These recommendations result from four meetings held in September, October, December, and November, 2006. About 20 people attended each meeting representative of state government, consumers, workers, and providers. The meetings were facilitated by Craig Freshley of Good Group Decisions and planned by Lisa Pohlmann, Brenda Gallant, Elise Scala, and Elizabeth Gattine.The purpose of the meetings was to develop a response to Section 1, Paragraph 4 of Legislative Resolve 2991 of the 122nd Legislature, as follows:

Evaluate the need for a direct care worker registry, including desired objectives of such a registry and a cost estimate.

In learning about the issue and preparing this recommendation, participants learned about registries in other states, learned about the current registry of Certified Nursing Assistants (the CNA Registry), Maine Roads to Quality (a registry for the child care provider system in Maine), and  PASA Connection (a website to help match employers with direct care workers).

Our Long Term Vision
The group is unanimous in its belief that a direct care worker registry is needed. Further, while the group is unanimously in favor of creating a comprehensive directory of Direct Care and other workers, we realize that it’s impractical to expect achievement of the vision right away. None-the-less, we have developed a vision for a registry that will be useful to employers, workers, consumers and regulators; and which would result in improved consumer safety, worker opportunity; quality care giving, and consumer choice.Vision Statement
We envision a registry that serves as a central place where workers, consumers and employers can find information that will help promote professionalism, access and safety in the fields of personal care, direct support assistance and certified nursing assistance.

Objectives
We envision a registry that achieves the following objectives:

1. Increase the number of direct care workers hired in Maine by expanding the functions of the Certified Nursing Assistant registry.
2. Improve consumer and worker safety and reduce the cost of background checks for employers.
3. Improve general understanding and legitimacy of the direct care/support profession and improve consumer choice by using the on-line registry for public educational purposes.

Characteristics
The group also developed unanimous support for the following list of characteristics of such a registry:ß Accuracy

• Real time (quick and immediate information)
• Confidentiality safeguarded
• Accessibility
• Contain only necessary information
• Efficiency (easy to click around)
• Consumer friendly language
• Easy for workers to sign up

It was generally assumed that such a registry would be web-based in order to achieve all these characteristics.

 A Phased Approach to Achieving the Long Term Vision
Based on our research about other registries, current institutional capacities, current needs, and current economic and political realities, we recommend a phased approach to establishing a Direct Care Worker Registry, as follows:Phase I
This phase should be implemented immediately.

1. Improve CNA Registry as follows:
a. Ensuring adequate funding to allow for efficient processing and updating of all registrants.
b. Ensure that the current CNA registry meets all state/federal criteria or better
 i. Re-certification every two years
 ii. SBI Checks every 2 years
 iii. Computer up grades
c. Upgrade CNA registry
 i. Expanded internet access and other enhancements to meet employer needs
 ii. Up-to-date, 24/7 Internet access for direct care/support agencies

2. Take steps to reduce duplication of effort
a. Representatives from the state, CNA Registry, providers, and others should meet to explore how to reduce duplication.
b. One idea discussed was voluntary public disclosure of results of back ground checks paid for by potential employers, among others

3. Add static information that benefits workers and employers
The following types of information were suggested although there was not absolute consensus on this list as presented herein:
a. Provide general education about the field of work
 i. Provide general information on various direct care/support job titles and responsibilities, including such details as the difference between certified, licensed and registered jobs and career ladder opportunities.
 ii. Develop a crosswalk for existing job requirements and current trainings/classes.
b. Provide information on job opportunities
 i. Link to Maine’s Career Center website for information about current direct care employment opportunities.
 ii. Encourage providers to use the Career Centers for job postings.
c. Provide information about job training opportunities
 i. Provide information about train-the-trainer programs for both PSS and CNA.
 ii. Provide information on continuing education opportunities.
d. Provide a resource guide for consumers to assist in understanding the different categories of workers, types of home care agencies and the various state funded programs that cover direct care services.
e. Provide analytic reports about the workforce on-line
 i. Requires someone to collect data on workers, similar to the nurses’ minimum data set, through on-line surveys
f. Provide links to organizations and coalitions working to address the direct care worker shortage and to improve the working conditions for direct care workers.
g. Provide information about how to conduct a hiring process that helps to achieve quality care.

Phase II
This phase should be implemented as soon as possible after Phase I.

4. Add Unlicensed Assistive Personnel to the CNA Registrya. It should be mandatory that all unlicensed assistive personnel are addedb. The following types of unlicensed assistive personnel should be added (perhaps the first priority should be adding workers who work in licensed settings or publicly funded):
 i. Unlicensed Assistive Personnel, such as:
 ii. MHRT 1
 iii. MHRT C
 iv. Peer Support Specialists
 v. Direct Support Professionals (get list from mat Lou)
 vi. Behavioral Specialists (for children)
 vii. Personal Support Specialists (formerly PCA’s)
 viii. CRMA (Certified Residential Medical Aides)
 ix. Homemakers
 x. Personal Assistants
c. The following types of information should be included about each worker:
 i. All info that is currently on CNA registry
1. Education
2. Number of Training Hours
a. Dates of completion
3. Dates of checks
4. Work History
 ii. Whatever is needed for state licensing
 iii. Substantiated complaints
 iv. Demographic information
 v. Age, gender, income

5. Improve safety via improved investigative process and authority
a. Consolidate and substantiate complaints
b. A variety of disciplines should collaborate on how to do this

Phase III
This phase should be implemented as soon as possible after Phase II.

6. Add a matching service to help employers and employeesa. Similar to current PASA Connections website
 i. Workers provide information on education and experience.
 ii. Employers describe their employment opportunities with specific job postings.
 iii. There is also the search function whereby a worker may search for a specific type of employer and an employer may search for a specific type of worker.