As 2019 nears its end, the HWRC-LTC is excited about the projects we have underway as well as the impact of our research. We’ve been on the road, writing reports, and discussing pressing workforce issues with policy leaders and journalists to support national and local efforts to ensure that our health care workforce is prepared to meet the growing long-term care needs of the aging U.S. population.
New Article on Changes in Home Care Providers
UCSF HWRC collaborator Michelle Ko, Associate Professor at UC-Davis, published an article with HWRC Director Joanne Spetz in Home Health Services Quarterly. The article, titled “Changing home care aides: Differences between family and non-family care in California Medicaid home and community-based services,” analyzes data on first-time home and community-based services recipients in California to examine factors associated with the likelihood of switching home care aides within the first year of services. The study finds that those with family home care aides were less than half as likely to change than those with non-family aides and racial/ethnic minorities with non-family aides had the highest switching rates. Lower wages and local unemployment were associated with switching of non-family aides but not family aides. Dr. Ko and her coauthors conclude that policymakers can foster continuity of home care by paying family members for home care and raising worker wages.
UCSF HWRC Faculty Present at the International Health Workforce Collaborative in Ontario, Canada
Susan Chapman, Joanne Spetz, and Beth Mertz attended the 18th International Health Workforce Collaborative meeting in Ottawa in October. Dr. Chapman presented a poster on community health worker skills in addressing social determinants of health and served on the Supporting Indigenous Health Workforce Participation and Career Advancement workgroup. Dr. Spetz presented two posters, one summarizing the recommendations to advance the workforce for care of those with serious illness developed at a Summit in 2018, and one on her recent research on nurse practitioner engagement in medication treatment for opioid use disorder. Dr. Mertz also presented a poster titled “Dental Therapists in the United States: Health Equity, Advancing?”
The meeting had a pre-conference “Data Olympics” day covering data and methods for health workforce tracking. Dr. Spetz presented “Integrated Primary Care Supply and
Demand Projections: Removing the Language of ’Physician Shortage’ to Advance a Policy Agenda,” which focused on her research with Janet Coffman on primary care shortages in California. This research guided the California Future Health Workforce Commission’s recommendations related to expanding primary care supply. Dr. Spetz won the “Integrated Health Workforce Planning” event and fellow HWRC director Erin Fraher of the Carolina HWRC won the “Data Visualization” event.
Presentations at the Gerontological Society of America Annual Scientific Meeting
UCSF HWRC research was part of the Gerontological Society of America Annual Scientific Meeting again this year. Susan Chapman chaired a session on Long-Term Care and, in that session, presented a paper titled “Technology in Long Term Care: Does it Facilitate the Workforce or Improve Satisfaction and Retention?” This was based on our report on this topic, published earlier this year, coauthored by Joanne Spetz and Jackie Miller. Dr. Spetz also was a coauthor on “Optimal staffing models to care for frail elderly adults in primary care and geriatric practices,” presented by Karen Donelan of Massachusetts General Hospital and Harvard University.
Second Annual Evaluation Report of the Support at Home Program Completed
Support at Home (S@H) is a pilot program of the San Francisco Department of Aging and Adult Services to provide home care vouchers to keep San Francisco adults with disabilities and seniors living safely in the community. The goal of Support at Home is to serve individuals who are not eligible for other subsidized home care programs, like Medi-Cal In-Home Supportive Services (IHSS), due to income/resource limits or other program requirements. The program is administered by Institute on Aging (IOA) and is being evaluated by Laura Wagner, Joanne Spetz, Jackie Miller, and Connie Kwong of the UCSF HWRC. The second-year evaluation report was published in September, reporting notable improvements in rates of emergency department visits, hospitalizations, and quality of life among participants. The final evaluation report will be completed in summer 2020.
New Reports on Scope of Practice Regulations for Midwives and Community Paramedics
UCSF HWRC researchers published two more briefs on scope of practice regulations for health professionals to guide future policymakers in California and nation. The first report, “Left Behind in California: Comparing Community Paramedicine Policies Across States,” provides an overview of state laws governing community paramedicine across the United States, including laws describing their scope of practice, educational requirements, and reimbursement policies. The second brief, “California’s Midwives: How Scope of Practice Laws Impact Care,” provides information about how states regulate nurse-midwives and direct-entry midwives and reviews the literature on midwives’ impact on access, quality of care, and costs. These briefs are part of a series
that examines California regulations of health professions, including nurse practitioners, physician assistants, and home care aides.
California Budget and Health Workforce for California
In October, a team of researchers from Healthforce Center at UCSF released a detailed analysis of how California’s state government budget this year includes allocations for health workforce development, where unspecified funds could be spent to make the biggest impact, and where the state should invest next year to continue making rapid progress in addressing the state’s health workforce needs. The authors, Janet Coffman, Timothy Bates, and Joanne Spetz prioritized five areas on which they recommend there be budget allocations next year.
Workforce Strategies Can Expand Access to HIV Prevention Medication
Faculty and staff from the UCSF HWRC work on many other programs and projects, including the California Health Benefit Review Program, which brings together researchers across the UC system to analyze the potential impacts of legislation that would affect health benefits. In October 2019, the legislature passed a bill that expanded access to HIV prevention medication. HWRC researcher Jackie Miller wrote a blog post, Increasing Access to HIV Prevention Medication, that discusses this new law and why it is important.
Strengthening International Relationships
In September, Joanne Spetz spent two weeks as a visiting professor at the Edith Cowan University School of Nursing and Midwifery in Joondalup, Western Australia. While there, she provided instruction and consultation on health economics analysis in nursing research and was invited to present HWRC research at local universities and hospitals. One of the presentations was for the Association of Culturally Appropriate Services, at which Dr. Spetz presented with Prof. Mari Miyake of Kansai Medical University, Japan. Dr. Spetz and Dr. Miyake spoke about strategies to meet the care needs of older populations in the U.S. and Japan, including the new government-funded long-term care insurance program in Japan, strategies to improve home care services, and community-based integrated care systems.
Recent Publications from UCSF HWRC-LTC Investigators
Coffman, J, Bates, T, Spetz, J. California’s 2019-20 Budget and the 10 Priority Recommendations of the California Future Health Workforce Commission. San Francisco, CA: Healthforce Center at UCSF. September 2019.
Coffman, J, Kwong, C. Left Behind in California: Comparing Community Paramedicine Policies Across States. Oakland, CA: California Health Care Foundation. November 2019.
Kwong, C, Brooks, M, Dau, KQ, Spetz, J. California’s Midwives: How Scope of Practice Laws Impact Care. Oakland, CA: California Health Care Foundation. October 2019.
Wagner, L, Miller, J, Spetz, J, Kwong, C, Hashem, T. Evaluation of the San Francisco
Support at Home Program: Year 2 Report. San Francisco, CA: Healthforce Center at UCSF. September 2019.
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