Page 26 - Modern Healthcare (January 2020)

Direct care workforce growth and projections
Projected job growth, 2018-28
… it may not be enough to meet future demand as
While the number of direct care workers has
workers leave the profession through separations.
increased 52% overall since 2008 …
2008
2018
New jobs
452,460
Personal care
736,700
986,400
446,140
Home health
317,700
710,900
540,890
1.04 million
Residential care
720,480
599,350
Nursing homes
-19,300
581,140
1 million
0 Employment, 2008-18 1 million 1.55 million 0 168,400 639,900 Separations 2.7 million
500,000
3 million
1.5 million
2 million
Employment Open positions
Source: PHI report: “Caring for the Future: The Power and Potential of America’s Direct Care Workforce”
will lead to further shortages and higher costs for those pervision, training and career opportunities, and the social
seeking care,” said David Grabowski, a health policy pro- status of direct care work are also essential.
fessor at Harvard Medical School, who recently visited a “We haven’t valued this workforce,” said Robyn Stone,
nursing home where the majority of caregivers were Hai- senior vice president of research at LeadingAge, which
tian immigrants. represents not-for-profit providers of aging services. “They
There’s a broad consensus that raising wages from the aren’t just taking people to the toilet. They are doing more
median hourly wage of $12.27, or $20,200 annually, to at sophisticated work such as observing changes in condi-
least $15 an hour is necessary to recruit and retain work- tion. Better wages can help, but the work environment is
ers. A number of states and cities have moved to do that, the most important ingredient.”
under pressure from labor unions. Fifteen percent of direct Getting medical professionals to recognize personal care-
care workers have incomes below the federal poverty level, givers as valuable members of the clinical team is key. “You
while 44% earn under 200% of poverty, according to PHI. can see the difference in patients when they have caregivers
Experts say it would also help to offer them health in- who are very engaged,” said Dr. Jennifer Reckrey, an asso-
surance and other benefits. More than 2 in 5 workers are ciate professor of geriatric medicine at the Icahn School of
enrolled in Medicaid or other public assistance programs, Medicine at Mount Sinai in New York City who visits elderly
based on PHI data. and disabled patients at home. “I’ve been surprised by how
“It’s a struggle paying rent, utilities and car insurance,” often physicians and nurses consider them an interchange-
said Thomasine Wilson, a veteran home-care aide in able pair of hands rather than someone providing nuanced
Richmond, Va., who makes $10.50 an hour with no health care. That respect piece is the first step.”
insurance. She’s working with the Service Employees In- Long-term care providers increasingly understand they
ternational Union lobbying Virginia lawmakers to raise have to do much more to expand the pool of high-quality
the state’s $7.25 minimum wage. “They’re paying us early direct care workers to serve the burgeoning population of
1970s wages and it’s 2020.” elderly and disabled Americans who need post-acute and
Improving pay and benefits is particularly necessary in long-term services and support.
the current tight labor market where unskilled workers can
earn as much or more in less demanding fast food or retail Policymakers, providers take action
jobs. But the pressure for higher wages is putting a squeeze Federal and state policymakers, as well as charitable
on long-term care providers, who rely heavily on Medicaid foundations, also are starting to step up. Congressional
payments that may not be adequate to cover higher pay. Democrats last fall introduced the Direct Care Opportunity
But a push for boosting Medicaid rates to cover higher Act to invest in recruiting, retaining and supporting workers
pay could lead to fewer services being offered. who provide daily living assistance to millions .
“Medicaid is always challenged by providers and other States like California, Minnesota, Pennsylvania and Wis-
stakeholders to increase reimbursements everywhere,” said consin have convened policy work groups to develop strat-
Matt Salo, executive director of the National Association of egies to respond to the looming workforce crisis. They have
Medicaid Directors. “So the call for a (higher) minimum focused on boosting compensation, improving training,
wage in long-term care is at odds with calls for increased expanding the scope of practice, and developing career
funding for dental care, primary care, hospitals, etc.” advancement opportunities. Wisconsin made $2.3 million
Better compensation isn’t the only issue. Improving su- available last year to train about 3,000 certified nursing as-
24 Modern Healthcare | January 27, 2020