At its recent 50th Anniversary celebration, Region IV Area Agency on Aging honored many people playing critical roles in the community. Some of the most moving stories came from persons serving as “direct care workers.”
These are folks whose work it is to care for persons needing regular assistance with common activities of daily living. Their work has immeasurable impact on quality of life for those they serve. The vocation of the honorees was palpable.
Direct care workers (DCWs) are most often employed by hospitals, nursing homes and home care agencies or can be a family member paid by an insurance system such as Medicaid. There’s also a “grey market,” where people are hired directly by the person or family needing care, and not through an agency or other payor.
These workers are in short supply, an issue compounded by the pandemic, with severe shortages projected forward. Last year, and in April of this year, the Paraprofessional Healthcare Institute (PHI) and Brookings Institution released reports on the trends, concerns and possible solutions.
Per PHI, “between 2021 and 2031, the long-term care sector will need to fill 9.3 million direct care job openings. This represents a nearly 18 percent increase in 10-year projected job openings compared to last year.” Per both institutions, growing the pipeline of domestic and foreign-born workers will be key to the growth of the direct care workforce.
The federal Administration on Community Living (ACL) has developed the National Direct Care Workforce Capacity Building Center to build collaborations to strengthen efforts to tackle key issues affecting recruitment and retention of DCWs such as: poor wages, lack of benefits, and limited opportunities for career advancement and professional recognition. A host of national groups, including USAging and the national entity of Area Agencies on Aging, are joined by state initiatives such as Michigan State University’s Impart Alliance, with commitment to finding a way forward.
That said, “Health Affairs,” the leading journal of health policy thought and research, with broad bi-partisan support, comments, “The U.S. native-born workforce, however, will not be able to fill the worker shortage on its own, underscoring the importance of broad immigration reform to grow the direct care workforce.”
Per PHI and Brookings, immigrants currently make up “at least” 27 percent of the nation’s direct care workforce. Both their reports underscore the importance of supporting and increasing the flow of immigrants to this sector.
A promising possibility seems to center around expanding our use of employment-based pathways, usually green cards, for direct care workers. These have been used successfully, primarily for recruitment of degreed professionals, and are designed to create an immigrant pathway to employers.
PHI offers broader ideas including the creation of a caregiver visa “…for direct care workers that would build the pipeline into this workforce and provide immigrants who obtain this visa with an opportunity to live permanently in the U.S.” Their brief also suggests Congress should enact laws such as the Citizenship for Essential Workers Act, to allow undocumented persons who worked as essential workers during the COVID-19 pandemic to be eligible for a path to citizenship. Immigration law is confusing. To learn more, check out brookings.edu/articles and find “How Immigration Reforms could bolster Social Security and Medicare solvency and solve direct care workforce issues.”
Current rhetoric declaring all immigrants as bad confuses the issue and denigrates good people; both those waiting years for their status to be confirmed, and those seeking a better life at our borders.
We need the workforce. History has shown through our own families how successful immigration can be.
Lynn Kellogg is former CEO of Region IV Area Agency on Aging in Southwest Michigan. Questions on age or independence services? Call the Info-Line for Aging & Disability at 800654-2810 or visit areaagencyonaging.org. The Generations column appears each weekend in The Herald-Palladium.