Report: Advancing the Home Care Workforce

6. Regional Context In this chapter, we turn our attention to counties in Western New York and Southeast Michigan. 60 For both regions, we examine demographics trends and current home care programs. In addition, based on additional data we were able to collect that was different in the two states, we included additional analyses. For Western New York, we report on an analysis we conducted of a home care training registry. For Southeast Michigan, we describe an emerging stakeholder coalition focused on developing the direct care workforce. Additional data we were able to collect is provided in Appendices 5 to 9. To examine demographic trends, we used data from the last five years and focused on two main population-level indicators: current and projected old-age dependency ratios. Old-age dependency ratio is defined as the number of individuals aged 65 and over per 100 people of working age defined as those aged between 15 to 64 years old. 61 We observed that the Western New York counties of interest have a relatively older population than the rest of New York. In contrast, Southeast Michigan counties of interest have a slightly younger population than the rest of the state. These trends are projected to continue in the future. See Appendix 1 for more details. 6.1. Western New York 6.1.1. Home Care in Western New York Home care is available in New York through several mechanisms 62 , as follows: 1. Medicaid Managed Long Term Care (MLTC) Programs 2. Community First Choice Option (CFCO) The MLTC offers personal care at home and in adult daycare settings. Enrollment in MLTC is mandatory for those who are eligible for both Medicare and Medicaid (dual eligible), are over 21 years, and need long-term care services for more than 120 days. About twelve MLTC plans are available in the Western New York region, and nearly 11,000 individuals are enrolled in these plans in the western counties of interest. See appendices 6 and 7 for more details. CFCO was approved in 2015 under New York’s State Medicaid Plan Amendment SPA 13–35. CFCO allows long-term services and supports that were previously only available through a waiver to be Medicaid State Plan Services. Additional federal money is available for home-based services performed by an HCW. CFCO participants can choose to hire personal caregivers, or New York state can choose them on their behalf. 3. Consumer Directed Personal Assistance Program (CDPAP) 4. Expanded In-home Services for the Elderly Program (EISEP) 5. Private Pay Home Care Services Program Pilot (Upcoming)

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