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American Recovery And Reinvestment Act Of 2009

Floor Speech

Location: Washington, DC


Mr. KOHL. I appreciate my colleague's remarks. I was pleased to collaborate with him on the dairy letter he just referenced, and I am glad to note his support for the work the committee has done to address the credit demands confronting family farmers. My expectation is that the USDA will utilize these resources in accordance with the programs and priorities set forth in the farm bill. Family farming and ranching businesses are facing many of the same challenges confronting our broader economy and the operating and farm loans contemplated under the bill are extremely important.


Mr. KOHL. We already have a shortage of health care workers who are trained and devoted to caring for older Americans and those with disabilities--a fact that is well documented in the report issued by the Institute of Medicine last year. This shortage is one that will only grow more desperate as our country ages rapidly. The United States will not be able to meet the approaching demand for health care and long-term care without a workforce that is prepared for the job.

Between 2005 and 2030, it is estimated that the number of adults aged 65 and older will almost double from 37 million to over 70 million, increasing from 12 percent of the population of the United States to almost 20 percent of the population. So it is not surprising that the Department of Labor's Bureau of Labor Statistics predicts that personal or home care aides and home health aides will represent the second and third fastest growing occupations between 2006 and 2016.

Only last week, the New York Times published an editorial concluding that, ``With more jobs being lost all the time across the board--more than 71,000 layoffs in the United States were announced on Monday and Tuesday alone--there should be comfort in the fact that one sector, health care, continues to add jobs.'' I will ask to have this editorial printed in the Record.

Government has a special obligation to care for vulnerable populations. Inadequate training in geriatrics, gerontology, chronic care management, and long-term care is known to cause misdiagnoses, medication errors, and inadequate coordination of services and treatments that result in poor care and are costly for the health care system as a whole. Yet personal and home care aides are not subject to any Federal requirements related to training or education, and States have very different requirements for this key part of the direct care workforce. Furthermore, Federal training requirements for nurse aides and home health aides have not been updated for more than 20 years. It is time to review and improve training standards for all direct care workers. Current training protocols focus too much on tasks and too little on teaching how workers can deliver person-centered care. Further, often training does not reflect the increasingly complex needs of the frail elderly. Inadequate training has been found to be a major contributor to high turnover rates among direct care workers, while more training is correlated with better staff recruitment and retention.

Equally important, the IOM report recommends that State Medicaid programs increase pay and fringe benefits for direct care workers. Investment in direct care jobs would significantly benefit our economy by providing greater economic opportunity to low-income workers, while also strengthening health services for our aging and disabled family members and friends.


Mr. KOHL. I thank Senator Wyden and Senator Baucus for their attention to these important policies and look forward to working with them in the weeks ahead.

Mr. President, I ask unanimous consent that the editorial to which I referred be printed in the Record.

There being no objection, the material was ordered to be printed in the Record, as follows:
[From the New York Times; Jan. 28, 2009]

Caring for the Caregivers

With more jobs being lost all the time across the board--more than 71,000 layoffs in the United States were announced on Monday and Tuesday alone--there should be comfort in the fact that one sector, health care, continues to add jobs. In December, employers added 32,000 health-related positions.

Unfortunately, one of the fastest-growing areas within the health care field--home care for the elderly--also is one of the lowest paid and most exploitable.

Outdated labor rules from 1975 allow home care aides to be defined as companions, which exempts their employers, usually private agencies, from federal standards governing overtime and minimum wages. As the population has aged, however, demand for home care has grown and the work has evolved far beyond companionship. It is not uncommon for home care workers to perform significant housekeeping chores and to help their elderly clients move, dress and eat, make sure they take their medicines and go to doctors' appointments.

In its last days in office in 2001, the Clinton administration proposed a revision to the labor rules to allow federal protections to apply to personal home care aides, but the Bush administration promptly threw that out and reasserted the status quo. A 2007 Supreme Court ruling upheld the rules, and a push that year by House and Senate Democrats to pass a bill to update the law went nowhere.

According to the Labor Department, personal and home care aides are expected to be the second fastest-growing occupation in the United States from 2006-2016, increasing by 51 percent, slightly behind the expected growth in systems and data communications analysts.

Most home care aides are women, low income and minority, and many of them are immigrants. Some states have taken steps to provide them with basic labor protections. Efforts to unionize home care workers in some states also has led to wage gains and better conditions. But the progress is incomplete without a federal law to recognize and protect the home care work force. It is unconscionable that workers who are entrusted with the care of some of the nation's most vulnerable citizens are themselves unprotected by basic labor standards.

It is also unwise, because poor pay for long hours leads to high turnover, which undermines the quality of care. Turnover also drives up the cost of providing home care--a needless drain on Medicaid, which pays for many home care services. And that is not the only way that poor quality home care jobs end up costing taxpayers. Nearly half of home care workers rely on food stamps or other public assistance, so taxpayers ultimately compensate for their low pay and inadequate benefits.

Of necessity, job creation and job quality will be the focus of the Obama administration in 2009, and, most likely, for many years. The Department of Labor could rewrite the rules to extend federal protections to home care workers. Or Congress and the White House could work together to pass a law granting those protections. Either way, the point is to ensure that home care, a 21st-century growth industry, creates good jobs.


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