee on
Higher Education and Workforce Investment
Thank you, Chair DeSaulnier. I want to add my thanks for our
distinguished witnesses' time today.
In addition to low pay and difficult working conditions, the direct
care sector lacks the training and career pathways that workers need to
join-and remain-in this profession.
Direct care is hard work. It is physically and emotionally
demanding and also requires knowledge of complex health conditions,
such as Alzheimer's disease and dementia. Yet, training for entry-level
direct care workers varies widely and is not reimbursed by Medicaid or
Medicare, leaving many workers unprepared to safely provide quality,
long-term care.
In addition, these workers often do not have the required education
qualifications to enroll in the training programs that would offer
professional growth. Without these pathways, direct care workers often
become stagnant without the opportunity to advance into higher-paying
positions.
In most professions, workers can increase their pay as they
increase their skills and experience. Direct care workers should have
that same opportunity.
The American Jobs Plan dedicates resources to improve the lives of
direct care workers. This mirrors the Direct CARE Opportunity Act,
which invests in recruiting, retaining, and advancing the direct care
workforce pipeline.
These resources will allow states and local organizations to pursue
the best solutions in their regions-from training programs and
registered apprenticeships to mentorship opportunities-to make direct
care a more sustainable career.
Supporting a well-paid and well-trained direct care workforce is
vital. It's vital for aging Americans, it's vital for individuals with
disabilities.
In 2015, in my home State of Florida, 6,000 people died while
waiting for home care services, according to the Department of Elder
Affairs. Sadly, this underscores the desperate need for increased
investment in the direct care sector.
Strengthening this workforce pipeline is not only the right thing
to do to support our Nation's direct care workers. It is also the smart
thing to do.
With the right investments, the direct care field will be able to
offer millions of good-paying jobs with low barriers to entry and ample
opportunities for career growth.
As we recover from the pandemic-which erased millions of jobs-
enhancing the direct care workforce would help people get back to work
immediately and secure quality long-term care for those who need it
most.
I look forward to our discussions today and I now yield to the
Ranking Member, Dr. Murphy, for his opening statement.
______
Mr. Murphy. Thank you, Chairwoman Wilson, for yielding.
I would like to thank the witnesses for joining us today.
Direct care workers are an essential part of the healthcare
sector. I personally have worked with these individuals for
over 30 years and understand the dedication that they have to
their craft. These individuals act as primary care providers of
care, supervision, and emotional support for older Americans,
people with disabilities, and individuals with chronic needs.
As a physician, I understand the value that they bring to our
healthcare system and the sacrifices that they make to serve
our patients.
Data from the Bureau of Labor Statistics estimate that
there are over 3 million direct care workers employed in the
U.S. today. These jobs provide an important source of income
for a diverse array of individuals.
As the United States population ages, and the need for
direct care workers blossom, the Federal Government must
consider how its programs foster an environment where more
people are encouraged to enter the healthcare workforce. I
believe the reauthorization of the Workforce Innovation and
Opportunity Act is the appropriate time for this Committee to
reassess Congress' role in us supporting a robust healthcare
labor market.
In the existing WIOA structure, each State must create a
one-stop delivery system that connects job seekers with in-
demand jobs. Direct care services should be a part of those
State and local workforce development board conversations.
But Congress cannot predict the future. Our laws must be
nimble and allow each community to address its unique needs. I
believe that supporting direct care workers through a
comprehensive WIOA reauthorization will give individuals
interested in these careers in the direct care field access to
programs that will help gain the skills necessary to succeed.
Legislation like H.R. 2999, the Direct CARE Opportunity
Act, is a duplicative--is duplicative to workforce programs
that we already have in place. I am concerned that a new
Federal program devoted exclusively to direct care workers may
threaten the performance of the broader workforce development
system.
Republicans on this Committee want to help all workers,
including those in the direct care sector, by strengthening
WIOA and other workforce development programs.
I look forward to hearing from witnesses today on how we
can buildup the healthcare workforce sector without detracting
from other critical professions.
Thank you, Madam Chair. Thank you, and I yield back.
[The prepared statement of Mr. Murphy follows:]
Statement of Hon. Gregory F. Murphy, Ranking Member, Subcommittee on
Higher Education and Workforce Investment
Thank you, Chairwoman Wilson, for yielding. I'd like to thank the
witnesses for joining us today.
Direct care workers are an essential part of the health care
sector. I have personally worked with these individuals for over 30
years. These individuals act as primary providers of care, supervision,
and emotional support for older Americans, people with disabilities,
and individuals with chronic needs. As a physician, I understand the
value they bring to our health care system, and the sacrifices they
make to serve patients.
Data from the Bureau of Labor Statistics estimate that there are
over 3 million direct care workers employed today. These jobs provide
an important source of income for a diverse array of individuals.
As the United States' population ages, and the need for direct care
workers blossoms, the Federal Government must consider how its programs
foster an environment where more people are encouraged to enter the
health care workforce.
I believe the reauthorization of the Workforce Innovation and
Opportunity Act (WIOA) is the appropriate time for this Committee to
reassess Congress's role in supporting a robust health care labor
market.
In the existing WIOA structure, each State must create a one-stop
delivery system that connects jobseekers with in-demand jobs. Direct
care services should be a part of those State and local workforce
development board conversations.
But Congress cannot predict the future. Our laws must be nimble and
allow each community to address its unique needs. I believe that
supporting direct care workers through a comprehensive WIOA
reauthorization will give individuals interested in careers in the
direct care field access to programs that will help them gain the
skills necessary to succeed.
Legislation like H.R. 2999, the Direct CARE Opportunity Act, is
duplicative to workforce programs that we already have in place. I am
concerned that a new Federal program devoted exclusively to direct care
workers may threaten the performance of the broader workforce
development system.
Republicans on this Committee want to help all workers, including
those in the direct care sector, by strengthening WIOA and other
workforce development programs. I look forward to hearing from the
witnesses today how we can buildup the health care workforce without
detracting from other critical professions.
Thank you and I yield back.
______
Chairman DeSaulnier. Thank you, Ranking Member Murphy.
Thank you, Chair Wilson, very much for those comments.
We will now go to our witnesses, and it is my pleasure to
introduce them. Thank you again for being here. We really
appreciate it.
Robert Espinoza is the Vice President of Policy at PHI,
where he oversees the National Advocacy Research and Public
Education Division on the Direct Care Workforce.
Zulma Torres has worked in direct care for over 23 years,
and works for Cooperative Healthcare Associates, a worker-owned
licensed home care service agencies located in the Bronx.
Paul Burani is the head of business development for North
America for Udacity, a company founded in 2011 to provide
training services for workers facing changing technological
landscapes.
And Representative Jessica Fay is a third-term Member of
the Maine House of Representatives. She was appointed to serve
as House Chair of the Commission on Study of Long-Term Care
Workforce Issues.
Our instructions for the speakers are as follows.
Again, we appreciate the witnesses for participating today
and look forward to your testimony. Your written statement will
appear in full in the hearing record, and you are asked to
limit your oral presentation to five minutes, please. After
your presentation, we will move to Member questions.
The witnesses are aware of their responsibility to provide
accurate information to the Joint Subcommittees, and,
therefore, we will proceed with their testimony.
And, first, we will recognize Mr. Espinoza.
STATEMENT OF ROBERT ESPINOZA, VICE PRESIDENT OF POLICY, PHI
Mr. Espinoza. Thank you, Chairman, and good morning.
On behalf of PHI, I would like to start by thanking
Chairwoman Wilson, Ranking Member Murphy, and the other Members
of the Higher Education and Workforce Investment Subcommittee,
as well as Chairman DeSaulnier, Ranking Member Allen, and the
other Members of the Health, Employment, Labor and Pension
Subcommittee, for the opportunity today to discuss the direct
care workforce and how the Direct CARE Opportunity Act would
support this vital job sector.
Across the country, 4.6 million direct care workers support
millions of older adults and people with disabilities in a
range of long-term care settings, from their private homes to
residential care homes, such as assisted living, to skilled
nursing homes. Most of these workers are women, people of
color, and/or immigrants, and 1 in 4 is aged 55 and older, all
facts that underscore the entrenched societal inequities that
many of these workers face both on the job and in their
communities.
Largely because our country is aging rapidly, the direct
care workforce has grown significantly over the years, and it
will continue this trend. Between 2018 and 2028, the direct
care workforce will add more than 1.3 million jobs--new jobs,
including nearly 1.1 million jobs in home care, representing
the largest growth of any job sector in the country. Already,
the direct care workforce is larger than any other single
occupation in the country.
However, despite their enormous value, direct care jobs
have been poorer-quality jobs for decades, which harms workers,
employers, consumers, and family caregivers. These workers
struggle with poverty level wages, which our research shows are
lower in all 50 States and D.C. than wages for other
occupations with similar entry level requirements, such as
janitors and retail salespeople. Training and advancement
opportunities are also inadequate, which makes it increasingly
difficult to recruit and retain these workers. These challenges
affect everyone in the long-term care system.
Forced into crushing poverty, workers too often leave the
sector for other fields. Employers struggle to recruit and
retain workers and will need to fill millions of direct care
job openings in the next decade. Without enough workers, older
adults and people with disabilities cannot access the services
they deserve, and family caregivers are often left without paid
respite and support. The COVID-19 pandemic has amplified all
these challenges.
To address these issues, the Direct CARE Opportunity Act
would provide a significant and much-needed investment in the
direct care workforce, coordinated at the national level to
ensure that funding goes where it is most needed. It would
invest more than $1 billion over 5 years in recruitment,
retention, and advancement strategies.
In direct care, it would require careful planning, needs
assessment, and evaluation that would help build the evidence
base on this workforce related to care outcomes, employment
outcomes, and cost outcomes. Specifically, this funding could
be used to support interventions related to entry level and
specialized training, advanced roles, recruitment and
retention, supervision and technology.
It could help create new models of long-term care service
delivery related to upscaling care integration, career
advancement, and universal worker roles. And it would support
individuals with prevalent conditions, such as dementia, and
more vulnerable people, such as people of color and LGBT
people, just to name a few. It would help professionalize and
transform these jobs, making them more attractive to job
candidates now and in the future.
Already, the field has designed numerous examples of
effective interventions, though it needs significant funding
and coordination at the Federal level. We have seen successful
training, recruitment and advancement programs in Arkansas,
California, and New Mexico, among many other States. And these
interventions have benefited workers, consumers, employers, and
the economy alike, but they are small in scale, and they
represent a tiny fraction of what will be needed to address the
national workforce crisis in direct care.
I will close by saying that strategically investing in
workforce development for this workforce is also a matter of
economic development. High-quality jobs and workforce
interventions can increase consumer spending, decrease public
assistance rates, reduce costly turnover, and promote cost
savings in healthcare spending in an already expensive system
with costs that balloon every year.
We encourage Congress to enact the Direct CARE Opportunity
Act and begin transforming this critical workforce. As Marisol
Rivera, care coordinator at Cooperative Home Care Associates in
the Bronx, said, I think the role of the home health aide
should be considered just as important as any other healthcare
role.
Thank you, and I look forward to your questions and to your
ideas.
[The prepared statement of Mr. Espinoza follows:]
Prepared Statement of Robert Espinoza
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you, Mr. Espinoza, and thank you
on the time. And thank you for your work as Vice President of
Policy at PHI. I need to wear my glasses when I read.
I now recognize Mr. Torres--Ms. Torres.
STATEMENT OF ZULMA TORRES, HOME HEALTH AID, COOPERATIVE HOME
CARE ASSOCIATES
Ms. Torres. Good morning. Thank you to the Members of the
Committee for inviting me to speak today.
My name is Zulma Torres. I am a wife, a mother, and a
grandmother. I have worked at Cooperative Home Care Associates
as a home health aide for over 23 years. I am also a proud
Member of the 1199 SEIU Labor Union.
I am very honored to have the opportunity to bring my voice
to support your efforts to make our jobs better and help our
union. My company employers and training providers provide
better programs and services. My training to become a personal
care aide and home health aide was intense. Attendance,
punctuality were very important. And if you were late or missed
a day, you had to make up the work you missed. We learned and
practiced demonstrating the required skills.
Cooperative wanted to make sure new recruits were serious
about the work. At first, the job was challenging. I went into
strangers' home introducing myself, and then providing some of
the most intimate care and assistance possible. I learned early
on that I had to understand my clients' situation and put
myself in their shoes. I had to separate my personal feelings
from my personal responsibilities.
My employer, Cooperative, is one of the best, both because
it is a union employer, and is a worker owner. Cooperative
supports us, and we have the opportunity to purchase a share of
the company. We have financial literacy classes and peer
mentoring to help with difficult work assignments. There are
also opportunities to become promoted into office-based jobs.
Also, I am grateful to be part of the 1199 SEIU Union with
60,000 home care workers. In 2018, the union fought to increase
our wages to $15 an hour. Now that minimum wage is in New York
City.
We have health insurance, dental, a Member assistance
program, and a home care pension benefit. We also have
education benefits that cover everything from citizenship
program, to register apprenticeships, to college tuition
vouchers.
Now, the union is fighting for higher wages and to keep our
great benefits. We should be salary workers with guaranteed
hours. Home care worker is not minimum wage work. The union
gives me a voice, advocates for us, and allows us opportunities
like this to testify in front of Congress.
Today, I am happy to say that I am a home care worker, and
we need more people to come--to go into the role so that they
can live with dignity in their community and be able to stay in
their home instead of high-cost emergency room visits and
hospitalizations or be moved into an institution.
We need to make home care jobs good union careers with
opportunities for care--for careers, advancement of higher
wages. The quality of the job must improve with excellent
recruitment, training, scheduling, and a good supervision
worker opportunity, so they stay in the field.
This is why President Joe Biden committed to investing in
home and community care jobs and providing workers with better
opportunities to join unions as part of the Build Back Better
Plan. It is so exciting.
Finally, I am happy that home care and community care
workers are being treated as essential workers that we are.
Thank you.
[The prepared statement of Ms. Torres follows:]
Prepared Statement of Zulma Torres
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you, Ms. Torres, very much.
Thanks for being here.
We will now go to Mr. Burani.
Mr. Burani, you are on for five minutes.
STATEMENT OF PAUL BURANI, HEAD OF BUSINESS DEVELOPMENT, NORTH
AMERICA UDACITY, INC.
Mr. Burani. Thank you.
Good morning, Chairwoman Wilson, Chairman DeSaulnier,
Ranking Member Murphy, Ranking Member Allen, and Members of the
subcommittees. Thank you for the opportunity to appear before
the subcommittees to discuss workforce development in the
United States.
I serve as head of business development for public-sector
partnerships at Udacity, an online education platform committed
to preparing the Nation's workforce for the careers of the
future.
In today's world, technology is advancing at an accelerated
pace. Corporations have invested about $2 trillion in digital
transformation to avoid getting left behind. Leveraging these
technologies requires them to adapt, but executives
consistently rank the shortage of skilled talent as their No. 1
risk factor. But they are not the only ones with something to
lose.
A recent McKinsey Report had estimated that automation will
displace up to 800 million jobs by the year 2030. Many of these
jobs will be in the U.S. If we don't plan appropriately, that
skill gap will widen, causing irreparable damage to our
economy.
At Udacity, closing this skill gap is what we do. We design
our curriculum with tech industry partners like Google, Amazon,
Microsoft, and IBM. We deliver it through our Nanodegree
programs, which provide instruction for employable technical
job skills in fields like programming, data science,
cybersecurity, and artificial intelligence.
These programs include both coursework taught by the
experts and hands-on projects for students to demonstrate
competency as practitioners in their field.
Udacity has educated over 15 million learners worldwide. We
work with over 110 corporate clients, companies like Shell,
Credit Suisse, Airbus, Mazda, and the U.S. Air Force. They
trust us to help their employees acquire the skills needed to
accelerate their company's digital transformation.
And, in the public sector, we upskill government employees,
we build partnerships for social impact, and we run ambitious
workforce development initiatives.
The reauthorization of the Workforce Innovation and
Opportunity Act, or WIOA, presents a world of possibility. Our
workforce system has successfully trained millions, but it
needs to be modernized. Employers still face challenges hiring
and retaining skilled talent, and millions of unemployed and
underemployed Americans deserve a chance to land in a
motivating career with growth potential.
To unlock this possibility, we can start with proposed
structural changes. WIOA maintains a vast array of data about
education providers, their programs, and performance. But these
systems use outdated mechanisms, and are siloed by State,
creating administrative burdens. Funding is mainly allocated
locally to distinct workforce areas, raising barriers between
employers and citizens across geographies, including those
aligned to remote work.
Let's envision a WIOA system in which funding, governance,
and operations are all executed at a more aggregated level, and
support that with incentives for neighboring workforce areas to
collaborate. Providers could better tailor their solutions to
fit market needs. The system would enjoy better budget
utilization, helping it educate more citizens, and job seekers
would benefit from more diverse choices in the marketplace.
Next, we will look at channel investment. Among the diverse
WIOA stakeholders, consider community colleges, for example.
They have a history of thriving in the U.S. workforce system
with strong employer connections, but they also have gaps in
their curriculum, which could be addressed through partnerships
with other providers.
Another example is the relationship between workforce
boards and the public. They sponsor programs that need to
inspire citizens to summon all their motivation and commit to
self-improvement. It is a pretty tall order.
A more modern WIOA would increase its focus on marketing
and operations to help the public better understand the role of
the workforce system, and the opportunity it can deliver. This
would improve the utilization of WIOA funds, speed up the
delivery of solutions, and create a better fit between
citizens' needs and the programs they pursue, leading to better
performance outcomes overall.
Finally, a word about labor market innovation. The pace of
technological change has created ripple effects that impact
many facets of modern life. Consider the word ``ransomware,''
which has permeated our daily news cycle. In 2014, the first
year of WIOA, it was barely a part of the public lexicon, but
this world is changing faster than ever before.
Investing in pathways to high-growth occupations helps to
ensure that as trends like ransomware evolve, our solutions to
combat them evolve even faster. This fast-paced evolution also
causes collateral damage in our communities. Some learners
might just worry about graduating, but others have a host of
curve balls to worry about. Maybe they lack healthcare, or they
can't find a babysitter. Maybe they study from the one corner
of the house that gets a free Wi-Fi signal.
The WIOA of today incentivizes important outcomes, but many
people in distressed communities are structurally disadvantaged
from achieving those outcomes and get turned away. The WIOA of
tomorrow should level the playing field for them, too.
We are here today because we know what the U.S. workforce
system is capable of achieving. A more modern dynamic WIOA
could help to fulfill that potential.
Thank you for listening and for joining the cause.
[The prepared statement of Mr. Burani follows:]
Prepared Statement of Paul Burani
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you so much for your time.
Thanks for your timeliness.
And that will bring us to our final witness. We will now
hear from Representative Fay.
Representative Fay, the floor is yours.
STATEMENT OF HON. JESSICA FAY, STATE REPRESENTATIVE, MAINE
HOUSE OF REPRESENTATIVES
Ms. Fay. Thank you.
Good morning, Subcommittee Chairs DeSaulnier and Wilson,
Ranking Members Allen and Murphy, and Members of the
subcommittees.
I am Maine State Representative Jessica Fay, and I
represent House District 66 in the Maine Legislature. Thank you
for inviting me here today.
In 2019, I served as the house Chair of Maine's commission
to study long-term care workforce issues, and I am pleased to
be able to share some of our findings.
Because Maine is the oldest State in the country, we are
seeing the crisis build, and be exacerbated by the COVID-19
pandemic. I came at this issue with an open mind as a
legislator, but also as a consumer and a family caregiver.
Statistically, most of us will need some form of assistance
with activities of daily living during our lifetimes. In a pre-
pandemic visit to a local high school vocational program, the
director gave me a tour. The classrooms for coding, carpentry,
and automotive were busy and full. When it came to healthcare,
there were only a few students, notably all female, in the
class.
As we walked away, I asked about participation in their CNA
program, and learned that it was declining. I asked why, and
his answer really disturbed me. He said, kids are smart and
don't want to go into dead-end jobs. They understand the
earning potential of various professions and choose their paths
based on that.
If the public perception is that caring for older adults
and people with disabilities is dead-end work, then an
important part of the solution is to change that perception. We
must address not only the workforce challenges, but also ageism
and ableism that leads to the devaluation of the care necessary
for older people and people with disabilities to live their
best, most independent lives.
When we have an undervalued workforce caring for an
undervalued population, we have a system that doesn't work for
anyone. Increasing the pay for essential caregivers is a
necessary component of attracting and retaining a diverse set
of people to do this economically foundational work. It is a
necessary piece of this solution, but not sufficient on its own
to solve the crisis we face.
Another barrier is that this workforce is seldom included
in conversations about economic development. In the quest for
high-paying jobs, the foundational jobs are often left out of
the conversation. It is important that when designing programs
for economic development, we include caregiving jobs as a
career choice.
During the pandemic, the lack of childcare had a
significant impact on local economies as people left the
workforce to care for their children. This is also true
concerning care for older family Members and people with
disabilities.
Professionalizing the workforce by offering ongoing paid
professional development, supportive supervision, and
opportunities for advancement in terms of both responsibility
and compensation were all recommendations of the commission I
Chaired. This will enhance the efficacy of programs designed to
attract and retain direct care workers. Making sure personal
care workers are considered part of the care plan and care team
will aid in elevating the status of the work that they do.
With some guidance, educational facilities could develop
and target education and certification programs for direct care
workers. Apprenticeships, earn as you learn, and pre-
apprenticeship programs are all ways to enhance the workforce.
Creating a path to professional growth through career ladders
will also be a critical piece of the puzzle.
Funding is a significant barrier to implementing the
Committee's recommendations. MaineCare, known as--what Medicaid
is known as in Maine--MaineCare providers are barely scraping
by and even closing. They don't have money to train or do
professional development with their workforce, let alone offer
career advancement opportunities. Access to funding for
training and retention and developing methods to increase the
workforce as proposed in the Direct CARE Opportunity Act will
certainly increase our ability to care for Mainers who need it.
In Maine, there are over 2,000 older Mainers and even more
Mainers with disabilities who cannot access services they
qualify for. There are empty beds in nursing homes and assisted
living facilities due to staffing shortages, and people are
spending longer time than necessary in hospitals because there
is nowhere to discharge them to.
Maine is a small State with a population of 1.3 million
people. We are older and more rural than any other State in the
lower 48. We have significant work to do to address this crisis
and to elevate and value the work that so many find so
rewarding, yet difficult to make ends meet doing. We need to
use many different strategies to make a change, and I am
grateful to the Members here today for recognizing there is a
crisis and who are working to craft solutions that will allow
caregivers and those they care for to live their best lives.
Thank you.
[The prepared statement of Ms. Fay follows:]
Prepared Statement of Jessica Fay
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you, Representative. Thank you
for your testimony and your work and your commitment in this
field.
Under Committee Rule 9(a), we will now question witnesses
under the five-minute rule.
As this is a joint Subcommittee hearing, after the Chairs
and Ranking Members, I will be recognizing Subcommittee Members
based on seniority order of the full Committee.
I will be followed, after my questions, by Ranking Member
Allen, and then Chair Wilson, and then Ranking Member Murphy.
So let me begin.
Again, Representative Fay and all the witnesses, thank you
so much for your testimony. For a lot of us, we have
experienced this with our parents and friends and neighbors and
loved ones. My mom passed away a couple years ago at the ripe
old age of 94, and my siblings and I were all very engaged in
taking care of her. And it was a struggle. And her last 5
years, when she was in a nursing home after she lost her
independence in San Francisco, I had multiple conversations
with the staff there and with the employers of the difficulty
of trying to provide services in that setting in a high-cost
area like San Francisco.
But, equally, as someone who was involved in our public
authority in the county that I represent and represented as a
county supervisor many years ago, the challenges to provide for
this care is really daunting.
So thank you all, and thank you, Representative Fay.
I want to ask you a question, Representative Fay. With the
Olmstead decision and the ADA, our understanding of the
position of people with disabilities in America has changed,
and our social context has changed. The social model has
changed dramatically from when I was young. We live farther
apart from each other. Families are not always able to provide
care and support.
Can you talk about the importance of strengthening the
direct care workforce and meeting the goals of the ADA and
meeting the needs of people with disabilities and the aged,
particularly in the context of this changing environment, where
young people and family Members have economic pressures of
their own to travel further and further to get employed, and
they have to move employment frequently?
So, the social model having changed, it seems to me that we
are slowly trying to adapt to this new social model that
doesn't have families as closely located where traditionally
they would provide many of these support systems.
Ms. Fay. Thank you, Mr. Chair, for the question.
The--the goal of the ADA is to allow people with
disabilities to live as part of our communities, with barriers
to that participation removed, and I think, if you require
assistance in order to do that, and then there is no one there
to provide that assistance, whether it is personal care,
transportation, or other activities of daily living, then you
are really unable to fully participate.
And so a direct care workforce shortage really is in
opposition to the goals of the ADA.
Chairman DeSaulnier. Thanks.
I want to ask you. As somebody who served in local
government and in the State legislature, now at the Federal
level, this difficulty of our roles and the genius of our
Founders in having local control, but also having a United
States, and coming from a large State, the largest State,
challenges, and from a large county in an urban area, as one of
the Ranking Members mentioned--Mr. Allen, I believe--the
importance of making it fit for the local community, what do
you think is the appropriate role, again, in this very
demanding, changing social model--the right role for the
Federal Government to play in this regard, so that we can have
a really effective conversation with our partners at the State
and local level?
Ms. Fay. I think that is a really good question, and I
think the word ``partnership'' is really important. Maine is a
State that values our local control a great deal.
I will say that one of the significant barriers for--for us
implementing any of the direct care workforce reforms that my
commission recommended was funding. And I think, you know,
allowing programs or funding programs--pilot programs that
would--would allow us to do some evidence-based work on what is
successful could be really, really helpful. But I think the
term ``partnership'' is a really key word.
Chairman DeSaulnier. Thank you for that.
And I would say one of the challenges with--I agree with
you, the part that pilot programs, but at a certain point, you
have to bring them to scale, and I always found that was one of
the biggest challenges. We were behind that. Great ideas, but
actually deploying it and having it be client-based strikes me
as a real struggle. And, of course, those goes to some of the
comments we have had earlier.
With that, it is my pleasure to recognize the Ranking
Member of the Health Subcommittee, Mr. Allen, for your five
minutes of questions.
Mr. Allen. Thank you, Mr. Chairman.
Can you hear me OK? I think I am unmuted. Good.
Chairman DeSaulnier. Nope, you are on.
Mr. Allen. OK. Great. Super.
Well, listen, thank each of the witnesses for your
testimony. I have firsthand experience with this in dealing
with my mom and dad and my wife's mom and dad. And it is
difficult, and--but I do believe that it is important that it
not be a top-down approach, that it be a bottom-up approach.
And that is why I want to work with the States and all of
our local communities to solve this problem, which is going to
grow, as our Chairman reported. It is going to be--as our
population ages, it is going to be more and more significant to
our responsibility to take care of folks--and I am getting
there--in our golden ages.
But, Mr. Burani, the COVID-19 pandemic revolutionized the
doctor-patient relationship by accelerating the use of
telemedicine and further integrating technology into treatment
models. However, the modernization of this part of the
healthcare industry could, unfortunately, leave some healthcare
workers behind.
What are you and other similar education providers doing to
make sure that healthcare workers have the tools and skills
they need to adapt to technology and thrive during this period
of rapid modernization?
Mr. Burani. Thank you for the question, Congressman Allen.
I think that we need to appreciate, it is a relatively low-
tech problem that we are solving for. We all, as individuals,
can relate to the inconvenience of sitting in a waiting room,
you know, waiting some unexpected amount of time for treatment.
We know how hard it is to fit an appointment into a busy
workday, or to juggle that with other constraints.
And I think that, to some degree, we have to appreciate
that, due to the COVID-19 pandemic, as with many technologies
that were adopted to adapt to this change, the genie is out of
the bottle. And, as a result, the conveniences, the benefits of
telemedicine have now become--let's call it mainstream.
As a result, I think what is important is to appreciate the
benefits of it, the ability to lower costs, to reach more
patients, and, in the process, make life less burdensome for
practitioners and patients alike.
As--with respect to your question around upscaling
healthcare workers to this rapid modernization, I think it
really comes down to--I believe it was Chairwoman Wilson made
reference to career pathways in her opening statement, and I
think that is an important concept.
To appreciate the fact that these individuals have spent
years, decades even, really entrenched in the system, they
understand care innately and intuitively. And, for those that
have a desire and an appetite to advance in their career,
perhaps using the insights and perspectives from direct care in
order to contribute to the modernization of the industry, we
look at that through the lens of Nanodegree programs that my
company represents at Udacity.
However, I think, more broadly speaking, we all just need
to appreciate that skill development is an industry-agnostic
topic. The skill shortage is affecting all sectors and
represents a massive opportunity, but what comes with it is the
risk of being left behind.
Mr. Allen. Right. Right.
Mr. Burani. And so anything which provides that growth
opportunity, we are in favor, and hope to support.
Mr. Allen. I remember talking to my mom and dad checking in
with them, and I said, what did you do today? And they said, we
spent the day at the doctor's office. So--and that was a
regular occasion.
As far as the ransomware and cyber attacks that have
wreaked havoc on our hospital's healthcare systems, recently a
hospital just outside my district experienced a ransomware
attack. From your experience, what can Congress do to improve
data security, especially when it comes to health data, and how
can we better educate healthcare workers to protect and secure
patient health data?
And we have got about 34 seconds.
Mr. Burani. Big topic for 34 seconds. But what I would say
is, at a high level, we need to think about basic hygiene for
safeguarding data. It comes to having a basic skill set broadly
applied to a workforce that people understand how to lock down
internal systems. But we also need to create governance models
and accountability so that there is, you know, a clear sense of
how this can be done at scale.
Mr. Allen. Great. Thank you, sir.
And, with that, Mr. Chairman, I will yield back.
Chairman DeSaulnier. Thank you, Mr. Allen. You're a fine
son.
I now recognize Chairwoman Wilson for her five minutes of
questions.
Chairwoman Wilson. Thank you so much, Chair DeSaulnier, and
thank you to all of our witnesses for lending your expertise
and time.
Mr. Espinoza, you emphasized career advancement for direct
care workers with 30 percent of funds reserved for career
advancement activities. In your written testimony, you describe
examples of promising career advancement and career pathway
initiatives.
Tell us, what are the challenges to developing career
pathways and advancement opportunities for the direct care
workforce, and how can we develop additional rungs in the
career pathways that offer meaningful increases in pay and
responsibilities and incentivize long-term retention?
Mr. Espinoza. Thank you for the question, Chairwoman.
I think part of the problem is in our failure as a sector
and as a country to understand the value that direct care
workers offer, and to create meaningful career advancement
opportunities for them to contribute more to the care team, and
to optimizing the health of the clients and residents that they
support.
I think, in most settings, the next formally recognized
healthcare title above home health aide and nursing assistant
positions is a licensed practical nurse. And yet, too often,
arriving at that level requires weeks and months--years of
training, I should say, and specifically to get into those
roles and to be able to offer those opportunities. And, yet
there are a number of ways in which we can create advancement
opportunities that State--that keep workers within the direct
care sector.
We also know that a lack of career growth opportunities
contributes to poor job quality. It has been identified really
as a barrier to attracting new workers and to retaining workers
over time. And, so, it's really important that we create these
opportunities with an elevation in title, function, and
compensation.
Some examples within direct care, direct care workers can
advance into peer mentors, where they are supporting fellow
workers and integrating them into these roles; care
coordination, so that workers are communicating changes in
clients' conditions and symptoms to other Members of the
healthcare team; and, also, into internal administrative
positions, such as assistant trainers or clinical coordinators.
One example is that, in 2015, PHI created a Care
Connections senior aide role. Following 240 hours of training
specifically in chronic disease knowledge; communication
skills; enhanced observe, record, and report skills; and care
team participation, home health aides were elevated to salaried
Care Connections senior aide roles.
They made home visits to support the upscaling of hundreds
of entry level home care workers, and they helped improve care
transitions, solve caregiving challenges in the home. And it
led--our evaluation showed that, from the initial 18-month
demonstration project, there was an 8 percent reduction in the
rate of emergency room admission among the 1,400 consumers
impacted, reduced caregiving strain among family Members, and
improved job satisfaction among home care workers.
The challenge for our field is there are not enough of
these career advancement opportunities in this country to
really grow to scale and to meet the growing demand that
consumers and workers need and deserve.
Also, we need more coordination at the Federal level, where
are the gaps within career advancement opportunities and
advanced roles that our government should invest in.
Chairwoman Wilson. Thank you. Thank you so much.
Ms. Torres, you have been in the field a long time, and we
know there is a very high turnover, and few workers stay in the
field as long as you have. How do you think the high rate of
turnover impacts the quality-of-care individuals receiving
long-term care, and how do you think turnover impacts your job
satisfaction? Do you think it makes your job more difficult?
Ms. Torres. I know that a lot of home health aides stopped
working during the COVID, and some clients refused services
because they were afraid of infection. It was and still is
difficult.
For me, I have a great team. All of us who care for our
current clients that have a lot of need to get overnight care.
We work together. It is difficult--it is a difficult job, but
we have to find joy and satisfaction in our work.
Still, many workers, myself included, thinks that we should
be paid more. We make a lot of sacrifices, and our job has been
more difficult since the COVID. We have to put a lot of extra
time and effort to make sure we are safe, and our clients are
safe, and our families are safe.
For me, I care for my patients. I never stop coming to
work.
Chairwoman Wilson. Thank you so much. Thank you.
I yield back.
Chairman DeSaulnier. Thank you, Madam Chair.
We will now recognize the Ranking Member, Mr. Murphy. The
floor is yours.
Mr. Murphy. Thank you, Chairman. I just kind of want to
reiterate a few of the comments that were just made, because I
have dealt, as I have said before, just as a physician, with
direct care workers for over 30 years. And I truly, truly
understand the dedication and devotion and difficulty that
these individuals have in their workforce.
We are going to be faced now with a growing, aging
population. Also, a lot more families are scattered, where
eastern North Carolina, where I live, there are a lot more
families that are staying close, and so their family Members
can take care of other individuals. But, in other areas of the
country, that is just not the case.
And, so, the increase in need for our direct care workers
is going to increase exponentially. Actually, now, as I
understand, it is the second largest occupational group in
United States after retail sales, and we are going to have a
problem in the future, really, if we don't connect--if we don't
fix this problem.
Obviously, we talked about turnover. Turnover can be 50
percent in a year, or 80 or 90 percent in 2 years. So there is
a massive turnover. I have really seen, however, firsthand, how
dedicated individuals can truly, truly help those at home. They
decrease emergency department visits. They save money. But
then, on the other hand, sometimes the quality is not that
great, and it actually affects poorly for patient care. So I
just really appreciate the problem that we are facing.
Mr. Burani, let me just ask you a question. As you noted in
your testimony, only seven of 10 learners programs actually
graduate from the WIOA program. While this completion rate
exceeds that of a lot of post-secondary institutions, it is
Congress' job--and this is what our job is, to ensure that
taxpayer dollars are spent efficiently and effectively.
In your testimony, you mentioned that a learner's incentive
to persevere through a challenging program can be diluted when
their own money is not invested. Do you have any suggestions
about how we can reform the system to essentially give folks
skin in the game, to allow individual buy-in that would also
not exclude low-income individuals from participating?
Mr. Burani. Thank you for the question, Congressman Murphy.
So, I think it is an important discussion, right, because
seven out of 10 is a standard for the U.S. workforce system,
and it is a classic case of glass half full, glass half empty.
We certainly like to see that a majority of these enrolled
students are making it through, but it does beg the question:
What's holding back the other three out of 10?
I think that one thing that is important is to look at the
training providers themselves, and understand what are the
interventions and support and wraparound services that they are
providing in order to sort of optimize those rates? It's not
enough just to open a textbook and study. That didn't get
anyone through college. And, nowadays, it is not enough to
click on a video and watch it.
We need to participate, and we need to get our hands on the
learning. Project work that creates practitioner-level skills
is, you know, one of our sort of mantras at Udacity.
The other way to look at this is let's take a page from the
book of traditional higher ed. Financial aid has very clear
channels of engagement. We have merit-based financial aid. We
have need-based financial aid. This really is a model that we
could look at for short-term or nontraditional credentials.
And I do think that a combination of all of these factors
would help to maximize those outcomes and get more value out of
these tax dollars.
Mr. Murphy. Thank you for the response. We do have a
challenging problem in front of us. As I said, as we age a
Nation, as we grow as a population, we are going to need more
of these individuals. And the turnover rate that we have noted
is just not acceptable, because it leads to a deficiency in
care for these individuals.
And, when they are being taken care of, a family Member who
is far away from, you know, children, et cetera, you want to
leave them in good hands.
So thank you for your comments, panel Members. I am going
to actually yield back.
Thank you, Mr. Chairman.
Chairman DeSaulnier. Thank you, Dr. Murphy, appreciate all
those comments.
And now we will go to the distinguished gentleman from
Connecticut, Mr. Courtney. And after Mr. Courtney, Mr. Walberg
is next in the queue.
Mr. Courtney, the floor is yours for five minutes.
Mr. Courtney. Thank you, Mr. Chairman.
And thank you to the witnesses to talk about, obviously, an
issue which is even bigger than COVID with the aging of our
population, but certainly COVID I think put the spotlight on
why the direct care workforce, you know, is so essential for
the country.
You know, as we sort of talk about strategies to, you know,
enhance and strengthen that workforce, I think it is important
for a moment at least to look at the American Rescue Plan,
which was signed into law on March 11th by President Biden.
One of the key components of it was to boost the Federal
match in the Medicaid program, FMAP, by 10 percent for home-and
community-based services.
Again, it sort of tracks somewhat the CARES Act, which,
again, was a very bipartisan bill where Republicans and
Democrats supported increasing FMAP, but, again, it was for a
temporary period of time that was for the whole Medicaid
program. Again, what we did in the Rescue Plan was surgically
target that increase to home-and community-based services.
The State of Connecticut just released their plan a few
days ago in terms of how they propose to use the allotment we
will enjoy as a result of the Rescue Plan. And it will come as
no great surprise that most of it is going to go into provider
rates. It also targeted increases in terms of wages. It is not
a short-term clip. They have actually come up with a way to
sort of extend that out to 2025.
But clearly, you know, Representative Fay, you know,
talking about her experience, you know, with, you know, the
pecking order of direct care employment for job training is
sort of dead end.
I mean, if we are going to have a strong demand signal for
people who are contemplating going into this, we need to push
out the American Rescue Plan match to make sure that that
financial base is going to be there.
Again, I Chaired the Medicaid Committee back in the day
when I was in the Connecticut legislature and I know, you know,
how that is now the biggest line item in Connecticut's and most
State governments.
Representative Fay, what would it mean to have, again, a
targeted boost for FMAP for Maine, as was contemplated in the
families plan bill from the President to really provide, again,
the financial underpinning so that we can, you know, implement
some of these changes?
Ms. Fay. Thank you, Congressman Courtney. I think it would
be a wonderful opportunity. One of the biggest barriers that we
identified as a commission were reimbursement rates.
So our main care reimbursement rates for the work being
done by essential caregivers was in some cases less than
minimum wage. And one of the things that the 10 percent FMAP
bump has allowed is--and our plan hasn't been completely
released yet, so I am not 100 percent sure of what's going to
be in it, but I do know that there will be some one-time
bonuses for people who have been working to be able to continue
to pay them a higher wage and to reimburse providers at a
higher rate and a rate that allows them to compete with other
sectors.
You know, hospitality and retail would be huge, because
right now we are just not reimbursing them as if we value the
work that's being done.
Mr. Courtney. Well, thank you. And, again, you know, at
some point, you know, to try and tell a young person, you know,
you should go into a training program for, you know, home
healthcare or institutional healthcare but, you know, the
financing system is just going to lapse back to its prior sort
of State is just not, you know, going to really get people's
blood excited.
You know, the other just point is, you know, we passed H.R.
447, which was the National Apprenticeship Act, earlier this
year, which would was size up the Fitzgerald Act apprenticeship
program to get into healthcare as a way of getting not just
pre-apprenticeship training, as is contemplated by WIOA, but
also full apprenticeship training, so people really have that
he were earn-as-you-learn ladder to acquire more skills.
I mean, would that model work, again, based on your
experience, Representative Fay?
Ms. Fay. I do think so. I think one of the things that
would be helpful to providers is to allow their employees to
work. And if you can earn while you are working, I think that
would be a wonderful thing.
Mr. Courtney. Thank you.
Thank you, Mr. Chairman. I yield back.
Chairman DeSaulnier. Thank you, Mr. Courtney. Thanks for
being so punctual and thank you for not bringing up the Red Sox
during your testimony, questions.
We will now go to Mr. Walberg, who will be followed by
Representative Bonamici. Tim.
Mr. Walberg. Thank you, Mr. Chair.
This is an important topic, of course, and I appreciate the
panel being here. And we could go all sorts of directions but
let me go to Mr. Burani.
One of the things I hear from employers across my district
is that today's college graduates don't always have the skills
needed by employers for in-demand jobs. In your testimony, you
note that community colleges maintain strong employer
relationships, which keeps them firmly rooted in the WIOA
system. And you indicate that WIOA funds could be enhanced by
allowing community colleges to reach out to nontraditional
educational institutions to fill curriculum gaps.
Could you elaborate a little more on what you mean with
this recommendation?
Mr. Burani. Sure. Thank you, Congressman, for the question.
I think it is an important topic because, as we know, in a
diverse marketplace there are always going to be point players,
and it's certainly not a case where you have one-size-fits-all
solutions.
So starting with community colleges, their strengths are
hyper-local relevance, right? They have been pillars of that
community that they serve, which means strong relationships
with the employers, endemically very well-entrenched in the
WIOA system. But they suffer what a lot of institutions of
higher learning suffer, which is the natural cycle of
generating the learning content that is timely for the
environment in which students are learning it.
So we use the example of cybersecurity, which came up
earlier in this hearing. This is literally changing every day.
Every attack, every response is an evolution and a pretty
radical one in some cases. And so the need to be able to time
the delivery to market as quickly as possible becomes
important. Who better than a specialist provider of that
learning content to partner with said community college to be
able to allow both entities to play to their strengths.
Hopefully, that helps shed light on my earlier testimony.
Mr. Walberg. Yes, I think that is important to understand,
that we have capabilities. And if we promote flexibility in our
educational system, that meets the needs of the real world as
opposed to turfs. That could be a significant help to us.
You note in your testimony that Udacity works with over 200
industry experts, including companies such as IBM and Amazon.
Can you describe the value of partnering with employers when
developing course curriculums?
Mr. Burani. There are a range of reasons why this is
important from a partnership point of view. I will speak to two
of them. The first one I touched on a moment ago, and it comes
down to the refresh cycle. Technology is changing so fast that
in order for this information to be timely, it needs to be--we
need to minimize middlemen, so to speak.
It is the same reason that Encyclopedia Britannicas are
disappearing from shelves around the homes nationwide, because
the format and the vehicle for information dissemination has
now become a barrier. And so having direct access to the
engineers, the creators of those technologies, allows us to
deliver that faster to market.
The second is, really, it comes down to credibility. We at
Udacity don't consider ourselves to be the voice of cloud
computing or artificial intelligence or machine learning. There
are plenty of technology companies out there who have earned
their place as the authorities on that.
What we do is we structure effective programs. We invest in
pedagogy and research to scope and run these programs. And,
therefore, by bringing in a technology partner, it adds
credibility and creates a greater impact.
Mr. Walberg. Makes all good sense. Again, turf is a key
issue, but inflexibility with creativity.
Finally, Mr. Burani, as the economy recovers from the
COVID-19 pandemic, it is critical that we assist the
unemployed, underemployed, and dislocated workers succeed in
transitioning to in-demand full-time employment. How can
Udacity, through its partnerships with industry and workforce
boards, help this effort?
Mr. Burani. Really, it is a complex answer, because there
are so many resources at our disposal. But just for the sake of
simplicity, what I will say is that we aspire to make use of
the infrastructure that is laid out in front of us. We look to
provide job-ready skills so that there is something of value
that these individuals carry with them out of their credential,
and we measure as much as possible to make sure that we
optimize our programs for maximum lifelong impact.
Mr. Walberg. Thank you, I appreciate it.
And, Mr. Chairman, I yield back.
Chairman DeSaulnier. Thank you, Mr. Walberg.
We will now recognize the distinguished Member from Oregon,
Ms. Bonamici.
Ms. Bonamici. Thank you so much to the Chairs and Ranking
Members, but truly thank you to the witnesses for being here
today to discuss this important issue.
Throughout the pandemic, I have spoken with direct care
workers who put their lives at risk caring for our loved ones.
And, unfortunately, despite their heroic efforts, their work is
far too often underpaid and undervalued. We know most home care
workers are paid poverty-level wages. They lack access to
training and support services and do not have access to paid
sick time or other basic benefits.
Forty-four percent of direct care workers live in low-
income households and 42 percent need to rely on some form of
public assistance. These working conditions have a
disproportionate effect on more than 86 percent of direct care
workers who are women, nearly two-thirds of whom are women of
color.
In Oregon, my home State, home care workers and personal
support workers gained the right to form a union back in 2000,
and through successful organizing and collective bargaining
workers have raised their base pay. They worked with the State
to provide a new model of healthcare for home care workers that
provides premium assistance, out-of-pocket expense assistance,
as well as dental, vision, and employee assistance benefits for
eligible workers.
SEIU 503 also recently launched an innovative program to
provide workforce training opportunities for direct care
workers. Their Care Works Program is the first registered
apprenticeship program for certified nursing assistants in the
State, and it focuses on mentorship and support services to
strengthen retention in the workforce, which is so critical.
But fair wages and benefits should be available to direct care
workers, not just in Oregon but across the country.
Ms. Torres, you in your testimony noted the barriers you
face accessing quality training when you started your career as
a home health aide. So was the training sufficient to provide
you the skills you needed to succeed, and how would access to
supportive services like childcare and transportation, how
would that have changed your experience?
Ms. Torres. Can you repeat the question?
Ms. Bonamici. Yes. Ms. Torres, you noted the barriers that
you faced accessing quality training when you started your
career, and how would access to supportive services like
childcare and transportation change the experience, how would
that have changed the experience for you?
I could rephrase it and say, would supportive services like
childcare and transportation be important to people who are
learning and training how to be a home healthcare worker?
Chairman DeSaulnier. I don't think she is--there we go.
Ms. Torres. Sorry, I don't have the answer, but I will give
you my point of view.
Ms. Bonamici. OK.
Ms. Torres. Yes. We had a really great--I had a great
support team from Cooperative Home Care. Our training was
intense. They were excellent. They made sure that we knew what
we were doing. If we missed out on anything then we would have
to make up the time, because they wanted us to go out there
knowing exactly what we were doing.
And at lot of companies, we get a forward training, and it
is intense. We take two tests. And it is awesome, because we go
out there prepared, even though we become a little afraid when
we are in the field, because we don't know where we are going,
and it could become a little bit stressful. But once we get
there, we access to the client and we make it comfortable and
clear, not cluttered for them so they won't fall, and we get to
know one another, and we build from there.
Ms. Bonamici. That is wonderful. Thank you so much. I
really appreciate your being here today to share your story.
And I want to get a question for Mr. Espinoza. I often
speak with direct care workers in Oregon about the challenges
with career development and with employers about retention.
So how could States better leverage local resources and
partnerships with community colleges and other programs to
improve the workforce development pipeline for direct care
workers, and how can this Committee better incentivize the
development of career pathways and support services to
encourage workers to stay in these very important jobs?
Mr. Espinoza . Thank you for your question, Congresswoman.
Creating a strong pipeline and addressing retention and
reducing turnover I think are some of the goals that the
interventions of the Direct CARE Opportunity Act would
specifically address. I mean, we know that oftentimes providers
name caregiver shortages and caregiver turnover as the top
threats. And the cost is expensive. It is $2,200. It impacts
quality of care, and it impacts workers.
We have seen across the country a variety of interventions
that have improved retention, and this act would specifically
support those kinds of programs and help us build the evidence
base.
Ms. Bonamici. Thank you, Mr. Espinoza.
And I know my time is about to expire, but just on a
personal level, I spent a couple of years taking care of my mom
in the last years of her life in various levels of assisted
living and skilled nursing facilities. And the turnover is a
serious, serious issue. It affects the quality of care, it
affects the continuity of care, and it is expensive for the
employer.
So we need to do all we can to improve these positions so
that people stay in them, and they really are valued for, and
paid and valued for the very, very important work these direct
caregivers provide.
And I yield back the balance of my time. Thank you.
Chairman DeSaulnier. Thank you, Ms. Bonamici.
And we will now go on to Mr. Grothman for five minutes.
Mr. Grothman. OK. Thank you. Can you hear me?
Chairman DeSaulnier. Yes.
Mr. Grothman. Mr. Burani, I have a couple of general
questions for you. First of all, I know a lot of the problem or
at least when I talk to my local providers, they feel a lot of
the problem is caused by people right now staying out, because
of the unemployment.
Is that what you are seeing? Is this a nationwide thing, or
is this just in Wisconsin?
Mr. Burani. So I want to make sure I understand this
question, Congressman. Is the question about the unemployment
safety net creating sort of a different environment, which is
driving decisionmaking?
Mr. Grothman. Well, yes, decisionmaking of potential
employees. I mean, I hear, be I talk to home care, be I talk to
anybody in that field, therapy places, retirement homes, that
sort of thing, they all tell me the same thing, that they are
having a bigger problem finding people in the last year because
of the excessive benefits. Is that so?
Mr. Burani. So I think that this is probably a topic better
addressed by a labor economist. I can tell you that from our
point of view, we have seen pretty steady demand for our
programs. And whether or not the baseline, you know, has the
floor been raised, has the ceiling been raised is probably more
of a macroeconomic discussion.
But what I can say is that, with respect to skill
development and that aspect of the unemployment safety net and
the benefits that are afforded to people that are out of work,
underemployed, low income, et cetera, especially under the
guidelines of WIOA, the COVID-19 pandemic has certainly created
a surge, but we also have seen that there really is a lot of
baseline demand, which probably reflects conditions that
predated the pandemic by a long span.
Mr. Grothman. Do you see people looking for training in
these fields who already spent time in a traditional 4-year
university?
Mr. Burani. Yes, we do. The reality that I believe we are
all facing at this point is that education is not a one and
done milestone. We tend to think of, you know, the span or the
arc of a lifetime, you are born, you graduate, you get married,
you have kids. This is not a pillar of our lifestyle. Lifelong
learning really is the new normal, and we are not in an
environment where a single degree is really appropriate or----
Mr. Grothman. I guess what I am saying, is it apparent to
you when someone with a 4-year degree comes there that they
would have been better off, rather than getting involved in
your field at age 25 or 30, better off being trained for this
sort of job when they were 19 or 20?
Mr. Burani. I would say in some cases, yes, that would be
the case. However, we also need to realize the fact that this
journey of educating oneself also has many twists and turns.
How many people in this meeting knew what they wanted to be
when they grew up at various ages?
I think that what we could say is, in hindsight, in some
cases, it might have been a better investment to go into a
short-term training program, maybe an apprenticeship, and save
the tuition, the opportunity cost of a 4-year degree. But to be
honest, it is a realm of opportunities, and it is a vast
marketplace.
Mr. Grothman. I would think so. I mean, do you see people
going through your programs that have not only a 4-year degree
perhaps but a student debt associated with that degree?
Mr. Burani. Absolutely. In fact, one of the drivers for
entry into one of these programs is that a lot of the
alternatives involve taking on more debt. And I believe that is
the individual calculus of any person who decides to join our
program. They think about that.
Mr. Grothman. So if they were in your program, first of
all, if you repeat again, how quickly do you go through your
program?
Mr. Burani. Four months.
Mr. Grothman. OK. So you could be a 19-year-old who already
went through your program and is helping out in this vital area
of the American economy, you could be doing that without debt
as opposed to even graduating from a 4-year, having substantial
debt, and then entering your program?
Mr. Burani. That is absolutely right. And I think the
environment that they are stepping into with this credential
has become more and more inviting for those sorts of
nontraditional educational pathways.
Mr. Grothman. I think certainly we do, on a Federal level,
have programs that encourage people to take that 4-year degree
and not use the 4-year degree. Do you think you find that
accurate from the people you are dealing with?
Mr. Burani. I think that there are a range of outcomes, and
I think that in some cases that could be the case, but it's
become a lot more complex.
Mr. Grothman. OK. Thank you very much.
Chairman DeSaulnier. Thank you, Mr. Grothman.
The Chair will now recognize the distinguished gentleman
from California, Mr. Takano.
Mr. Takano. Thank you, Mr. Chairman.
I want to first begin my question with Ms. Torres. Ms.
Torres, could you please describe the work you do on a daily
basis as a home health aide. Just describe a typical day, the
daily work that you do.
Is Ms. Torres still here? Ms. Torres?
Ms. Torres. Yes.
Mr. Takano. There you are. Just tell us what your day is
like, just the daily tasks, the work you do. Like when you get
to a, you know, particular client's home, I mean, just can you
tell me what that is like.
Ms. Torres. I do overnights. I make sure I remind them of
their medication. I assist with meals. I provide companionship.
I really love my job. It is very rewarding. It is not only the
necessary tasks. I do the necessary tasks that my clients will
need to make them happy, to assist them, to see a smile on
their face, to know that I am there for a reason and it is to
help them. And they appreciate it, especially those that don't
have family. So my nights of work is companionship, making sure
that my patients are OK, reminding them, making sure they have
eaten their breakfast, giving them a sponge bath, grocery
shopping for them, if necessary, and making sure they are safe.
Thank you.
Mr. Takano. Ms. Torres, I mean, how much physical--I mean,
are some of your tasks physically, you know, exerting? Do you
have to exert yourself physically? I mean, is it physically
challenging at times to be able to----
Ms. Torres. Yes.
Mr. Takano. It is.
Ms. Torres. It is.
Mr. Takano. I mean, maybe helping lift people or you have
to move people around, that can require quite a bit of physical
exertion. So it is physically demanding work is what I am
trying to say.
Ms. Torres. Yes, it is. I use a Hoyer lift. I have to use
my body mechanics to strengthen my body, and I have a lot of
contact. It is very difficult.
Mr. Takano. How long are your days, typically? How long
does your day go?
Ms. Torres. Well, I do 12-hour shifts.
Mr. Takano. Twelve-hour shifts?
Ms. Torres. Yes.
Mr. Takano. Twelve-hour shifts. And so you will work maybe
4 days out of the week?
Ms. Torres. Yes. I work from 8 p.m. to 8 a.m. in the
morning. I do 12 hours.
Mr. Takano. And do you have to go--is it just one client
that you work with, or do you have a number of clients, you go
different places?
Ms. Torres. Right now, yes, I have one. But as a home
health aide I will say my hours vary as needed.
Mr. Takano. Now, tell me, I wanted to ask what was it like
during the pandemic, you know, and when the pandemic began, how
long did it take before you were provided with proper PPE?
Ms. Torres. They gave us some in the beginning. But we have
a sister union in North Carolina, and they shipped us out a lot
of masks and gloves and gowns and shields for us. So we were
lucky, and we were blessed.
It took some time in the beginning, of course, because we
didn't expect this to happen. And many a times we had to buy
them ourselves until the shipment came in and they were able to
give us more. So now, going forward, we are pretty well on
that.
Mr. Takano. Great. Well, thank you. Thank you, Ms. Torres,
for sharing that with us.
Mr. Burani, I just want to ask a question about the short-
term training program. It is a 4-month program, but would you
describe the pathways, the training pathway as one that is
stackable, stackable credentials? You kind of get the first and
this could lead to a 4-year degree at some point?
Mr. Burani. So yes, it is a stackable credential. We have
Nanodegree Programs that are structured at different skill
levels, and the idea is to create pathways and even to bake in,
you know, some decisions along the way. It is not identical to
a 4-year degree, but there are parallels in terms of the
outcomes and the skills.
Mr. Takano. But it could lead to one?
Mr. Burani. We are not an accredited institution, so we
don't compare our credential to a 4-year institution's
credential.
Mr. Takano. OK. I am over time. Thank you, sir. I yield
back.
Chairman DeSaulnier. Thank you, Mr. Takano.
The Chair now recognizes Representative Miller-Meeks for
five minutes.
Mrs. Miller-Meeks. Thank you so much, Mr. Chair. And I
thank our witnesses. And I think it is an interesting
conversation, because although I am a physician, in my job
prior to Congress I started out volunteering in a mental health
facility, in nursing homes, then became a student nurse and
then a nurse and then a physician. So I have had this spectrum,
if you will, which interesting that Representative Takano would
mention stackable degrees or education that builds upon itself.
And throughout that, I have certainly seen healthcare change
and also, you know, home care.
And one of the concerns I have--and I think Mr. Burani,
this goes to your point--is one of the key problems in our
workforce development system is that we place too much focus on
jobs of the past as opposed to the labor market of the future.
And I think we in government trying to determine what the
jobs of the future are we're woefully inadequate in doing so.
For instance, one of the things the pandemic has shown us, it
is so hard for people to come back into nursing homes after the
events that had happened, especially in places like New York
and New Jersey and Michigan. So that there may be a shift in
the future, even though there was already a shift toward care
at home, it may be more of a push for care at home rather than
in a residential care facility.
And at the same point in time, we are seeing an explosion
of technology. And so we now have technology that can do blood
pressure monitoring at home. I am an ophthalmologist so eye
pressure, glaucoma pressure checking at home. We can do EKGs at
home. You can monitor and use technology to monitor medication
boxes if you set up the medication when a patient has removed a
medication or individual has removed a medication from their
medication box and whether they have taken it or not. At the
University of Iowa, in our Aging Centers looking at determining
falls.
So there is a variety I think of--I won't necessarily call
it artificial intelligence, but it is in some ways artificial
intelligence that is used to help us monitor people without
someone physically being there.
So to that end, Mr. Burani, what role does Udacity play in
preparing people for tomorrow's workforce, which I think is, as
you have indicated, going to integrate AI and other methods of
technology?
Mr. Burani. That is a great question, Congresswoman. Thank
you. So I think it starts with understanding, being able to
contextualize the industry. So you could look at, you know, the
long-term growth of an occupation like a health information
specialist. They are going to add approximate about 30,000 jobs
by 2029, and that is valuable context for the direction of the
industry. Earlier, we heard that it is the fastest growing
industry.
Consider on a shorter-term basis that by 2024 more than one
in three new jobs will be in the healthcare industry. Today,
that is 2.3 million open jobs, and the top occupations are
registered nurse or personal care aide. You are looking for
skills like nursing, CPR, even records management.
But I think what we need to do is look at the occupations
within healthcare. So if you were to take an occupation code
like computer and mathematical, that subset is about 50,000
open jobs, but the median salary is about 50 percent higher. A
third of these jobs don't even require a bachelor's degree.
And so what kind of titles are we talking about: Business
intelligence analyst within healthcare, clinical informatics
specialist. And they want computer science. They want
programming languages likes Sequel or Python. They want, you
know, agile methodology in some of those sort of project
management skill sets.
So whether it is AI or some other technology that is being
applied to the healthcare industry, what we are really trying
to do is just solve analog problems, problems from the
nondigital world, like physician shortage and the burnout
associated with that, all of the data that has been collected
for eons in this industry through a clipboard and a ballpoint
pen.
If we can manage these things at scale, through
telemedicine, through data science and machine learning, we can
get better at removing outliers from our diagnoses. We can get
better at trend spotting, so that if there is another pandemic
around the corner maybe we spot it a bit sooner.
It is very abstract and certainly warrants a longer
conversation, but hopefully that helps to answer your question.
Mrs. Miller-Meeks. I agree it absolutely does warrant a
longer conversation. I would love to talk with you more about
the data acquisition, the amount of data out, how that goes
into population health and public health, but my time has run
out, so perhaps in another conversation we can continue this.
Thank you so much.
And thank you, Madam Chair. I yield back my time.
Chairwoman Wilson of Florida.
[Presiding.] The co-Chair of the Committee had to step away
to another Committee to vote, so I am assuming the gavel.
And I now recognize Chairman Scott.
Mr. Scott. Thank you and thank you for the recognition.
I would like to ask Representative Fay a couple of
questions. Thank you for your service. I served in the State
legislature and I know the sacrifices that are made by State
legislators.
I think you have heard a number of people comment on the
disappointment that people feel when they think a CNA is a
dead-end position because somebody moving up to a CNA was just
the first step in a long tradition, because you can go from CNA
to an LPN to an RN and then to advanced practice, midwife,
nurse anesthetist or even an independent clinical practice, and
you would be amongst some of the best paid professions in the
country. So considering that a dead end was certainly a
disappointment.
But you served on the Committee that studied this issue.
Did you issue a publicly available Committee report?
Ms. Fay. We did. We did. Thank you.
Mr. Scott. We will try to get that, because I am sure you
have got some nice recommendations that we can take advantage
of.
I was also intrigued when you said that sometimes there is
no place to discharge people, because they don't have access to
direct care. Did you make any attempt to quantify this, how
many people were staying in an expensive hospital for the lack
of direct care at home?
Ms. Fay. Thank you, Congressman. We didn't have access to
that data at the time we were doing this. And I think the issue
has really become exacerbated because of COVID, but it has also
really shone a light on concerns.
So what I can do is check with our Department of Health and
Human Services and see if there is any specific data available
on that, and I can submit that in my comments later.
Mr. Scott. Good. Thank you.
I am not sure who this question, maybe Mr. Espinoza: Within
just direct care--we have got different levels of certification
within nursing. Would there be different levels of
certification within direct care?
Mr. Espinoza. Thank you for the question, Chairman. You
know, we would look at the opportunities. There would be
advanced roles that would fulfill different roles, so there
would be peer mentor roles, there would be care coordinator
roles, et cetera. However, the occupations would be within you
know personal care aide, home health aide, and nursing
assistant.
We have seen some States adopt advanced home health aide
occupations that do represent an elevation in title and
compensation and responsibilities. So there are ways in which
policymakers can create these advancement opportunities and
different certifications, for example.
Mr. Scott. And what can be done to make training more
available and consistent?
Mr. Espinoza. It is a great question. I think there are a
variety of approaches. I mean, one is making sure that training
requirements are as strong as possible for all occupations
within direct care. Right now only home health aides and
personal care aides have a Federal training requirement, but
personal care aides do not. And so the State requirements for
personal care aides vary considerably across States.
I mean, certainly we would also argue for the importance of
routing training in core competencies, making sure that
programs are training workers across occupations. The potential
of universal worker roles, for example, that could be funded
through the Direct CARE Opportunity Act would be an opportunity
to think about what are the core competencies and training
approaches that these workers need across occupations so that
they could be more portable across settings and in an ideal
world across States. So those are the kind of opportunities
that this act could support.
Mr. Scott. A direct care worker has, just for logistical
reasons, a limit to the kind of caseload that they can handle.
If they are properly trained and getting more money, how would
they get paid? Medicaid, obviously, could increase pay. Does
insurance, private insurance pay for these services?
Mr. Espinoza. It does, but in most instances the primary
payer for Medicaid--the primary payer for long-term care is
Medicaid. And this is part of the challenge is that too often
what we hear is that providers do not receive a sufficient
level of Medicaid funding or reimbursement rates to deliver the
services that they need to deliver and much less to----
Mr. Scott. Well, we can fix that by just doing it, but you
can't just do it to tell private insurance or self-pay, the
self-pay, you just can't tell them to pay more. Would people be
able to afford the services?
Mr. Espinoza. No. Unfortunately, these services are very
expensive, and most people spend down their assets or income
just to qualify for Medicaid.
Mr. Scott. Thank you, and I yield back.
Chairwoman Wilson. Thank you, Mr. Chair.
And now, Mr. Fulcher, Representative Fulcher.
Mr. Fulcher. Thank you. Thank you, Madam Chairwoman.
A question for Mr. Burani, if I may, please: Mr. Burani, I
personally have the belief that a one-size-fits-all model in
higher education is preventing more individuals from successful
careers. And it seems to me that too often we hear the only
pathway to success is through a bachelor's degree and a
traditional 4-year college path, but companies like yours seem
to prove that notion wrong.
Could you describe for me, first of all, do you agree?
Second, if so, what are the types of learners, what is the
profile of that learner that participates in Udacity's
programs?
Mr. Burani. Thank you, Congressman. I could not agree more.
And I think that that is emblematic of the environment in which
we find ourselves in 2021.
So, to your second question, the types of learners in our
program, I would say there is not a specific type. It is a vast
diverse spectrum of learners. So I'll give you some examples.
We have some fascinating case studies we have been tracking
over the years. A trucker who was sort of dissatisfied with the
direction of his career and decided in his spare time on the
road to start learning how to code and gained access to a
scholarship program to nanodegree in programming from Udacity
and ended up in a front-end web development career and has
completely reinvented himself.
Another example I can give you is very different. So this
earlier gentleman I believe was in his late forties. And we
have got a kid who is no more than 18, 19 years old working two
retail jobs at minimum wage to try and make ends meet and
actually got accepted to a 4-year university, decided not to
take that opportunity, and instead gained access to a
Nanodegree Program through a partnership we had with Google,
landed an internship with NASA, and now is gainfully employed
by GitHub, which is a Microsoft subsidiary.
We work with learners who are incumbents in corporations,
some of those that I mentioned in my opening statement. They
are looking to us to drive big capacity building initiatives.
So these are employees that are just looking for a way to move
up.
But we work with distressed communities, dislocated workers
from the pandemic, partnering with workforce development boards
at a local level in order to find people that maybe don't fit
any particular profile other than they are hungry for change.
So we try to provide them with a platform to take control of
their careers and come out with job-ready skills.
Mr. Fulcher. You also mentioned, Mr. Burani, in your
testimony that the processes for providers to maintain their
catalogs of programs is different in every State. I know that
we have got some differences in my home State of Idaho, which
creates a number of administrative burdens for new providers.
Would you talk to me about that process, the
cumbersomeness, if that's a word, of the process for providers
to be added to an eligible training provider list and what
changes you might recommend to that process.
Mr. Burani. Absolutely. This is an important topic,
Congressman. So when we think about the structural
underpinnings of WIOA, the system needs to know who is
training, what they offer, what their performance is, because
it needs to maintain accountability. So that is important.
However, what we find is that if you choose to engage in
one State versus another, one workforce area versus another,
some things are consistent, and some are not. Some States will
require different types of records. They may ask for financial
records for a private institution. That can get a little
thorny. They may ask for certified documentation from a company
officer.
There is a lot of inconsistency in this sort of structural
blueprint for the system. And I would say a solution, I would
liken it similar to the common application that a lot of people
use to get into higher ed, right? You fill out one application,
it gives you access to a lot of different institutions. Maybe
that is a model we can look at with the reauthorization of
WIOA.
Mr. Fulcher. Just very quickly, because I am just about out
of time, but I am going to shift gears right quick. We have
this tendency in Congress to throw money at things, and
sometimes money is not always the answer.
How do we take a reform and tie the connection better
between the learner and the taxpayer?
Mr. Burani. This goes back to my opening statement. No. 1,
have a more clear-minded, modernized view of what the labor
markets of today need. No. 2 is to create some of the
structural reforms, and No. 3 is to invest in channels and
facilitate the collaboration between entities.
Mr. Fulcher. Thank you, Mr. Burani.
Miss Madam Chair, I yield back.
Chairwoman Wilson. Now Representative McBath.
Representative McBath. Representative Jayapal. Representative
Manning.
Ms. Manning. Thank you, Madam Chair. And thank you for
holding this very important hearing.
Representative Fay, I found your testimony, your written
testimony to be informative and thought-provoking in framing
the ways we need to professionalize and refer to caregivers. I
have also found that so many people lack any real appreciation
of caregivers until they need assistance for their own family
Members. And then it is like an epiphany and suddenly they
realize the importance of having trained professional people in
those positions.
So I wonder if you could tell us how direct care workers
are trained in your State and whether you have any
recommendations regarding the importance of having statewide
programs that are focused on providing training to this
workforce, both in terms of ensuring quality and also the
impact of training on retention and the development of career
ladders for this workforce.
Ms. Fay. Thank you, Congresswoman. That's a big question.
And in a big State that is both geographically large and also,
we have significant rural populations, I think the answer
depends on where you are.
So for--to answer the first part, the training happens
depending on I think where you are, whether you have access to
a vocational program or it's something that you are called to
do, the work is work that you are called to do, or whether you
are working for a provider or need a job. So our private
providers will train personal care attendants. Anecdotally, I
have heard that sometimes the training is short and not
particularly comprehensive, and I think that's part of the
professionalizing of the workforce.
So, you know, I am not trying to give a nonanswer answer,
but it really does depend on where you are and what resources
you have access to and what your motivation is.
Ms. Manning. Thank you.
Mr. Espinoza, one goal of the Direct CARE Opportunity Act
is to spur investment in new recruitment efforts for direct
care workers. And in your written testimony, you describe some
examples of promising recruitment initiatives.
Can you talk a little bit more about the elements of a
successful recruitment program. How can recruitment efforts
bring untapped labor pools into the direct care workforce?
Mr. Espinoza. Thank you for that question. Recruitment is a
major challenge for us in the direct care workforce. Generally,
we think about the various strategies that employers can use to
recruit more workers, from improving the hiring process to
strengthening entry-level training, providing employment
supports, the kind of wraparound supports that Zulma testified
to earlier, promoting peer support so that workers are getting
that attention of other workers and learning about the job from
other workers. Also ensuring effective supervision, developing
advancement opportunities, recognizing and rewarding staff and
measuring progress.
Typically, in a recruitment approach, the approach first
looks at how do you attract and select the candidates that are
best suited for providing quality services and support, and
then they help employers establish the kind of partnerships or
boost the kind of partnerships that will help them reach a
broader pool of candidates. And really, how do you strengthen
an employer's brand.
We have seen a variety of retention recruitment projects
throughout the country that have really focused on bringing
more workers into the sector, from a program in Wisconsin that
brings more nursing assistants by training them and then
connecting them to employers through partnerships in the field
to an intervention in Minnesota where an assisted living
facility in the rural part of the State partnered with a social
media firm to develop paid ads to target key markets and drive
them to apply online through their mobile devices.
So there are a range of recruitment processes that can be
used to bring more workers into this sector and, of course,
strengthen the retention once those workers are--take on these
jobs.
Ms. Manning. Thank you. My time has expired. I yield back.
Chairwoman Wilson. Thank you so much.
And now we have Ranking Member Foxx from North Carolina.
Ms. Foxx. Thank you, Madam Chairwoman.
My comments and questions will be for Mr. Burani. A well-
skilled direct care workforce is critical for serving our most
vulnerable populations but adding more Federal programs is
often duplicative of broader efforts and creates an inflexible
system that does not meet the needs of local employers.
Rather, Congress should work to reform our existing
workforce development system to ensure all workers, including
those in health-related fields, have the skills they need for a
successful career path.
Mr. Burani, programs like WIOA have the potential to be a
flexible and robust workforce pipeline for millions of
Americans. In your view, what are the top three things in
current law preventing this from occurring?
Mr. Burani. Thank you, Congresswoman. That is a compelling
question and narrowing it down to three is my challenge. I
would say there is, in no particular order, one important
priority is creating opportunities for distressed communities
to thrive within this system. So what that means is effectively
looking at the outcomes and the standards to which we hold
these, appreciating that these populations may be structurally
disadvantaged from thriving within the system simply because
the way workforce boards are measured works against them and,
therefore, leaves them cut out of the mix. How to do this is
another conversation, but one that I think is very compelling
and happy to always explore further.
The second is the host of structural reforms that I have
discussed in my opening statement as well as in response to
some of these other questions. And what I would say is that it
goes beyond simply the mechanisms for managing training
providers. We also want transparency into the performance data.
It is hard to just take a pulse on WIOA and understand what is
working and what is not, in which geography, for which learner,
et cetera. And so I would propose expanding structural reforms
to also include more free access to that data.
And then if I had to pick a third and exclude others as a
result, what I would do is I would think about how we can look
at maintaining individual accountability while also broadening
service delivery to a more aggregate level.
American Job Centers, for example, are tasked with liaising
one on one with individuals and really taking a case management
approach to letting people into these programs. As the training
provider in this equation, we have observed countless times
that that becomes the biggest bottleneck. It is not a job that
can be approached with shortcuts. It simply needs to be
modernized in such a way that service delivery can be a
smoother process. Hopefully, that helps answer your question.
Ms. Foxx. That helps a little bit. And I think making the
language a little simpler--you use a lot of big words that I
think don't need to be used and we could use simpler ones.
But from your testimony and the answers you provide today,
it is clear Udacity serves learners much more efficiently than
the Federal Government does. While our time is limited today, I
want to followup with you after this to better understand how
we can focus taxpayer dollars to enhance our workforce
development system and help the individuals gain the skills
they need for a successful career.
And I appreciate Udacity's focus on producing lifelong
learners. That is certainly an interest of mine. Our economy is
rapidly evolving, as we have talked about, and it is important
that individuals have the ability to upskill and reskill. That
is very clear in this hearing today.
So how can individuals advance their career development
with your company? If an individual learns one skill and then
desires to learn additional skills in the chosen field, what
avenues are there for the person to pursue that goal?
Mr. Burani. That is an excellent question. I appreciate
your compliment and your earlier feedback as well,
Congresswoman Foxx. I think that it starts with understanding
the multitude of options available. Udacity is but one training
provider, and we are reaching a point where there are more
specialists.
People need career guidance. They need to understand what
is out there before they can begin to make decisions. We
provide career services, and on occasions our programs also
include soft skills, so they learn teamwork, collaboration,
leadership and so on. And we feel like this helps to create
more opportunities for lifelong learning.
Ms. Foxx. Well, thank you very much. And I hope you will
put more of a focus on education than on the T word, because I
think when you use that you are limiting, very seriously
limiting people's options. Thank you very much.
And thank you, Madam Chair.
Chairwoman Wilson. Thank you.
And now Representative Morelle of New York.
Mr. Morelle. Good morning. Thank you, Madam Chair. And
thank you to both our Chairs for holding what I think is a
very, very important hearing to discuss this topic, and
certainly to all of our witnesses for being here today and
sharing their expertise. And I will say also that many of the
questions that I had thought about asking, have been asked by
my colleagues, so I want to thank them. I think this has been a
really enlightened conversation.
You know, each year the nearly 20 million adults in the
country who need assistance with self-care deserve the dignity
of receiving these services in the comfort of their own home.
But obviously, as the witnesses have testified, you can't
ensure that those services will be provided in the appropriate
way unless we have a robust direct care workforce, each of whom
receives appropriate pay and has the opportunity to grow
professionally within the healthcare system.
Just parenthetically, I note I was proud last year to
introduce the Senior and Disability Home Modification
Initiative, which would have helped support independent living
for older individuals living with disabilities.
And I was proud to see some of the provisions related to
older individuals become law with the passage of Supporting
Older Americans Act, but I know we still have a lot to do when
it comes to recruiting an effective workforce and retraining
them with proper wages, improved working conditions, and
advancement opportunities.
I just wanted to make note of a program. It is a Federal
program, the Health Profession Opportunity Grant Program, also
known as H-POG, or HPOG, which I think is a pretty effective
healthcare training program that helps address workforce
shortages for in-demand jobs.
And the program creates career pathways, such as
apprenticeships and ongoing training, to empower advocates,
many of whom are low income, to take on new jobs as nurses and
technicians. It also supports many indirect aspects that people
must consider and which you have talked about here this morning
when working in those settings, including childcare,
transportation, work supplies, application fees, et cetera.
So the program stands out because it has helped advance the
careers of people who have been disproportionately left behind
in workforce training programs, especially low-income single
women of color, and it is more likely to result in a person
being employed in a health program upon graduation. The
availability of this program has been particularly an asset to
my community.
Action for a Better Community is an organization that
receives money from the program, and I have been blessed to be
in contact with them, meet with the folks who have gone through
the program. I think it is something we should continue to work
on.
I wanted to just, if I can, ask a question of
Representative Fay. I am a proud former Member of the New York
State Legislature, so I have great appreciation, as many of my
closing who served in State government, for that role.
I wonder how we might be able to utilize programs and how
the States might be able to utilize programs like this Health
Professions Opportunity Grant Program to leverage funds to
improve recruitment and develop defined pathways for career
advancement for the direct care workforce. You might be able to
comment on that, not simply HPOG, but as I have described it,
perhaps other programs as well.
Ms. Fay. Thank you. Yes. And so I am thinking about that as
we adjourned sine die last night fairly late. So I might be
just a little foggier than I would be normally.
I would say it depends on the State. So in Maine, our
workforce is really kind of disparate. And while our Department
of Health and Human Services and MaineCare does the funding, at
a level where we are talking about home healthcare, they don't
necessarily have a jurisdiction over all of that. I mean, we
have credentials and training. So I think--yes.
Mr. Morelle. Yes, let me ask this, Representative: Would it
be helpful, in terms of thinking of it, and do you think about
it in terms of creating rungs on a career ladder. So that
people come in--in terms of skill set--having relatively few
skills but continue to work up and have a more defined? Would
that be helpful, and is that something you think about in your
responsibilities?
Ms. Fay. Oh, absolutely. I mean, we definitely--that was
definitely one of the recommendations of the commission that I
Chaired. And any assistance and guidance in making that happen
I think would be helpful.
Mr. Morelle. Very good.
Well, Madam Chair, I will have additional questions, and I
appreciate the hearing very much. I see my time is up, so I
will yield back. Thank you.
Chairwoman Wilson. You may submit them for the record if
you want answers.
Mr. Morelle. And we will do that. Thank you.
Chairwoman Wilson. So ordered.
Chairwoman Wilson. And now Representative Banks of Indiana.
Mr. Banks. Thank you, Madam Chair.
Mr. Burani, Udacity has educated over 15.4 million learners
since its founding in 2011.
Can you tell us, in what ways do you believe an effective
reauthorization of WIOA can help Udacity further expand
learning opportunities for even more individuals?
And are there reforms to the Higher Education Act, such as
allowing Pell grant recipients to enroll in short-term
workforce development programs that would allow you to
successfully help more learners?
Mr. Burani. Thank you, Congressman, for the question.
So, while we have had good success, to the tune of 15
million learners, the reality is that metric reflects our
business around the world. And so we have run programs in a
variety of contexts, direct to consumer, working with
corporations, you know, at an enterprise level, as well as
through the public sector, and that 15 million encompasses all
of it.
We are in the early days of WIOA at Udacity, and to be
honest, I think I can speak for, you know, the broader world of
short-term credentials.
So, when we think about reauthorization, going back to my
opening statement, certainly there are a lot of reasons to be
encouraged by what this potential, you know, reauthorization
actually signifies. Anything that helps bring more dynamic
options and choice to the learners' and employers' marketplace,
we are in support of. If that helps students have a better
range of options and if that helps employers have a more robust
talent pipeline, we support it.
To your second question around the Higher Education Act,
this is an area in which, generally speaking, what we can say
is, as short-term credentials start to get their moment in the
spotlight next to additional 2-year and 4-year degrees, we
think that these programs should be open to accepting more
learners from different backgrounds. And, if, you know,
different grant eligibility becomes a topic for discussion, we
support that.
Mr. Banks. Good. Appreciate that.
You also mentioned in your testimony that Udacity offers
over 60 Nanodegree programs. Can you describe what these--what
that means? What do these programs entail?
Mr. Burani. Yes. So a Nanodegree program is effectively a
combination of technical learning and hands-on project work. So
earlier, we spoke about industry partnerships for curriculum
development.
If you were to enroll in a program to learn the fundamental
skills of cloud computing, you would have an expert in cloud
computing, potentially someone, you know, employed or connected
to that industry who is effectively delivering this content
through sort of bite-sized learning modules. And this
experience is augmented by a series of supports, just
interventions.
We have session leaders who effectively work not unlike
graduate students in a higher-ed context, facilitating
discussion and lab work and project submissions. We have got
tutors and mentorship resources available. We have got
community resources, because we acknowledge that a lot of our
best learning comes from observing our peers.
And this also includes--I could go on and on, but there is
career resources. There is an employer platform to help
motivate students and remind them that there are interviews
waiting on the other end.
The--these two components, the project work and the
technical instruction, come together. And, over time, what we
have done is we have optimized a lot of these interventions in
pursuit of the best completion rates, the best career outcomes
that we can find.
Mr. Banks. How many--how many Nanodegree courses would it
take for me to get--for me to receive a degree, let's say, in
business?
Mr. Burani. So a Nanodegree credential can be done with a
single program, and it would be 4 weeks, roughly 10 to 15--I am
sorry--4 months, 10 to 15 hours a week is the type of
commitment we are looking for.
Mr. Banks. And, for the purposes of this education for my
colleagues on this Committee, how much would that cost?
Mr. Burani. So, to the learner, we typically have--you
know--what we do is, especially in the public sector, is we
orchestrate funding through different entities in order to
effectively grant a full ride. So, we position these as
scholarships.
The reality is that there is a wide range of, sort of,
commercial schemes in which we have kind of positioned our
programs on a consumer level. If you were to come in through
the website, you would pay $3.99 a month, and you would have
access until you are complete, and $3.99 a month is sort of
like all you can eat.
Mr. Banks. Well, this is fascinating and revolutionary. I
appreciate that feedback.
My time has expired. I yield back.
Chairwoman Wilson. Representative Wild of Pennsylvania.
Thank you.
Ms. Wild. Thank you, Madam Chairman.
I would like to direct my question to Ms. Torres. Good
morning, Ms. Torres. Thank you for being here and thank you for
the work that you do every day to care for people who are in
need of extra help.
In my own family, we have experienced the need for direct
care to my mother, who, in 2014, was diagnosed with brain
cancer and came to live in my house using home hospice. And,
because we--this came out like a bolt out of the blue, we had
no warning that that was going to happen. We hadn't made
arrangements, and I had no choice but to hire somebody to come
in and take care of my mother while I went to work for a few
hours a day. And she was very well cared for in the few months
that she had left in her life, and I thank you and all who do
this kind of work. It is so important.
Unfortunately, we know that the industry is known for its
low pay and high turnover rates. The median wage for direct
care workers is $12.27 an hour. And, during the year 2018, the
direct care workforce experienced a turnover rate of 82
percent.
So, I guess my question to you is: Do you see career
advancement as something that you desire? And, if so, do you
believe that there is any possibility for career advancement
for you in your field? Do you have any kind of pathway to jobs
with greater responsibilities and higher pay?
Ms. Torres. Yes. I do believe that I can go forward with my
job. I can build--they have opportunities--through the
Cooperative, we have opportunities to get involved with office
work, or through our union, if you want to become a nurse.
There are opportunities. We just need more funding.
Ms. Wild. Uh-huh. And so you have--I assume you have
experienced coworkers who have left their job because of the
low pay. Is that true?
Ms. Torres. Yes.
Ms. Wild. And have you considered doing that? Have you
considered looking for other kinds of work because you just
weren't making enough money?
Ms. Torres. No, because I found a love for my job.
Ms. Wild. Well, thank you for that.
How do you believe that you could be affected if you were--
what would it mean for your family if you were able to make
more money?
Ms. Torres. That would be awesome. That would be----
Ms. Wild. How many hours a week do you work?
Ms. Torres. I work 36 hours a week. I am a night worker. I
do overnights. I used to do a CVPAC [inaudible] but now I do
overnights.
Ms. Wild. Do you receive any kind of benefits in your job,
healthcare----
Ms. Torres. Yes. Yes, I do.
Ms. Wild. Do you get vacation pay?
Ms. Torres. I have--yes. I have PTO. I have 401(k). I am a
worker-owner to the company. I have life insurance through my
union, 1199.
Ms. Wild. OK.
Ms. Torres. Health insurance, which is very important,
because I have my son with me. So I do have benefits. And
sometimes benefits are better than the pay in certain
situations, because we need those for when we get sick.
Ms. Wild. So have--so, in your case, you feel that the work
that you are doing is satisfying enough that you don't aspire
to leave and go into another line of work?
Ms. Torres. Uh-huh.
Ms. Wild. I believe that that is what you said.
What about the people that you work with? Do you know
others who leave the job, which is such an important job,
simply because they want a job that pays more?
Ms. Torres. Yes, because we need raises. We need the money.
And not everyone wants to stay on board knowing that they could
make more money somewhere else. And it is difficult, because
even though I love my job, my wages, I live check to check. I
do transportation back and forth. I reside in Connecticut and
work in New York. So that is also money, going back and forth.
Ms. Wild. Sure. Costs money.
Ms. Torres. It would be great if it--paid my bills, right.
You know, like everyone else. So, if we were to get a raise, it
would be awesome for every home health aide? Why? Because they
will find interest in wanting to go out to work. We could
recruit more home health aides and give them the benefits that
we are--that Cooperative and our union is offering. So that
would be awesome.
Ms. Wild. And which union do you belong to?
Ms. Torres. 1199 SEIU.
Ms. Wild. OK. Thank you so much. I appreciate your
testimony.
And I yield back, Madam Chair.
Chairwoman Wilson. Thank you so much. Thank you.
And now Representative Good of Virginia.
Representative Good?
You have to unmute, sir. We can't hear you.
Mr. Good. There we go. Thank--sorry about that. Trying to
hit it, and it wasn't working for me.
Thank you, Madam Chairman, and thank you to all of our
witnesses, and I appreciate your time with us today.
Mr. Burani, last Congress, the Republican Study Committee
proposed the establishment of an E-Verify Program that would
require all individuals to be confirmed through the Department
of Homeland Security before being eligible for Federal jobs
programs. This would mean that only people who are legal,
eligible to work in the United States would be able to take
advantage of Federal jobs programs.
Would you recommend that Congress implement this proposal?
Mr. Burani. So, at Udacity, where we have typically focused
our energy is on getting people through the system once they
are allowed in. We haven't traditionally taken positions on
eligibility of that nature.
Mr. Good. Well, I--the question of E-Verify--mandatory E-
Verify for the Federal workforce is one that my office has been
discussing for some time now, and a policy like this would be a
simple fix to ensure that American workers are prioritized, and
the rule of law is followed and upheld. So I certainly continue
to strongly urge my colleagues to consider policies that would
institute mandatory E-Verify for the Federal workforce.
But, Mr. Burani, I appreciate your focus on working within
the existing framework that we have instead of adding to an
already bloated welfare State like some on this Committee would
seek to do.
Under current law, there are--and this relates to a
previous questioner, but there are social welfare benefits that
are reduced if a beneficiary increases their income. And the
consequence of this can be a difficult tradeoff scenario where
lower-wage workers must choose whether or not to continue
receiving welfare benefits as they potentially increase their
income. And this has--can have the effect of disincentivizing
work or advancement for many lower-wage workers.
How would you suggest that be addressed?
Mr. Burani. That is a good question, Mr. Congressman, and I
think, you know, it takes a lot of analysis to understand the
benefit cliff and how it is actually changing behavior. People
who are entering programs such as ours are making an
investment.
To the earlier question, you know, this is not necessarily
a financial investment. However, the opportunity cost of
stretching their lives even thinner, making sacrifices,
potentially even taking themselves out of the labor market,
need to be considered.
I think that the important thing is to look at the outcomes
of these programs and to understand, as WIOA has stipulated
since its enactment 7 years ago, that not only is credential
attainment and job placement important, but also, we are
looking at median salary. We are looking at it--the system
looks at it after 6 months and after 12 months, because we want
to see retention, and we want to see effectively a standard of
living that has been sustained.
In our particular programs, the sort of archetype of a
learner who upskills through a Udacity Nanodegree program has
set themselves up for, in many cases, a much higher standard of
living because they are entering high-growth pathways in which
the supply and demand in the labor market has supported that.
So we believe that accountability and transparency into
those outcomes, certainly in our world, helps to keep that
momentum moving forward.
Mr. Good. I agree. And that is what we all aspire to do, is
to help people get to those higher-wage situations.
In your testimony, Mr. Burani, you emphasized the
importance of creating effective mechanisms that encourage
individuals to invest in their own career transformations. What
are some ways that you have seen individuals set themselves up
for success by creatively developing their long-term skill
sets?
Mr. Burani. That is an excellent question, and I think that
there are--there are so many paths to the finish line. But as
is probably no secret to anyone in this discussion, they get
what they put in, and, so, people that look for the path of
least resistance might succeed, but, on balance, generally will
not succeed as much as the people who look for ways to augment
their learning experience.
Earlier, I mentioned career services that we offer. Some of
them are mandatory project submissions. Some of them are
discretionary. You can choose to have your resume reviewed, and
you can choose to do the work to polish it up, ditto your
LinkedIn profile.
You can hone your interview skills. You can also--you know,
there is the variety of free courses that we offer as well as,
you know, the marketplace in general. And, so, that is the best
answer, is the more you can invest, likely the more you stand
to benefit.
Mr. Good. Great answer. There is no substitute for hard
work or being the CEO of your own career and taking
responsibility. So thank you so much for your time.
And I yield back, Miss Madam Chairman.
Chairwoman Wilson. Thank you. Thank you so much.
Ms. McClain--I am sorry. Ms. McBath of Georgia, welcome.
Welcome back.
Mrs. McBath. Thank you, Madam Chair, and thank you so much
for convening this panel today and thank you to all of our
panelists.
And everyone, thank you for sharing your testimonies with
us. And I know that this is a vitally important topic, and I
appreciate the focus of this Committee on continuing to serve
all of our workers in America.
And I know that we have all experienced a time when an
aging apparent, or a disabled family Member, really needed
additional care in the home. I myself, as many of our
colleagues have expressed earlier, had the responsibility to
care for my ailing mother during the last years of her life,
and finding a good, loving care provider was extremely
important to our family.
And we know that nearly 20 million Americans need
assistance with self-care and daily living, and that number
just continues to grow as our population ages.
This is an issue that touches the lives of almost every
American. And, when the time comes, we all want to leave our
loved ones in the care of a compassionate and very capable
individual. And we should treat those caretakers with the same
compassion and the same respect that we expect them to treat
our loved ones.
And, despite the essential nature of their work, you know,
as we have been expressing, direct care workers face an
extremely high turnover rate of about 80 percent. And these
high rates of burnout, low pay, and limited benefits, and a
feeling of being just so undervalued are all central to the
challenges facing the direct care workforce.
However, we know that, you know, there are solutions for
these problems. We have been talking about this today, and
President Biden and this Committee have proposed bold action to
address the direct care workforce shortage and ensure that
these are good-paying, middle-class, high-quality jobs.
So my question is for Representative Fay. One of the
elements that you touched on in your testimony is the need to
raise the perception of direct care as a viable, meaningful
career pathway.
Can you talk about proposals that your State is considering
helping implement and achieve these goals?
Ms. Fay. Yes. Thank you, Congresswoman, for that question.
So I think the No. 1 issue is pay, is wage rates. And so,
if we sort of set that aside, which is something that our
commission did, because I think everyone on the commission was
in consensus agreement that--that the pay was not commensurate
with the work. And, if we value work by the amount of money
that we pay people, then we are not doing justice to the value
that this work provides to our loved ones, but also to our
economy.
There is a parallel between the childcare workforce issue
and the caregiving workforce issue as well.
So I think I will just--I will just stop there with the
pay. You know--yes. That is where I will stop. Thanks. Sorry.
Mrs. McBath. OK.
Ms. Fay. I don't want to take too much time.
Mrs. McBath. Thank you so much for that.
And, Mr. Espinoza, individuals who are receiving consumer-
directed care are often responsible for finding and hiring
their own direct care workers, as my family and I had to do as
well. And, while these--this gives these individuals, really, a
great deal of individual choice--you know, we had a large
choice of care providers regarding who provides, you know,
services for families and, you know, we had to do the same for
my mother.
Can you talk about some of those strategies that PHI
actually recommends that helps connect people like us, families
like us, with workers who can provide those kinds of services?
Mr. Espinoza. Yes. Absolutely. Thank you for the question,
Congresswoman.
One of the best strategies I think that we have been seeing
in the field are matching service registries or caregiver
registries. These are online platforms that help home care
consumers and workers find one another.
In California, there are four centers for independent
living that offer matching service registries, and they include
features for consumers and workers. They include the option for
workers to record short messages. There are a variety of
technological features that make that interaction more
possible, and it allows them to connect based on preference,
based on their needs, and based on their availability.
However, there are only matching service registries in 10
States. Many of them are chronically underfunded and do not
embody the best of technological processes. And, so, certainly
the Direct CARE Opportunity Act could make a big dent in this
issue. It could ensure that all States have matching service
registries, or that we find other viable ways to connect
consumers and consumer-directed programs to workers.
Mrs. McBath. Thank you so much.
And, Ms. Torres, I just want to say in my last few seconds,
thank you so much for everything that you do. The work that you
provide and the care that you provide the residents that are
depending on you is truly, truly vital, and we just really
appreciate everything that you do for this industry.
Ms. Torres. Thank you.
Mrs. McBath. And I yield back.
Ms. Torres. Thank you.
Chairwoman Wilson. Thank you, Ms. McBath.
And now Ms. McClain of Michigan.
When she finishes, the gavel will go back to Mr.
DeSaulnier, who has returned to the meeting as co-Chair.
Ms. McClain of Michigan.
Mrs. McClain. Thank you, Madam Chair.
Mr. Burani--thanks--sorry about that--your work involves
upskilling individuals with vital skill sets that leads to
promising careers.
Some of my colleagues across the aisle often argue that
throwing more and more funding on new Federal programs is the
answer for workforce development. This is simply not true, and,
actually, could detract from existing workforce development
efforts that already work.
I intend to actually introduce legislation addressing ways
to promote awareness and information on these incredible
programs and their beneficial role in shaping our next
generation's workforce. I believe we need to focus on helping
all workers, including those in direct care sectors, by
strengthening really existing programs that will further help
address the skills gap.
Can you speak about the current success and employment
outcomes--the actual outcomes that these programs, such as
Udacity, can lead to, you know, as well as any structural
changes or reforms that could be better serve both prospective
students and actually taxpayers?
Mr. Burani. Yes. Thank you, Congresswoman, for this
question.
I think that, you know, the way that we look at a
successful program is largely within the context of the systems
that support it. So WIOA's standard of performance is based on
credential attainment. It is based on job placement, retention
of that job for 6 and 12 months. It is based on the median
salary coming out of that program.
So we look at all of these things, but we also use a
broader definition of positive career outcomes. We have run
programs around the world in which what we have done is
measured the impact for a learner coming out of our program not
only on the ability to attain the job offer, because that may
or may not have been their goal. It may or may not have been
the goal of the funders and the sponsors of this program.
We have run a program in Egypt, for example, where we are
working with tens of thousands of graduates to put them in
gainful freelancing work, and the attainment of a freelancing
gig or a series of them would be a positive career outcome. So
would a promotion, either in title or pay or both. So would the
launch of a successful venture. It could even simply be that
you self-report yourself as being happier on the job.
So we look at these positive career outcomes, and they are
broadly defined. It gives us a basis on which to optimize our
programs and really make sure that this technical curriculum
paired with the projects also is supported with the right
wraparound services to maximize those outcomes.
Mrs. McClain. Sure. Thank you.
And then, workforce shortages in the healthcare industry
have long been an issue but have only been really exacerbated
by this pandemic. As our next-generation workforce takes shape,
there will likely be advancements in technology in the
healthcare industry, which will require, obviously, a robust
workforce.
Can you speak to how programs and platforms, such as
Udacity, can help address some of these shortages, and the
skill sets they can provide for future healthcare and jobs?
Mr. Burani. Yes. It is a fascinating topic, and we are in
the early days at Udacity of looking at, sort of, sector-
specific solutions of this sort. But I will give you one
example.
We offer a program for artificial intelligence in
healthcare, and this really provides what we see as a, you
know, a very modern skill set, which is a bit of a lead pass
for where we see the industry going.
Now, you will recall earlier, I spoke to the 2.3 million
open jobs in healthcare, and the very small subset of those
today that represent these types of technology, sort of,
related skills. But we do see that changing over time, and that
is due to all of the investment in digital transformation.
So our AI for healthcare Nanodegree will--you know, here is
an interesting application. Using the data that comes from
wearable devices to understand the context around some of these
indicators, something as simple as your heart rate or pulse,
right? If we understand the context, we understand the--you
know, the altitude, or the accelerometer tells us that this
person was actually moving quickly, right. This can now add
important metadata for a practitioner to understand, I can rule
out explanations A, B, and C, and focus my diagnosis on X, Y,
and Z. So we hope to use that technology in a productive way.
Mrs. McClain. Thank you, sir. And thank you for all the
guests today.
I yield back my time. Thank you.
Mr. DeSaulnier.
[Presiding.] Thank you, Chairwoman Wilson. Wonderful to
partner with you.
And now, I would like to recognize the distinguished
gentlelady from Michigan, Representative Stevens, for five
minutes.
Ms. Stevens. Well, thank you, Mr. Chair, and thank you
for--to our witnesses for today's very important hearing on
caring for our communities and supporting and investing in the
direct care workforce.
Let me just couch this in the Michigan sense really
quickly. Michigan has about 60,000 direct care workers who take
care of our elderly peoples and peoples with disabilities in
their own homes.
In addition to our current shortage of direct care workers,
State officials estimate that Michigan is going to need an
additional 178,000 direct care workers in the next 10 years to
meet growing demand. That is more than twice the current
workforce.
Currently, there are not any Federal or Michigan State
training initiatives or certification requirements to work as a
direct care worker in someone's home. We all know, and we have
talked about today the pay being low, the benefits being
virtually nonexistent. And, over time, it is becoming more and
more common that the work is obviously--grows to be physically
and emotionally demanding. Michigan home care workers are paid
somewhere between $9.50 and $12.00 an hour without a lot of
benefits.
So, Mr. Espinoza, you had mentioned in your testimony that
COVID-19--that the COVID-19 pandemic worsened existing
challenges for the direct care workforce. Could you just talk a
little bit more about that specifically and the impacts that
the pandemic had on our home care workforce and the people they
support?
Mr. Espinoza. Yes. Thank you for that question,
Congresswoman.
What we saw in our experience and through our research was
that, in the early stages of the pandemic, direct care workers
were on the front line, but they were often there without
enough PPE, without enough supplies, without childcare or paid
sick days, and without proper compensation. In fact, we heard
some horror stories in New York City, for example, where PHI's
headquarters are based, of workers using garbage bags as gowns
and purchasing their own protective equipment.
And many workers were being made--asked to make the
impossible choice: Do I go to work and risk getting infected or
infecting my families and clients without paid sick days, or do
I stay home and collapse financially?
And employers and industry groups also sounded the alarm.
Our research would show that about 280,000 workers left the
direct care sector in the first 3 months.
Now, that said, over time, we have seen that these numbers
have begun to settle and return back to normal, but there are
still a variety of questions that I think the direct care
workforce and the long-term care sector needs to address,
really to strengthen jobs and to protect ourselves during the
next healthcare crisis.
What has been--the mental health impact, for example, on
workers who saw clients and family Members die, how does this
affect turnover? What does it mean that this sector often lacks
grief support and bereavement leave for workers? How should
this sector improve safety standards, infection control and
prevention, emergency preparedness? How do we recruit
effectively when so many workers saw how dangerous and
unprotected these jobs are, especially in nursing homes?
And how do we learn from the short-term measures that were
adopted, from hazard pay to paid leave, to childcare centers in
certain cities, or virtual trainings, to think long-term, to
modernize the job, and to transform this sector in the long-
term?
I mean, certainly we would ask for a Federal report on the
lessons learned of this workforce and how to prepare for
ourselves in the future.
Ms. Stevens. Great. Thank you so much for that really,
really thorough explanation, and just all of your background.
And with my remaining time, Representative Fay, in your
testimony, you talk about individuals who are eligible for home
care and community-based services going unstaffed because there
is simply a shortage of workers to provide the services that
the individual is eligible for.
Could you just tell us what is at stake when an individual
is not able to access the care they need?
Ms. Fay. In some circumstances, people will die, because
they can't access care. And that is part of what really keeps
me doing this work. You know, making sure that there is a
workforce there to care for folks that need it so that they can
live their best lives is, I feel like, one of the most
important things that I can do as a Representative.
So not being able to do the things that bring people joy or
simply live with dignity is what is at stake here.
Ms. Stevens. Thank you for that.
And, with that, Mr. Chairman, I yield back.
Chairwoman Wilson of Florida.
[Presiding.] Thank you, Ms. Stevens. I am back.
This hearing is impacting each and every one of us
personally, and it has really just impacted our constituents,
and this is very moving.
And now, we will hear from Mrs. Harshbarger of Tennessee.
Mrs. Harshbarger. Thank you, Madam Chairman.
My question is for Mr. Burani. I have been in the
healthcare industry for 35 years, and I have absolutely
serviced and worked right alongside with these direct
healthcare workers as a pharmacist in making sure that we work
with home health and hospice at the agencies as well as the
healthcare providers in that. And I absolutely know there is a
shortage of direct healthcare workers. You know, there is a
shortage of registered nursing, especially in rural
communities.
And, from Representative Fay's comment of what they saw
from some research that this is a dead-end job, I absolutely
agree with the Chairman that there--that is a marketing failure
in my opinion, because this is just a springboard to so many
other areas in healthcare as far as the nursing industry goes.
And, from the business component, more money does not equal
better outcomes, and I can tell you that from my profession and
being a business owner, too.
I looked at your testimony, though, and there are so many
things that you recommended for the WIOA program as far as
structural changes. And, just like you created more scalable
registered providers, every State is different. Make that easy
for them to, you know, compile that information.
I am looking at the facilitating the mobility of dollars
across labor markets. I am a border State right at the tip of
Virginia. So a lot of those people that may live in Virginia
work in Tennessee or vice versa. That is a huge problem.
Increase the accessibility and transparency for all
programs. You know, make a single source--single source where
they can record that data. That is a no-brainer as well.
There is just--you have got a ton of good recommendations
in here.
Incentivizing community colleges to work with employers.
You know, we have community colleges in my district that do CNA
programs or LPN programs. We have workforce development
agencies who do the same. We have a hospital system who will
train at no charge, do the CNA program to where they can go get
certified.
You know, some of the things--you talk here about fostering
a more dynamic relationship between the workforce board and
learners, about the marketing operations. People don't know
what they don't know, and marketing is a huge part of that.
And, in your industry, with all the AI and things you have,
this should incentivize people to come look at this.
But what I want you to talk about is to incentivize
distribution of funding toward distressed communities. I have
two distressed counties in my district, and, like I said,
people don't know what they don't know. How do you get the word
out to those people that there are opportunities out there, and
how do we do that? How do we bring them into the fold and keep
them there by giving them that opportunity, sir?
Mr. Burani. Thank you, Congresswoman. I appreciate the
feedback, and I appreciate your taking time to think through
all that goes into these reforms.
So, when we consider this critical point of view around
facilitating a relationship between workforce and the general
public, you hit on exactly the problem. What do they know about
the system that is designed to serve them?
The workforce board of any given county or metropolitan
region or State is not a consumer brand. The closest thing to a
consumer brand is the job center, which has a retail presence,
and is where you go to get coaching and to look at the job
board and maybe attend a career fair.
But what we need to do is--and I used this word
``modernize'' a lot today--we need to sort of 10X the
sophistication of the relationship between the server and the
recipient of that service. So understanding the range of
programs, understanding the range of conditions or, you know,
sort of status quo that these----
Ms. Harshbarger. Uh-huh.
Mr. Burani [continuing]. programs are designed to serve.
And, to your point about distressed communities,
structuring programs in such a way that we provide the
supports. I will give you a very simple example. Our programs
don't work if you don't have a laptop and a broadband
connection.
Now, penetration of broadband is quite high at an
aggregated level. But, when you go into distressed communities,
those numbers plunge. So that requires us to broker those
partnerships on the side. Sometimes we will work with community
partners, sometimes the workforce board can nominate someone,
or we have got to do the work to find those connections to get
people to donate laptops.
And, so, I know there are always good ideas in the mix for
how to make these provisions for distressed communities, but it
needs to be more endemic to the workforce system versus a box
that we check and something we pursue separately.
Mrs. Harshbarger. We will continue our conversation, sir,
and great ideas.
And I yield back.
Mr. Burani. Thank you.
Chairwoman Wilson. Thank you so much.
And now Mr. Levin of Michigan.
Mr. Levin. All right. Thank you so much, Chairwoman Wilson,
and also to Chairman DeSaulnier for putting together this vital
hearing on the direct care workforce.
You know, direct care professionals do the challenging work
of taking care of the most vulnerable populations in our
country, our young, our old, our folks who are sick. And, as
our Nation ages over the coming decades, this direct care work
will become ever more essential. And so, we will need more
direct care professionals. But, if you look at the obstacles
they face, it is no wonder that we see such high turnover in
this field.
Direct care workers must contend with low pay, a lack of
resources, lack of benefits, lower job agency and inadequate
training options. And it is not due to marketing of workforce
agencies.
I would--in Michigan, actually, our workforce investment
boards are very strongly branded as Michigan Works, and the
public knows about them. But these are just not jobs that
enough people are able or willing to do, because they are so
low paid, and they have so low--you know, low status in
society, which is all of our faults--the fault of policy.
So, we have got to invest more in direct care to ensure
that direct care workers are valued and have the resources and
respect fitting this essential, complicated, and dangerous work
that they do.
Mr. Espinoza, you mentioned in your testimony that, in all
50 States and D.C., the direct care worker median wage is lower
than the median wage for other occupations with similar entry
level requirements due in large part to the limited funds
available through Medicaid.
So, as you know, the American Rescue Plan increased Federal
funding for home-and community-based services by 10 percent.
Can you talk about how these funds have enabled States or will
enable States to improve wages for these workers? Will the
money really get through to the workers?
Mr. Espinoza. Thank you, Congressman.
I think the American Rescue Plan can make a big difference
in improving jobs and improving supports for people who need
this level of support.
What it does specifically is it increases the Federal
matching rate by 10 percentage points. It encourages States to
use that additional funding to both expand home and community
services, but also, in many instances, improve jobs.
Several States have put forth their spending plans, and we
have seen a number of measures in those plans that would do a
great deal for workers in those States.
So, for example, North Carolina recently introduced its
spending plan, and some of its measures include $210 million a
year for recruiting, retaining, and building the network of
HCBS direct care workers, also money for employment training
for direct care workers, and money for a direct care workforce
survey to better understand what the driving factors are for so
many workers to come into the sector and leave the sector. And
this would, of course, not just address marketing, but it would
address how do you transform the overall quality of the job.
New York has also put forth its spending proposal, and it
includes about $2.1 million for direct care workforce issues,
including the long-term care workforce and the value-based
payment readiness, improving jobs for direct support
professionals, which are a segment of the worker--workforce
that supports people with intellectual and developmental
disabilities, but, also, issues like transportation, Medicaid
rehabilitation rates, training and supports, and building
evidence-based practices, and more.
So it shows, I think, both the possibilities that increased
Medicaid funding can have on improving jobs and improving
services, but, also, the incredible need that is needed in this
sector in every State to strengthen recruitment and retention.
Mr. Levin. Does PHI have specific recommendations regarding
increasing Federal Medicaid funding on a going-forward basis
after, you know--after we have--what we have already done?
Mr. Espinoza. Yes, absolutely. I mean, we would argue for
many of the items that we--that I mentioned just right now. But
we would include how do you improve wages for direct care
workers? How do you strengthen the training infrastructure for
employers, including virtual, but also in-person and hybrid
approaches? How do you create career advancement opportunities?
Can this money be used to strengthen the data collection
infrastructure so that employers and policymakers can better
track workforce capacity and job quality? And how do you
improve research and surveys on these workers?
Those are a handful of recommendations that we would issue,
yes.
Mr. Levin. Well, thanks.
You know, Madam Chairwoman, I started working with
healthcare workers who wanted to organize in the early 1980's,
and I have--throughout this whole--all these decades, this
workforce has never really been changed in terms of being paid
adequately, having real career tracks, real opportunities for
advancement, and the training and supports they need. It is
high time we get that done. They need it, and the people they
care for need it.
And, with that, I yield back.
Chairwoman Wilson. Thank you, Representative Levin. I agree
with you 100 percent. It is our responsibility to change that
scenario.
Mr. Levin. Yes, ma'am.
Chairwoman Wilson. Representative Fitzgerald, and then,
after Representative Fitzgerald is recognized and speaks, I
will pass the gavel back over to co-Chair, Mr. DeSaulnier.
Representative Fitzgerald, you are on mute.
Mr. Fitzgerald. Madam Chair, our--I am here. Are you ready?
Chairwoman Wilson. Ready.
Mr. Fitzgerald. OK. Thank you.
Mr. Burani, you know, in Wisconsin, over the last, and
obviously, unique circumstances where a lot of these caretakers
and the workers that are doing this very difficult job, their
challenges have been increased significantly. You know, we are
still working on the steady pipeline of individuals that are
willing to take this type of work on in the direct care space.
In those discussions, I mean, is there any relationship
that you feel is being developed? And I would say probably more
of a--in the traditional educational institutions, like tech
colleges, or, you know, there are some instances, I would
think, in which hospitals or clinics would provide OJT for some
of these individuals. That would be kind of the first question
I would have.
Mr. Burani. So I want to make sure I understood your
question, Congressman, so we are asking do we see entities in
this ecosystem, the industry and the training providers
actually moving closer together and working more closely in
partnership?
Mr. Fitzgerald. That is right, yes. Yes.
Mr. Burani. So I think that it is--yes. In--broadly
speaking, absolutely. I think that you--there is a lot of
evidence of it. On one extreme, you have got tech companies
that are actually launching their own, quote/unquote,
``universities,'' their own upscaling programs, because the
adoption of their products and services in many ways is
bottlenecked by skill shortage. No surprise there. That goes
back to, you know, the narrative we have been talking about all
day long.
But I think that there is, you know, another aspect of
this, which is--it is what the system is demanding. We have a--
I think an increasing--the reality and the mandate for these
educational providers of all stripes is to show these outcomes.
I have been beating a dead horse today with that word,
``outcomes.''
But the reality is, if you zoom out and you think about the
student debt crisis, right. At the end of 2020, the first
year--the first wave of graduates who came out during the
pandemic, the joblessness rate of those graduates was 3.5 times
what it was the year prior.
So, when you look at the average amount of debt, about
$36,000, 45 million Americans having that debt, you are
measuring the impact to American GDP in the trillions, and it
is literally becoming a bigger part of that pie. So I do think
that organically, just basic supply and demand is pushing us in
that direction.
Mr. Fitzgerald. Very good. And let me just followup with:
So, if there is a reauthorization of WIOA, is there one thing
that really--and I know you probably touched on this more times
today, but is there one thing that really stands out that we
should maybe make adjustments to or make changes to that could
actually, you know, help us in determining whether or not the
full reauthorization is warranted, or is there something that
should be tweaked, I guess?
Mr. Burani. That is an excellent question.
In preparation for today, I narrowed it down to about 15
for the purposes of brevity. I think that, you know, if we had
to narrow it down to one, I would say we need to have a free
flow of ideas and a free flow of awareness for all stakeholders
in this ecosystem. What is it we are trying to do, and how do
we make the most of the system that we have?
And that means learners of all archetypes. It means, you
know, educational institutions of all--you know, traditional,
nontraditional, long-term, short-term. It means employers
representing all industries.
There would need to be some sort of a forum, or some sort
of a sort of consistent vehicle for all needs to be put out in
the open for us to then realize that, actually, we are all more
or less going for the same thing.
Mr. Fitzgerald. Got it. Very good. Very good. Thank you
very much.
Madam Chair, I would--I would yield back.
Mr. DeSaulnier.
[Presiding.] Thank you, Mr. Fitzgerald. I will now
recognize Mr. Bowman for five minutes.
Mr. Bowman. Thank you, Mr. Chairman.
Mr. Espinoza, thank you for all the work you do at PHI in
the Bronx. As you know, part of my district includes the Bronx
and is home to many caregivers.
As we emerge from the pandemic, we have an historic
opportunity to build an America that works for all people by
centering the care that all people need. So often, the very
people who provide critical caregiving work in our communities
are not able to care for their own loved ones, like an ill
family Member or a young child.
Earlier this year, I introduced my Care for All agenda
resolution, because we need to dramatically expand and
strengthen the care economy and improve conditions and
compensations for care workers nationwide.
In addition to better wages, can you talk about specific
conditions, such as pathways to unionizing and free or low-cost
childcare for care workers, that we need to consider in the
face of rising demand for care work?
Mr. Espinoza. Yes. Thank you for the question, Congressman.
There are a variety of strategies that are needed to really
strengthen the direct care workforce and ensure supports for
the people they support. As you mentioned, I think unionizing,
collective bargaining has been used as a strategy in many
States to elevate wages, to provide benefits and a wide range
of employment supports, to provide career advancement
opportunities, and to create a collective voice that can
advocate for change on the job and in their sector.
We have also seen in New York--we are affiliated with
Cooperative Home Care Associates, and Zulma is speaking here
from CHCA. Opportunities for worker-owned cooperatives, or
other ways in which workers can have a voice in defining the
quality of a job and ensuring that those supports are as strong
as possible.
When you look at the research on direct care workers, what
you see is these incredible challenges. I mean, certainly, we
often point to poverty level wages, which forces about 45
percent of direct care workers into in or near poverty. But,
because of that poverty, so many workers then rely on public
assistance to survive, and, in many instances, it is low-wage
jobs and the ability to access higher-paying jobs in fast food
or retail in most States that are driving these workers out of
the sector and are destabilizing the workforce.
So, as we think about strategies to strengthen this sector,
certainly any of the interventions that the Direct CARE
Opportunity Act support, from training to advancement
opportunities, to recruitment and retention innovation, to
technology and other kinds of supports are critically needed,
but so is the evidence base. How do we make sure that the
Federal Government is investing in those interventions that are
most effective that improve employment, that improve care, and
that improve cost savings,
So, I think this is a critical opportunity for this
country.
Mr. Bowman. Thank you, Mr. Espinoza.
PHI has a powerful resource that shows, in New York, 57
percent of home care workers are accessing some form of public
assistance, which is a clear demonstration of underinvestment.
President Biden's American Jobs Plan----
Mr. Murphy. No it isn't, people----
Mr. Bowman. Excuse me. President Biden's American Jobs and
Families Plan would make a significant investment in Medicaid's
home-and community-based services, which is a necessary step in
the right direction.
In addition to funding, what do you think needs to change
about the way we talk and think about care work? How can that
translate to Federal policy?
Mr. Espinoza. Yes. Thank you for the question, Congressman.
I think there are a number of representations about direct
care workers that are inaccurate. One of them is that it is
unskilled or low-skilled labor when, in fact, what we know
through our work and what many people in this field know is
that direct care requires a range of skills and knowledge.
The National Academy of Medicine encourages that direct
care training include at least 75 hours of training, which
acknowledges the level of skill, knowledge, and confidence that
these workers need to succeed in these roles.
Another representation is that these workers aren't dealing
with life challenges, or job-related challenges that are
threatening their stability on the job, and yet what we know
and what employers can show is that there are a wide range of
challenges that they are facing both in their jobs and in their
communities.
In the job, it includes everything from safety and
workforce violence. It includes a lack of training, a lack of
career advancement opportunities, often challenging situations
with consumers, but also family Members, and, in general, a
lack of recognition and respect for the critical role that they
play.
And, for many of these workers who are women, people of
color, and immigrants, they are facing challenges in their
communities that make it that much harder to succeed on the
role.
So I do think that challenging those misconceptions and
valuing workers for the critical role they play by funding
something like the Direct CARE Opportunity Act could do a great
service for these workers and all of us who need this level of
support.
Mr. Bowman. Thank you so much.
Mr. Chairman, I yield back.
Chairman DeSaulnier. Thank you, Mr. Bowman.
I will now recognize Representative Letlow for five
minutes.
Ms. Letlow. For all the witnesses, thank you for taking the
time to testify before the Committee today.
After the past year we have had, it is clear just how
important it is for our country to have qualified, trained
professionals in the healthcare sectors. Our doctors, nurses,
and healthcare workers across all fields are vital in providing
essential services and helping patients and families through
some of their most difficult times.
While I understand the motive is good, I have serious
hesitations with authorizing another massive new grant program
for $1.5 billion to address only one sector of the healthcare
field. I believe we should be utilizing existing funding
streams under the Workforce Innovation and Opportunity Act and
the Registered Apprenticeship system to prioritize high-demand
fields, such as direct care workers.
Additionally, having employers more involved in workforce
education curriculum will help future employees come out of
school prepared to handle the latest challenges and trends and
ready to enter the workforce.
My question is for Mr. Burani. In your testimony, you
emphasized the importance of facilitating the mobility of
dollars across labor markets and incentives to collaborate with
neighboring workforce areas. What specific reforms should be
made to promote greater coordination across communities, and
what benefits are there to incentivizing collaboration?
Mr. Burani. Thank you, Congresswoman, for the question.
I think this is important. Let's just consider a
hypothetical case study. You are in a specific county. You live
there and are a contributing Member of that society, and you
happen to be interested in upskilling yourself.
It could be that most of the career opportunities happen to
be in the next county over. And, as a resident of one county,
with employers buying into a program that is headquartered, for
all intents and purposes, in another county, we encounter
difficulties where that money does not flow freely unless there
are partnerships established within those two distinct
workforce areas.
Now, there is nothing holding back those workforce areas
from collaborating, but that takes time and attention and
energy and resource, and that is immediately creating drag on
the process.
So there needs to be--it starts with a fundamental
understanding of how the labor markets in this economy have
evolved over time. There is more breadth--look at commute
times. That is a perfect example of how geography has changed
this dialog.
But also consider the growing--the rise of remote work.
What we need to do is make provisions for these circumstances,
and create abilities, either with a--you know, a--sort of a
parallel hierarchy in which that particular type of partnership
is facilitated, or some other workaround, some other carve-out
that allows me in county No. 1 the ability to go with
confidence and try to get involved in a workforce program that
might not be in my backyard.
Ms. Letlow. Thank you so much. I appreciate it.
I yield back my time.
Chairman DeSaulnier. Thank you.
We will now recognize Representative from New Mexico,
Representative Leger Fernandez.
Ms. Leger Fernandez. I want to thank both Chairs and
Ranking Members. And I want to thank the witnesses for their
excellent description about what--how important this care is to
each of our families, to each of our communities, to our
country as a whole, how difficult the work is.
I really did appreciate Ms. Torres' description of the
number of hours she works, the--you know, how heavy the work
is, how hard the work is. But also, how much care she puts in
that work. It truly came through. And so, for your testimony, I
am extremely grateful, Ms. Torres.
I want to address my questions to two types of direct care
workers: those working in rural communities, and those who are
immigrants. I represent the Third District of New Mexico, a
beautiful district, but it is the size of Pennsylvania. It is
beautiful. It has got wide open landscapes and lots and lots of
small rural communities, some in a sense that we were listening
to Mr. Burani talk about. It is like multiple counties.
Representative Fay, you represent Maine, a State that is
also very rural. Can you describe the specific challenges
direct care workers face in rural communities and ways--maybe I
will combine it--ways in which Congress can incentivize
individuals to work in those rural communities?
Ms. Fay. That is a fantastic question.
So in our commission hearings we heard from rural direct
care workers, and one of the primary barriers for them was
travel time. So they are not reimbursed, home care workers are
not reimbursed for their travel time. And if you are working in
Penobscot County or Piscataquis County, it might take you an
hour to get to your client and then an hour back. If you have
more than one client, then you are doing an awful lot of
travel.
So I think we can think of other things. Broadband access.
We have electronic visit verification now, which is required.
In some of those places, there is no internet access. You are
required to have some sort of electronic device. And that can
be a challenge, and providers don't have necessarily the
funding available to them to pay for those devices.
So I think we could play that out in many different ways.
But those are two of the most significant barriers that we
discussed.
Ms. Leger Fernandez. Well, thank you very much. And I think
that this testimony also highlights to us that in Congress we
must address all of these complex issues, recognizing the
interconnectedness, so that we work on broadband at the same
time that we work on properly valuing our home care workers and
our direct care workers.
Mr. Espinoza, you know, New Mexico has got a long history,
culture, and economy based in valuing our immigrant and our
immigrant workers. Although New Mexico, the border changed on
us, we have always welcomed and honored our immigrant workers.
You mentioned in your written testimony that 27 percent of
the direct care workforce are immigrants. And I know there has
been discussion about the disparities immigrant direct care
workers face compared to their colleagues.
You know, in another place where there is this
interconnection, could you describe how offering undocumented
immigrants a path to citizenship might help stabilize the
workforce and eliminate disparities? Is that something you can
speak to?
Mr. Espinoza. Yes, absolutely. Thank you for the question,
Congresswoman. Just as background, our research shows that
about one in four direct care workers is an immigrant, and that
totals about 1.2 million immigrants. Our research also shows
that that segment of the workforce, immigrants in direct care,
is growing faster than U.S.-born workers. So it is part of the
future of this sector.
Our research doesn't capture undocumented workers and it
doesn't capture workers who are hired in the gray market. But
certainly, we can assume that being an undocumented worker who
is working in home care most likely runs a variety of
challenges, right? They often fear retaliation from their
employers. They often struggle with the challenges of
navigating an immigration system and the rise of anti-immigrant
hostility.
And a pathway to citizenship in particular would stabilize
the job for those workers, but it would as importantly
stabilize the workforce for consumers who need those workers,
right, especially recognizing that immigrants are a big part of
the future.
Ms. Leger Fernandez. Thank you for that. I would note that
if we actually did the American Citizenship Act, it would
provide a $1.4 trillion benefit to our economy, as well as
provide the workers in this industry we need.
My time is expired. I yield back.
Chairman DeSaulnier. Thank you, Representative.
Next would be Representative Spartz if she is interested in
speaking. I don't see her. She was on. Give her a second. If
not, we will go to Representative Sherrill.
Representative Sherrill, you are recognized.
Ms. Sherrill. Thank you so much, and it is great to be
here.
Representative Fay, your State and Nation have been
struggling for years to develop a strong pipeline of direct
care workers to meet the needs of our residents. You have said
the shortage of direct care workers has become a real crisis in
your State. Can you say more about why this is a crisis, and
what have the impacts been on older and disabled residents,
based on this?
Ms. Fay. I think the crisis was laid bare by the pandemic
for reasons that we have talked about a little bit today. There
are some problems for workers going into folks' homes I will
say specifically.
In Maine there are some personal care attendants who are
not characterized as healthcare workers and they didn't, for
instance, early on have access to vaccines. So that was
problematic for them and problematic for their clients and the
people that they care for, because if you rely on someone else
to help you cook meals then your nutrition suffers. If you
require someone else to help you get to doctor's appointments,
then your health suffers. And we also know that isolation has a
significant impact on mental health.
So I think those are some specific impacts that we saw of
the growing crisis in the workforce shortage. And that
continues. We have a workforce crisis across the State in most
sectors.
So we are now having the challenge of having to try to
attract workers into this particular low-wage work, and then
for reasons which I mentioned before the healthcare impacts to
their clients is really negative.
Ms. Sherrill. So is any of what you are discussing a
funding need directed toward job training and recruitment of
direct care workers, or it sounds as if it is not necessarily
on the training end, that it is just that the actual payment,
the low payment? I am just wondering if this is a recruitment
and training problem or if it is simply wages need to be higher
in this industry.
Ms. Fay. It is both. I think necessary to increase wages,
but not sufficient. One of the things I mention in my testimony
is the way we value the work. And if we are having folks whose
work isn't valued caring for people who maybe have less of a
voice, who are less visible, people with disabilities and older
folks, then we have a system that is sort of a negative
feedback loop. So we need to raise the wages, but we also need
to raise the visibility and the way that we value these jobs.
Ms. Sherrill. So given this, what would the effect of the
American Jobs Plan's $100 billion investment in workforce
development on the long-term ability of the home care industry
to recruit the level of staff it needs, what would that impact
be?
Ms. Fay. I think the impact would be significant. In Maine,
much of the work is funded--much of our direct care needs are
funded through MaineCare, which is our Medicaid. And while the
State matches, that is a significant impact on our State
budget. And having ongoing funding and the ongoing ability to
do workforce development through additional funding coming into
the State would just be huge.
Ms. Sherrill. Well, thank you so much. I really appreciate
your testimony today.
Thanks, Mr. Chairman. I yield back.
Chairman DeSaulnier. Thank you, Representative.
I have got Representative Mrvan next. I don't see him on
the camera, but if you are ready, please proceed.
Mr. Mrvan. Mr. Espinoza, in your testimony you note the
astronomical turnover rate among home care workers of 65
percent. Can you tell us more about the impact of the high
turnover on the continuity and quality of care and also
outcomes for older people and people with disabilities who rely
on long-term services and supports.
Mr. Espinoza. Yes. Thank you for the question, Congressman.
As I mentioned earlier, turnover is one of the top threats that
providers specifically named facing their agencies. They name
caregiver shortages and caregiver turnover.
And two recent studies did show that the turnover rate for
nursing staff and home care workers are about 99 percent and 65
percent respectively, and it often happens within the first 90
days.
Turnover has a huge impact on everyone in the system. It
creates job instability and financial challenges for workers
who must move from one job to another. It disrupts continuity
of care for consumers. And oftentimes a worker will have quite
a bit of valuable information on someone's health, someone's
preferences, someone's experiences, and a lot of that can get
lost when a worker turns over to another worker. And it affects
employers. The estimated direct cost of replacing a nursing
assistant or home care worker is about $2,200, and that affects
employers, and it affects the system.
There are ways in which interventions can dramatically
address turnover and retention. We launched an initiative in
2013 that provided a 120-hour adult learner-centered home
health aide training curriculum with about 500 trainees in New
York City. And it led to a variety of improvements.
And, most importantly, in addition to the ways in which it
improved patient-centered care or cultural competence, we found
that 90 percent of participants completed the course and that
trainees were more than twice as likely to be on the job at 3
months and 64 percent more likely to be on the job at 6 months.
So there are ways in which workforce interventions, if
well-designed and evaluated in different parts of the country
to allow for the local context, can make a big dent in
addressing turnover and retention.
Chairman DeSaulnier. You are muted, Congressman.
Mr. Mrvan. I just wanted to give a quick narrative. I was
able to join a symposium where it was long-term workers, and
there was a family who had an individual who was disabled, a
daughter, and ultimately the continuity of care was their most
important aspect of what was going on in their life. And the
continuity of care actually did play a role in the quality of
care and the outcomes.
With that, I was just going to ask Ms. Torres if you could
briefly just touch base on the value of continuity of care as
you do this job.
Ms. Torres. Could I have the question again?
Mr. Mrvan. Just if you would touch base on the continuity
of care, how valuable it is to have a long-term employee with
someone who needs long-term care.
Ms. Torres. It is really important. It is really important
because they need us. They need us. Some of them don't even
have family Members. And without us, they can't take their
medication, take a shower, have something to eat. So we are so
important to them, and they need us that much. So it is
absolutely important to be there.
Mr. Mrvan. Well, I thank you for what you do.
And, again, I yield back my time. And thank you both for
your answers.
Chairman DeSaulnier. Thank you, Representative.
The Chair will now recognize Representative Castro for five
minutes.
Mr. Castro. Thank you, Chairman.
Immigrants make up over a quarter of the direct care
workforce yet are largely unprotected and provide essential
support for so many Americans.
And this is why I introduced the Citizenship for Essential
Workers Act, to ensure that these workers who are risking their
lives during COVID are now provided the protection that they
deserve. We must ensure protections and support for our care
workers, and we cannot overlook them any longer.
And so I had a question for Mr. Espinoza: Can you talk
about the importance of immigrant direct care workers in the
healthcare workforce and what challenges they face in this
workforce, such as isolation and the risk of contracting COVID-
19?
Mr. Espinoza. Yes, absolutely. Thank you, Congressman. I
mentioned earlier that about one in four direct care workers is
an immigrant, and we can assume that immigrants are also a big
part of the gray market where many consumers, out of financial
need, hire workers off the books, so to speak, and create those
employment arrangements.
Our research shows that they are a vibrant part and a
growing part of this sector. They come from 124 countries. They
speak 157 languages. And yet we know that we are at a time in
our country where anti-immigrant hostility is on the rise, and
many workers feel unstable, not just in their jobs but in their
communities.
So all of the challenges that all direct care workers face,
like inadequate compensation, limited training and advancement
opportunities, a lack of workplace benefits or general
recognition and support, immigrants face as well, but they face
it within a heightened context, because so often the
instability they are facing doesn't end at the job. It
continues on in their lives, in their homes and in their
communities.
I do think there are a wide range of interventions that
could be used to bolster supports for immigrants in this
sector. Certainly, we would advocate for pipeline approaches
that would bring more immigrants or foreign-born workers into
this sector. We would also argue for interventions that support
immigrants who are already here and working in direct care.
In New Mexico, an organization called Encuentro developed a
really amazing home care training program that it delivers in
Spanish and English for immigrants in home care. And it
prepares them and employs them once they undergo the training,
but it also helps them navigate life challenges and employment
challenges.
So I do think, as our country becomes more diverse, that
there are great opportunities for innovators in the field to
think about how do we capitalize on a rich and diverse country?
How do we draw on the strengths that immigrants bring to this
sector?
Mr. Castro. Sure. And you touched upon some of the things
that, as a Congress, as an American government, we can do to
support them.
I want to ask you specifically about a few more things.
First, with respect to workforce training, what can we do to
provide better workforce training for this group of folks? And
also, support that is available in their language and in their
communities as well.
Mr. Espinoza. Thank you for the question, Congressman. In
general, to improve training for these workers, we need a few
strategies. One is we need to strengthen training requirements
for all direct care workers, but especially personal care
aides, which are a growing--probably the largest segment of the
direct care workforce, yet there is no Federal requirement. And
no State goes past 40 hours a week of training, right? So--40
hours training total for entry-level workers.
So we certainly need to strengthen training requirements.
We need to standardize training and make them portable and
stackable so that workers can work across occupations, but
also, they can work across settings and across States. Too
often workers need to be retrained again when they move jobs or
when they move States, for example, right?
And we certainly need training that is culturally and
linguistically competent, recognizing that so many workers are
people of color and women and might benefit from training that
is more appropriate for the kinds of challenges or learning
styles that they have.
There are opportunities I think in the Direct CARE
Opportunity Act to test and bring to scale those kinds of
training interventions so that we can make sure that all
workers have the knowledge and the skills and confidence to
succeed in the jobs.
And we need more research specifically on the gray market.
What does that sector look like? What are the experiences of
workers, specifically immigrants, in that sector? And what are
the experiences of consumers who, out of financial need, are
turning to the gray market? And that is another place where I
think Federal leadership can really make a dent in this
workforce.
Mr. Castro. Well, thank you very much for those responses.
And I yield back, Chairman.
Chairman DeSaulnier. Thank you, Mr. Castro. I don't see
anyone else. If there is anyone else, any Members who would
like to speak, now is the time. If not, I am going to go to a
little housekeeping work before we go to closing comments. And,
again, thank you to all the witnesses for being here. Really
great testimony, very helpful.
So, with that, I want to remind my colleagues that,
pursuant to Committee practice, materials for submission for
the hearing record must be submitted to the Committee Clerk
within 14 working days following the last day of the hearing,
so by close of business on August 3rd, preferably in Microsoft
Word format. The material submitted must address the subject
matter of the hearing.
Only a Member of the joint Subcommittees or an invited
witness may submit materials for inclusion in the hearing
record. Documents are limited to 50 pages each. Documents
longer than 50 pages will be incorporated into the record via
an internet link that you must provide to the Committee Clerk
within the required timeframe, but please recognize that in the
future that link may no longer work.
Pursuant to House rules and regulations, items for the
record should be submitted to the clerk electronically by
emailing submissions to [email protected].
Witness questions for the hearing record--I just want to
mention again I want to thank the witnesses for their terrific
participation today and your obvious interest and passion for
this subject matter and expertise. Members of the joint
Subcommittee may have some additional questions for you, and we
ask the witnesses to please respond to those questions in
writing. The hearing record will be held open for 14 days in
order to receive those responses.
Again, I want to remind my colleagues that, pursuant to
Committee practice, witness questions for the record must be
submitted to the Majority Committee Staff or Committee Clerk
within seven days. The questions submitted must address the
subject matter of the hearing.
Now we will go to closing statements. And I want to
recognize the distinguished Ranking Member of the Higher
Education and Workforce Investment Subcommittee, Dr. Murphy,
for a closing statement. Dr. Murphy.
Mr. Murphy. Thank you, Mr. Chairman.
I understand the difficult work--I want to thank all the
Committee Members and the witnesses. I appreciate your counsel
and a lot of good discussions today.
I understand the difficult work environment that direct
care workers can find themselves in, because I have worked
alongside them, as I have said previously, as a physician for
over 30 years. Their contributions are meaningful. They make a
difference in so many, many lives, especially toward the end of
life. We are going to rely on these important individuals as
our populations grow and as our population ages.
Our witnesses did a wonderful job today of illuminating
some of the challenges that these and other healthcare workers
face. I look forward to working with my colleagues on both
sides of the aisle to consider how public policy can foster an
environment where more people will consider the healthcare
workforce as a valuable and rewarding career path.
The best way to do this is to strengthen WIOA. Healthcare
occupations must be examined within the context of all
professions to make sure that job seekers are fully informed.
WIOA can help direct care workers gain the skills that they
need to succeed in the long term, no matter which career path
they can pursue.
Thanks again to all the witnesses. This was a very good
Committee meeting.
Thank you, Mr. Chairman. I yield back.
Chairman DeSaulnier. Thank you, Representative Murphy,
appreciate your comments.
And now I would like to recognize my co-Chair and thank her
again for being able to step in for me. I had a couple other
hearings going on at the same time, and one of them requires a
little nimbleness, the Oversight Committee.
So Chair Wilson, thanks again, and happy to have you have
any closing comments.
Chairwoman Wilson. Thank you, Representative DeSaulnier.
I want to thank our amazing witnesses for sharing their in-
depth expertise and moving experiences. This has been a very
insightful hearing. There are people in our country doing God's
work. Thanks to all of the direct care employees in the Nation
who help our families and our constituents every single day. We
appreciate you.
As we all heard throughout our discussions, direct care is
physically and emotionally taxing work. It is hard. Yet, while
the demand for direct care services is surging, workers today
aren't earning living wages or even receiving the necessary
training to safely do their jobs. They need our help, and it is
our responsibility to help them.
People are living longer and longer and desire to live in
their own homes. That is why we need to secure significant
resources for direct workers by passing the American Jobs Plan
and the Direct CARE Opportunity Act.
These proposals would take significant steps toward
recruiting and reinforcing the direct care workforce pipeline,
and they would help create millions of good-paying jobs as our
economy recovers from the pandemic.
Most importantly, investing in our direct care workers
would increase our capacity to help aging Americans and
individuals with disabilities live with independence. We have
to pay these employees what they are worth. As a matter of
fact, their job description is priceless.
I am grateful for our discussions today, and I yield to the
Ranking Member--and I yield to the Ranking Member for his
closing statement.
Chairman DeSaulnier. We will go to the good son, Mr. Allen.
Mr. Allen. Thank you. It is great to be with you today. And
I thank the witnesses for their helpful testimony.
COVID-19 brought attention to the immense sacrifices
frontline workers make every day. They deserve our recognition
and thanks. In fact, all of our medical professionals do.
As Republican leader of the Subcommittee tasked with
developing healthcare and labor policies, I am particularly
interested in supporting individuals who may be interested in
entering the direct care workforce. In my mind, Congress must
clear the way for State and local workforce boards to leverage
private sector innovations occurring in their communities.
Mr. Burani's testimony shows us how critical it is to set
folks up for long-term success. Creating additional single-
interest government programs is short-sighted. Our Committee
can do better than spending additional taxpayer dollars on
short-term Band-Aids. We need to heal the root cause of our
problem.
As this Committee considers a bipartisan reauthorization of
WIOA, we must consider how we can address all workforce
challenges facing our Nation, and they are many.
Thank you, Mr. Chairman, for the hearing today, and I yield
back.
Chairman DeSaulnier. Thank you, Mr. Allen. It is always a
pleasure.
I would now like to recognize myself for the purpose of
making a closing statement. Again, thank you all, all of the
witnesses, for participating. Really terrific. Ms. Torres,
thank you, always most important to hear from the people
actually providing the services, not to diminish the
contributions of the other witnesses as well.
And to the Ranking Members and Chair Wilson, thank you so
much. Certainly, I think if we can't agree on helping seniors,
our moms and dads, our uncles and aunts, gosh, I don't know
what we could agree with. And knowing and respecting that there
will be some challenges with that, I do want to mention Ranking
Member Murphy's comments about being good stewards of
taxpayers' funding. I completely agree.
One of the interesting things that we talked about a little
bit is just the effective and efficient role for the Federal
Government and our partners at the State and local level and
being client-based on their needs and listening to them and the
workers like Ms. Torres.
So that is a real challenge, and I really appreciate all of
the comments from the witnesses. You clearly see this in
delivering these services in a very different social model. I
always think of growing up in a rural community in New England,
not far from Representative Fay, in Massachusetts that was
changing into a suburban community outside of Boston, where all
of my uncles and aunts and my grandparents were all within 15,
20 minutes, and we all shared. It was a really remarkable bond.
But that time, for better or worse, is not the world we live in
now. So you all know that, and how we adapt to that is so
important.
And then last, just the urgency I feel, having been in this
field for a while at the State, local, and now Federal level.
People are suffering now and, indeed, people are losing their
lives that could be extended and the quality of life could be
extended if we acted with urgency collectively.
And I think of my own mom, and I really appreciate all the
comments from Members about their personal experiences as well
as their professional, but the issues around transfer trauma as
she moved out of independence, but also the trauma of workers
coming in and having to establish a relationship in a new
environment when they came into her home.
So all of these things, I think there is a real opportunity
for us to work together to really improve the system. And I
would say, when we look at internationally and nationally,
there are really good models. And as we look at workforce
investment, a conversation I have had with Ranking Member Foxx
for years, sometimes comical from our perspectives, but the
importance of incentivizing best practices at Workforce
Investment Boards at the State and local level so we can learn
from one another, as Representative Fay has indicated, but not
just accepting the status quo.
So, with that, as we reflect on the critical role that
direct care workers play in ensuring that aging Americans and
Americans with disabilities can live independently, I just want
to thank everyone again.
Unfortunately, the challenge is real, as we discussed.
Direct care workers are still not being provided the basic
tools to make them successful for their clients: Fair pay, good
working conditions, and continuing training that would allow
them to join and stay in these professions and change the
really horrible 82 percent turnover. And that is prepandemic.
So some of the comments by some of my colleagues, the pandemic
has clarified and made it worse, but we had a real problem
before the pandemic.
So this chronic lack of investment in direct care workers
must change if we are to secure the future of direct care
workers and the clients that they serve. To that end, I am
pleased we discussed how the investments in the American Jobs
Plan, drawing from the Direct CARE Opportunity Act, would
strengthen the direct care workforce pipeline.
I look forward to drawing from our conversations today and
working with all of my colleagues to secure the support that
our direct care workers need to provide long-term care for our
communities and for our country.
Thanks again so much. And if there is no further business,
without objection, the Joint Subcommittees will now stand
adjourned. Thanks again so much.
[Questions submitted for the record and the response by
Representative Fay follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
[Whereupon, at 1:43 p.m., the Subcommittees were
adjourned.]
[all]