GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
S	1
SENATE BILL 180*

 
 
Short Title:	Long-Term Care/Enhancement Funds.	()	
Sponsors:	Senators Purcell;  Carter, Dannelly, Forrester, Harris, and Metcalf.	
Referred to:	Appropriations/Base Budget.	
February 19, 2001

	A BILL TO BE ENTITLED
AN ACT TO APPROPRIATE FUNDS FOR LABOR ENHANCEMENT PAYMENTS FOR WORKERS IN LONG-TERM CARE FACILITIES AND AGENCIES.

Whereas, North Carolina's population of adults age 65 and older currently totals one million and is expected to increase by 34% to over one million six hundred thousand by the year 2020; and
Whereas, nurse aides and other aide workers provide about 90% of all the paid long-term care needed by older and disabled adults whether at home or in facilities; and
Whereas, this workforce is essential to quality care and preserving the dignity of persons who need help with the very basic and personal tasks that many of us take for granted; and
Whereas, North Carolina invests more than $1.4 billion for services that rely heavily on the aide workforce to meet the needs of vulnerable citizens in the State who cannot afford to pay privately for the long‑term care they need; and
Whereas, between 1996 and 2006, nurse aides and other paraprofessional aides are and will be among the occupations with the fastest and largest job growth; and
Whereas, demand for these workers will continue to grow well beyond 2006 as a result of aging baby boomers who will put further increased demand on the State's long‑term care system; and
Whereas, North Carolina is experiencing aide shortages of crisis proportions in all long‑term care settings including home care, assisted living facilities, and nursing homes; and
Whereas, 58% of North Carolina's nurse aide registrants are not working as nurse aides and have substantially higher average annual earnings and more stable employment than they would have were they working as nurse aides; and
Whereas, our State's low unemployment rate is only one factor contributing to the severe shortage of aide workers; and
Whereas, there are other major factors that contribute to high turnover rates including low wages and few paid benefits in spite of very physically demanding work and lack of a career path that recognizes attainment of increased skills; Now, therefore,
The General Assembly of North Carolina enacts:
SECTION 1.(a) There is appropriated from the General Fund to the Department of Health and Human Services the sum of seventeen million six hundred seventy thousand nine hundred seventy-five dollars ($17,670,975) for the 2001‑2002 fiscal year and the sum of twenty‑three million four hundred sixty thousand, seven hundred thirteen dollars ($23,460,713) for the 2002‑2003 fiscal year.  These funds shall be used to match federal Medicaid funds to provide a ten percent (10%) labor enhancement payment for Medicaid‑reimbursed long‑term care services.  These funds shall be in addition to funds provided for routine inflationary increases in Medicaid reimbursements for long‑term care services.  The funds appropriated in this section shall be used only to increase wages or benefits for long‑term care aide workers, or to provide for shift differential payments for long‑term care aides who work during hard‑to‑fill working hours or shifts.
SECTION 1.(b) Funds appropriated in this section shall be allocated in accordance with the following:
(1)	The amount of the labor enhancement benefit shall be allocated equitably among the various care settings.
(2)	Long-term care facilities and agencies that receive labor enhancement funds shall have the flexibility to determine whether labor enhancement funds are used for wages, benefits, or shift differentials, or any combination thereof.
(3)	If labor enhancement funds are used to enhance wages, the long‑term care facility or agency shall determine which aides receive wage increases and the amount of the increase provided. The determination shall be based on local market wage demands, rewarding longevity of service by the worker, and other wage‑related needs of the agency or facility.
(4)	Long‑term care facilities and agencies that receive labor enhancement funds shall, as a condition of receiving the funds, submit reports and information required by the Department for the purpose of verifying use of the labor enhancement funds. Reports and information provided by facilities and agencies shall include for each facility and agency information needed to determine annual labor turnover rates in the agency or facility, including data on prelabor enhancement turnover rates and turnover rates at the end of each fiscal year for which labor enhancement funds are received.
SECTION 1.(c) Not later than January 15, 2002, the Department of Health and Human Services shall report to the House Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Human Resources, and the Legislative Study Commission on Aging on the use of labor enhancement funds appropriated under this section.  The report shall include detailed information on:
(1)	The amount of funds used for wages, for benefits, and for shift differentials.
(2)	Comparative information on average hourly wages paid to aides and turnover rates by setting (e.g. home care, assisted living, nursing home) for fiscal year 1999‑2000 through fiscal year 2002‑2003.
SECTION 2.(a) The Department of Health and Human Services, Division of Facility Services, shall develop and implement a Carolina Educates Caregivers Program ("Program") for aides working in long‑term care.  The purpose of the Program is to facilitate the development of a stable, well‑trained labor force to provide long‑term care services.  To this end, the Program will provide bonuses, tuition, and other financial assistance and incentives to support continuing education and professional development for long‑term aides.  The Program shall provide ongoing support to educate long‑term care workers and shall be modeled after the TEACH program for child care workers.  For purposes of this section, long‑term care includes home care agencies, assisted living facilities, and nursing homes.  The Department may contract for assistance with the development and implementation of the Program with a public or private nonprofit organization that does not represent one or more long‑term care provider groups and that has expertise in low‑wage or health care workforce recruitment and retention issues.
SECTION 2.(b) There is appropriated from the General Fund to the Department of Health and Human Services the sum of one million four hundred six thousand twenty‑nine dollars ($1,406,029) for the 2001‑2002 fiscal year, and the sum of two million ninety‑seven thousand three hundred one dollars ($2,097,301) for the 2002‑2003 fiscal year.  These funds shall be used for the development and implementation of the Carolina Educates Caregivers Program established pursuant to this section.  Funds shall be used to provide bonuses, tuition, and other financial assistance and incentives to support continuing education and professional development for long‑term care aides.  Not more than ten percent (10%) of the funds appropriated for each fiscal year may be used for administrative expenses and start‑up costs to implement and operate the program.  Funds unexpended and unencumbered at the end of each fiscal year shall revert to the General Fund.
SECTION 2.(c) Not later than January 15, 2002, the Department shall report to the North Carolina Study Commission on Aging on the implementation status of the Carolina Educates Caregivers Program.
SECTION 2.(d) The Department of Health and Human Services shall develop a career ladder and associated new curricula requirements and job category qualifications for long‑term care aide workers.  The purpose of the career ladder is to provide a career path for aide workers that recognizes the attainment of additional skills and broadens the pool of potential workers by providing additional job opportunities for persons who may not currently consider long‑term care as a career option.  The Department shall work with appropriate State organizations such as the North Carolina Board of Nursing, the Center for Nursing, the Community Colleges System, long‑term care provider organizations, and others to consider the need to reengineer current job categories of aide workers and develop new job categories of licensed and unlicensed personnel as needed to meet current and future care needs of long‑term care clients and patients.
SECTION 2.(e) There is appropriated from the General Fund to the Department of Health and Human Services the sum of one hundred thousand dollars ($100,000) for the 2001‑2002 fiscal year for the development of a career ladder as provided in this section.
SECTION 3.(a) The Department of Health and Human Services shall compile and evaluate demographic, turnover, and wage and benefit data for the long‑term care aide workforce across long‑term care settings.  This compilation and evaluation shall be ongoing in order to provide the information necessary to track the impact of efforts to increase the supply and stability of the long‑term care aide workforce and to provide data from which additional efforts can be considered.
SECTION 3.(b) There is appropriated from the General Fund to the Department of Health and Human Services the sum of fifty thousand dollars ($50,000) for the 2001‑2002 fiscal year, and the sum of fifty thousand dollars ($50,000) for the 2002‑2003 fiscal year.  These funds shall be used for data collection and compilation required under this section.  The Department may contract with the North Carolina Institute on Aging for this data collection and analysis activity.
SECTION 4.  The Legislative Research Commission may study workforce issues pertaining to the long‑term care aide workforce.  In conducting this study the Commission may consider State and national efforts to address a crisis in developing and maintaining a stable, well‑trained workforce of workers providing long‑term care services.  The Commission may also propose actions the State may need to take to ensure that the State's long‑term care workforce capacity meets the long‑term care needs of an increasing elderly population.  In appointing study committee members, the Speaker of the House of Representatives and the President Pro Tempore of the Senate may consider including public members who represent the long‑term care industry, long‑term care consumer advocates, and individuals employed as nurse aides in this State.
SECTION 5.  Section 1 of this act becomes effective October 1, 2001.  The remainder of  this act becomes effective July 1, 2001.