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by Darcey Trescone

Poverty level wages and poor working conditions were problems for direct care workers pre-pandemic. According to a new report from PHI, the nation's leading expert on the direct care workforce, the workforce has only suffered more since COVID-19.

The PHI report, Direct Care Workers in the United States: Key Facts, provides a new annual snapshot on the direct care workforce, including its demographics, occupational roles, job quality challenges, and projected job openings. The report includes detailed overviews of three segments of this workforce: home care workers, residential care aides, and nursing assistants in nursing homes.^1.  

The direct care workforce grew from 3.1 million workers in 2010 to 4.6 million in 2020. PHI projects that from 2019 to 2029, 1.3 million new direct care worker jobs will be added to meet the rising demand. This growth will only amplify recruitment and retention pressures for employers moving forward.

Like present and projected nursing shortages, demand will continue to outgrow the talent pool, and efforts will need to be put forth to draw individuals back into the profession.

Wages

Home care workers' wages have only increased slightly more than the costs of goods and services over the past decade. The median wage for direct care workers was $13.56 in 2020, median annual earnings were $20,200, and 44 percent of these workers relied on some form of public assistance, such as Medicaid, nutrition support, or cash assistance. Rare raises have not been enough to change the financial well-being of home care workers.

According to the PHI report, among residential care aides, 32 percent do not have affordable housing, and 17 percent lack health insurance. Coupled with heavy workloads and high injury rates, it is not an appealing profession to pursue.

PHI's Direct Care Job Quality Framework

Since 2017, PHI has collaborated with providers in Minnesota and Wisconsin on an initiative focused on elevating the home care worker's role in health care delivery. Strategies to train and support home care workers in achieving this initiative are outlined in Direct Care Workers in the United States: Key Facts.

PHI's new direct care job quality framework comprises 29 elements that are addressed in five pillars. The framework is focused on employers; however, these solutions will also require systemic policy and industry reforms.

PHI’s Five Pillars in the Direct Care Workers in the United States: Key Facts

1. Quality Training - A quality direct care job should ensure that all workers acquire the skills, knowledge, and confidence to succeed in their complex roles 
2. Fair Compensation - A quality direct care job should enable workers to achieve economic stability, safeguard their health, and plan for the future.
3. Quality Supervision and Support - A quality direct care job should offer workers the support and supervision they need to work safely and effectively.
4. Respect and Recognition - A quality direct care job should honor workers' expertise, contributions, and diverse life experience. 
5. Real Opportunity - A quality direct care job should invest in workers’ learning, development, and career advancement
   

PHI Recommendations – Solutions for the Direct Care Workforce

PHI believes that "improving direct care jobs requires a comprehensive, national strategy that guides national, state, and local leaders across the public and private sectors."Recommendations outlined focus on all relevant stakeholders being engaged and held accountable when implementing the strategy. Policymakers, employers, industry leaders, advocates, and anyone involved in building the direct care worker profession. (Details of each can be found in Direct Care Workers in the United States: Key Facts)

1. Reform long-term care financing to strengthen direct care jobs
   • Protect and strengthen Medicaid to cover more individuals and improve direct care jobs
   • Increase reimbursement rates to bolster job quality indirect care.
   • Create a stronger public financing approach for long-term care and the direct care workforce
   
   
2. Increase compensation for direct care workers
   • Pay direct care workers a living wage.
   • Improve access to full-time schedules for direct care workers.
   • Strengthen the social safety net and improve access to workplace benefits for direct care workers.
   • Evaluate the unintended impact of wage increase measures on direct care workers, their employers, and consumers.

      

3. Strengthen training standards and delivery systems for direct care workers
   • Establish a national standard for direct care competencies.
   • Overhaul direct care worker training curricula to reflect the full set of skills needed for this work
   • Strengthen training infrastructure to support adult learner-centered training and the attainment of meaningful direct care credentials.
   • Increase funding for direct care training delivery and training standard enforcement.

      

4. Fund, implement and evaluate direct care workforce interventions
   • Strengthen the workforce pipeline indirect care
   • Integrate direct care workers onto the care team
   • Develop rungs in the career ladder accessible to direct care workers and build on their experience.

      

5. Improve direct care workforce data collection and monitoring
   • Create robust workforce data collection systems
   • Update federal industry and occupational classification codes to understand the direct care workforce more fully.
   • Strengthen and integrate direct care workforce quality measures into research, practice, and policy.

      

6. Center direct care workers in leadership roles and public policy
   • Establish a statewide workgroup to create recommendations for advancing policies that improve direct care jobs.
   • Create a division of paid care that supports direct care workers with accessing their employment rights and resources.
   • Integrate direct care workers into key advisory roles and leadership positions throughout the public and private spheres.

      

7. Rectify structural gender and racial inequities for direct care workers
   • Develop strategies to address systemic barriers and strengthen diversity, equity, and inclusion within this job sector
   • Build the evidence base on equitable direct care workforce interventions.
   • Bolster supports for immigrant direct care workers

      

8. Shift the public narrative on direct care workers

• Fund public education campaigns that improve the general public’s understanding of the direct care workforce
• Build communications capacity to effectively advocate for direct care workforce policy solutions
• Support storytelling projects that empower direct care workers to tell their stories in their own words
  

As PHI points out, the poor quality of home care jobs does not align with the high demand for their services. Job quality concerns drive high turnover and cause job vacancies. COVID-19 has only made recruitment and retention strategies worse.

^1. Direct Care Workers in the United States: Key Facts. PHI. https://phinational.org/resource/direct-care-workers-in-the-united-states-key-facts/. Published 2021. Accessed September 20, 2021.

Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at darcey@tresconeconsulting.com.

©2021 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com