Finding and keeping caregivers: A growing crisis

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Stephen Campbell
Stephen Campbell

Edgewood Centre* in Portsmouth, NH, has focused considerable effort over the past decade on building a strong workplace culture as the foundation for quality care.

Working with PHI, a national nonprofit that focuses on quality direct care jobs, Edgewood has trained staff in communication, improved supervision, implemented consistent assignments and developed a peer mentor program.

Nonetheless, in a recent conversation, the home's administrator, Tricia Cummings, explained that it is becoming increasingly difficult to find and keep nursing assistants. In fact, some shifts are so difficult to fully staff, Cummings said, that she offers a $6 an hour differential — a significant cost to a relatively small, independently owned home such as Edgewood. Aside from the financial cost, short staffing makes the job of delivering exceptional care to Edgewood residents even more difficult for those CNAs who stay.

As a researcher who studies trends in the direct care workforce, I have found that Edgewood's staffing challenge is the norm. We are facing a shortage of paid caregivers nationwide that undermines our ability to provide older Americans and people living with disabilities the long-term services and supports they need.

The workforce shortage is not a crisis waiting to happen; it is already here. Research and reports from the field indicate staffing difficulties nationwide, across the senior housing and care spectrum. Although data on other settings are scant, nursing homes have nearly 50,000 caregiver vacancies, and half of the workforce turns over every year.

Multitude of reasons exist for the shortage, but at a basic level, the current system fails to meet paid caregivers' fundamental needs. Home care workers typically earn $10 an hour, and nursing assistants do not fare much better, with wages around $12. Limited hours and few employer-provided benefits mean that 42% of paid caregivers live in households that rely on public assistance such as Medicaid and nutrition assistance.

This poor compensation does not match the difficult nature of the work. Lifting and carrying residents is physically strenuous. As a result, nursing assistants are 3.5 times more likely than the average worker to be injured on the job. In nursing homes, short staffing increases the likelihood of injury, as workers hurriedly lift residents by themselves, rather than waiting until another caregiver is available to help.

Beyond low wages, other barriers have made it challenging to find and keep direct care workers in today's tight labor market. In many nursing homes and continuing care retirement / life plan communities, those workers feel overworked and underappreciated. Often, training is inadequate, supervisory support is limited and aides are excluded from decision-making despite having important information about the health and well-being of the residents for whom they care. In addition, these jobs offer few opportunities for career advancement.

Addressing these issues, through supervisory training, quality continuing education, appreciation programs and new advanced roles can improve productivity and decrease turnover. As a result of these types of investments, Edgewood Centre has a core of long-term, career CNAs who have been with the organization for a decade or more.

But even a great employer such as Edgewood is struggling in today's market. Because trained caregivers are scarce, Edgewood will pay to train and certify new caregivers. It is difficult to fill classes, however, and too few trained caregivers are available to replace those who leave.

Anecdotes such as this one demonstrate that individual operators such as Edgewood are limited in their ability to attract workers and, therefore, it is imperative that we find solutions that make the entire field more attractive.

Without bold, holistic interventions that change our employment model for direct care workers, the shortage will only worsen. The population of older adults will nearly double in years to come, from 48 million today to 88 million in 2050. Almost 70% of people turning 65 today will need some form of long-term care in their lives, so the growing population of older adults will fuel unprecedented demand. In fact, we will need more than 1 million new paid caregivers by 2024 alone. If we cannot attract the workers we need today, how can we expect to attract so many new workers in the near future?

Changing deep-seated norms in the long-term care field will take consensus-building among all stakeholders. At PHI, we are trying to do our part to strengthen the caregiver workforce by launching our #60CaregiverIssues campaign. Over the next two years, we are tapping into our decades of experience, as well as the expertise of stakeholders in the field, to offer 60 new ideas to help address the caregiving crisis.

Join us in helping to reverse the caregiver shortage. By paying attention to the needs of paid caregivers, we can ensure that individuals and families access the quality care they need and deserve.

* Story shared with permission.

Stephen Campbell is a policy research associate for PHI, a national authority on the direct care workforce.

McKnight's Senior Livingwelcomes guest columns on subjects of value to the industry. Please see our submission guidelines for more information.

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