Robyn Stone & Robert Espinoza hedshots

Although the pandemic elevated the visibility of the direct care workforce, it didn’t do it to the level they deserve, according to an expert on a Mathematica panel Thursday about addressing workforce challenges post-COVID.

“As we emerge from this crisis, I think it will be essential that we continue to draw attention to who these workers are, why they’re so valuable, the challenges they face, and the solutions that we need to explore,” said Robert Espinoza, PHI vice president of policy. “It’s been a learning experience, but it’s one that we’ll continue as we think about the sector.”

The direct care workforce faced many challenges before the COVID-19 pandemic, but the pandemic, in some ways, exacerbated many of these issues, said Debra Lipson, a Mathematica senior fellow and panel moderator. Those issues, she said, include too few workers to meet needs, combined with high rates of turnover, low wages and benefits, inadequate training and career ladders, demanding schedules, and physically and emotionally difficult work.

Among all types of direct care workers, Lipson said, the demand for home care workers is the highest, expected to grow by more than 568,000 on average each year over the next decade — a 34% increase.

“Although most of the headlines in the last year focused on nursing home workers, those who provide care in homes and community settings faced extraordinary pressure as well,” she said. Those pressures, Lipson said, included fears of contracting or spreading the virus, acute shortage of personal protective equipment, childcare obligations, burnout and lack of  training programs. 

Espinoza said the direct care workforce contracted by approximately 280,000 workers within the first three months of the pandemic. That, he said, tells the story of a workforce being “forced to make the impossible choice” of risking infection or losing wages. 

A LeadingAge survey found that the major reasons people left the direct care workforce were the lack of preparation and communication from their employers, and training programs shut down during the pandemic, said Robyn Stone, Dr.PH, LeadingAge senior vice president for research and co-director of the LeadingAge LTSS Center @UMass Boston.

“There were no real pipelines for training,” Stone said. “It influenced so many aspects of what provides the pipeline for this workforce — the support and protection, and all the things that would minimize hard and maximize safety.”

From the beginning, Espinoza said, major federal bills that boosted funding for COVID relief often did not specify the direct care workforce, which he called an oversight. Inadequacies in data collection and reporting requirements, and a COVID-19 response that varied across states, reflects the reality of how the direct care workforce is governed and structured, he said. 

And although hazard pay and bonuses during the emergency were great, both Espinoza and Stone said, their need underscored how undervalued the direct care workforce is in society. Creating a living wage, comprehensive benefits, a universal worker model and portability across states is critical, Espinoza said.

“There are opportunities for this workforce to be much more flexible and nimble. As we think about post-COVID, restructuring is something we should at least be exploring,” Stone said.