“Who will care for grandma” has become the warning cry from those aware of the looming direct care workforce crisis.
Direct care workers are the foundation of our long-term care system. That foundation is set to give way if key issues aren’t addressed, leaving older people, people with disabilities and their families stranded without support.
Direct care workers include personal care aides, home health aides and nursing assistants. Some job tasks include assisting clients with bathing, dressing and eating. Personal care aids also help with housekeeping, chores, errands and transportation to appointments. Home health aides and nursing assistants also perform clinical tasks such as blood pressure monitoring, help with range-of-motion exercises and more.
The varied nature of the work is tailored to the individual client and is often the key to a person’s ability to maintain their independence, improve or maintain their health status or live more comfortably and successfully in the setting of their choice throughout life.
It’s noble work. It’s also physically demanding, often underappreciated and at the low end of the pay scale.
Increased longevity and prevalence of chronic disease combined with medical advances that allow for recovery from serious illnesses or accidents, are driving significant increased demand for direct care workers.
According to the Bureau of Labor Statistics, by 2024 we’ll need roughly one million new jobs in direct care. And it’s not just frail elders who need long-term care. Of the 8.4 million people currently receiving long-term services and supports, 37 percent are under the age of 65.
The supply of direct care workers is not meeting the current need, and certainly is not on pace to meet the growing demand.
According to PHI National’s research center, there were 2.1M home care workers and 600,000 nursing home aides in 2016. However, more workers are leaving this sector than are entering it, often citing low and stagnant wages as the primary reason, PHI reports.
In Michigan the average hourly wage for a home health aide grew by only 11 cents between 2007 and 2017; nursing assistant wages grew by 31 cents; and personal care aides saw their average wage decrease by 7 cents in the same timeframe.
Other reasons PHI research cites for the high turnover rate include lack of benefits, strenuous travel schedules and workloads, and few opportunities to move up the career ladder.
While much of the direct care workforce news is dire, there are bright spots where policy makers, employers and other stakeholders are taking action.
On the legislative front, Main passed a bill in 2018 to increase Medicaid reimbursement rates improving wages for direct care workers. Minnesota launched a statewide job board to help consumers find workers and help workers find the right employment fit. At the national level, the Geriatrics Workforce Improvement Act was introduced in the Senate in May of 2018 paying the way for workforce enhancements.
Locally, the Area Agency on Aging held listening sessions in 2018 with employers to understand direct care workforce issues specific to our area. As a result, a pilot program is underway to test two interventions aimed at helping workers overcome identified obstacles to sustained employment. Data from that pilot program will inform future direct care workforce initiatives and policy recommendations.
While these efforts are other promising practices are emerging across the nation, people need care now, and many of them are getting it from dedicated direct care workers who have found a calling in this work.
Workers like Sam, a home care aide who says, “Caring for others mean so much more than just what I do for them. It gives others independence and choice….”
Or Lynn Jenkins who says “The impact of being a [direct care] worker was not immediate for me. But after about a month, I got it… you have to give yourself a chance to understand and feel the difference you can make in another person’s life, and the difference they can make in yours.”
Direct care workers like Sam, Lynn and the millions of others who are caring for our family, friends, neighbors – and perhaps for us someday — deserve jobs that properly reflect and reward them for the significant role they play in our country’s long-term care system. We can, and we must, do better.