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.
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.
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
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)
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 firstname.lastname@example.org.
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