Prospects for workfare in nursing homes.

Last year's welfare reform set ambitious targets for finding work for the four million adults in the United States who were receiving Aid to Families with Dependent Children (AFDC) in December. By the end of this year, one-fourth of these adults are required to be in some type of work-related activity, of which paid employment is only one of several options. By the end of the year 2002, the adult welfare caseload must be reduced to two million, or fewer than 2% of all adult Americans.

In fact, the welfare rolls have already been dropping dramatically. According to a spokesperson for the U.S. Department of Health and Human Services (HHS), our booming economy, combined with recent minimum wage increases making employment more attractive, has generated employment for almost 20% of the adults formerly on AFDC. The immediate problem is finding appropriate work experience for enough people during the second half of this year to meet the individual targets for each state.

Can nursing homes and other long-term care providers help? In all truth, analysts at the U.S. Department of Labor are not optimistic. They acknowledge that, in the past, "nursing homes have traditionally been used by the employment and training system to place individuals." However (and perhaps unbeknownst to many in long-term care), this changed during the early 1990s, when Federal and state employment and training system officials discouraged the unemployed from seeking training for nursing home and home health care jobs because pay scales were too low and benefits lacking. They reasoned that many would decide that welfare, including Medicaid and state-financed child care, was in fact a better deal than working in nursing homes.

These disincentives changed somewhat with welfare reform, when any job became a "good job." Still, the analysts at the Federal Bureau of Employment and Training conclude that nursing homes would themselves be unwilling to employ former welfare recipients. According to the Bureau's Charles L. Atkinson, "The key is that nursing homes often want trained individuals . . . which works in contrast to the Work First principle."

Michael Kharfen, Director of Public Affairs at the HHS Administration for Children and Families, says his Department of Labor colleagues may be right about the skill level of most welfare recipients, but that many attempting to escape welfare may indeed be trainable for skilled nursing home and long-term care work. "It's true that half of AFDC recipients do not have a high school degree," he notes, "but that means that half do. In fact, we've been finding hundreds of people with community college and even four-year college degrees on the rolls."

Kharfen notes that $3 billion has been targeted for investment in areas with high welfare caseloads. States have the flexibility to use these funds for innovative approaches, including training targeted for specialized fields, such as health care. "The states are now tailoring individual programs for individual recipients. Instead of saying, "Show us that you need money,' the states are using case management to say, 'This is who you are, these are your strengths, and this is what you have to do.' The result is much more geared to individuals' employment prospects and skills and to matching individuals with meaningful careers."

Though Kharfen was unfamiliar with the OBRA requirements for nursing assistant training, when these were described to him he responded that states and nursing homes might achieve a win-win situation by devoting some of the new Federal money to bearing the costs of this rather than relying solely on nursing homes themselves to do so.

This all sounds very promising, but there is a potential - and very ironic - hitch: the criminal record check recently endorsed by the American Health Care Association and other nursing home industry supporters aimed, quite rightly, at reducing resident abuse. Most welfare recipients are not criminals, but as a group have higher than average rates of conviction for criminal offenses. Some of this relates directly to welfare status, notes a spokesperson for the Child Welfare League of America. For example, single mothers seeking jobs or attending classes may leave children unattended at home; if they are on welfare caseloads, they are likely to be monitored by child welfare departments and receive citations for child neglect. Some welfare recipients have also, of course, sought to supplement their incomes within the "underground economy," meaning anything from running an unlicensed day-care center to trafficking in illegal drugs. Whatever the situation may be, the Child Welfare League spokesperson noted that "poor people are most likely to accept a plea bargain because they don't have the resources to make even a token legal defense."

The subsequent criminal record will stand in the way of their future employment by nursing homes or others, as background checks tighten up. In the last analysis, this may maintain the nursing home job market for immigrants willing to work in low-income positions, and dim the hopes of Americans seeking to break free of welfare's vicious cycle.