Direct care workers remain undervalued and underused in the long-term care sector, according to a new report that provides recommendations on moving the sector forward.
In an analysis of the direct care workforce — residential care aides, nursing assistants and home care workers — the authors of “Caring for the Future: The Power and Potential of America’s Direct Care Workforce” from national research, advocacy and workforce innovations organization PHI, said that a chronically underfunded, fractured and dispersed long-term care system has failed to improve job quality.
The report officers eight recommendations to improve jobs for this rapidly growing workforce:
- Reform long-term care financing;
- Increase compensation;
- Strengthen training standards and delivery systems;
- Fund, implement and evaluate interventions;
- Improve data collection and monitoring;
- Include direct care workers in leadership and public policy roles;
- Rectify systemic gender and racial inequities; and
- Shift the public narrative
Nationwide, 4.6 million direct care workers — including 735,000 residential care aides, 566,000 nursing assistants, 2.4 million home care workers and 900,000 workers in hospitals, rehabilitation services and other settings — care for a growing population of older adults with increasingly complex conditions, according to PHI.
The direct care workforce grew by 52% in a decade, from 3 million in 2009 to almost 4.6 million in 2019. The report anticipates the long-term care sector will need to fill 8.2 million job openings in direct care. This includes 1.3 million new jobs to meet rising demand and 6.9 million openings as existing workers leave the field or exit the labor force altogether. The report anticipates 1.2 million will have job openings for residential care, 621,000 nursing assistant jobs for nursing homes, and 4.7 million job openings in home care.
The long-term supports and services industry also is rapidly expanding to meet the growing demand, the authors said. According to the report, long-term care added 34,700 new establishments from 2007 to 2017. Of the total, 12,000 were in residential care and 4,700 were in assisted living communities. Nursing homes added just 600 establishments. Most (22,200) were in home care.
The COVID-19 crisis
The report authors also said that the pandemic reinforced how undervalued direct care workers are in healthcare and society. Although direct care workers were deemed “essential employees” at the onset of the pandemic, they struggled with limited compensation, benefits, training and job supports, they wrote.
Direct care workers earned a median hourly wage of $12.80 in 2019 — a 19-cent increase from 2009. About 45% of direct care workers live at or near the poverty level, and 47% access public assistance. Many workers also lack paid sick days, paid family and medical leave.
The wages, the authors said, are not competitive with occupations at a similar level, which contributes to the difficulty providers have in recruiting and retaining quality workers.
A recent study estimated that the number of direct care workers dropped by 280,000 during the first three months of the pandemic — assisted living and nursing home settings saw 50,000 departures, whereas home care lost 232,000 workers.
The pandemic, the authors wrote, amplified a “perfect storm of long-term care dysfunction that has been brewing for decades.”
“As this pandemic has made devastatingly clear, direct care workers are essential to the health and survival of millions of older adults and people with disabilities, but the quality of their jobs doesn’t reflect this enormous value,” PHI President Jodi M. Sturgeon said. “It’s time that leaders across the country, from government to the private sector and more, prioritize this workforce and transform these jobs once and for all.”