Explaining the Care Gap

f you need someone to understand the urgency of the growing care gap in long-term care, you might want to pass on a copy of Occupational Projections for Direct-Care Workers 2006-2016.

“Our analysis suggests that demand for direct-care workers over the next decade, particularly in home- and community based settings, will continue to outpace supply dramatically-unless policymakers and employers work together to make these jobs competitively attractive compared to other occupations,” says the six-page fact sheet by PHI Director of Policy Research Dorie Seavey.

Short text blocks and charts like the ones reproduced here interpret U.S. Bureau of Labor Statistics data in often striking ways. For instance, did you know the U.S. is expected to need a million additional direct-care workers, for a total of 4 million, by 2016? Or that direct-care workers will outnumber teachers from kindergarten through high school combined (3.8 million), fast food & counter workers (3.5 million), and cashiers (3.4 million)?

That additional million workers represents an increase of 34 percent in just one decade, the fact sheet points out, and we can’t count on finding all those people in the usual pool of workers - women aged 25 to 54 - since that pool is expected to increase by less than 1 percent between 2006 and 2016.

Norman DeLisle, MDRC
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Caregiving is Women’s Work

Caregiving is women’s work.

It is with that simple statement in mind that I went to the Raising Women’s Voices Conference last month, sponsored by the Avery Institute, Merger Watch, and the National Women’s Health Network.

I was invited to participate on the opening plenary panel to discuss voices that are traditionally left out of health care reform discussions. I talked about direct-care workers — and about Health Care for Health Care Workers and the broader work of PHI.

The conference brought together women’s health advocates, providers, and women in general to talk about health care issues and shape a women’s agenda for health care reform. There were the usual PowerPoint presentations and policy recommendations, but the way the organizers encouraged presenters to tell our stories made it clear from the start that this was no ordinary conference. Raising Women’s Voices lived up to its name, honoring the power of women’s voices and experiences as consumers and providers.

In my day-to-day work talking with policymakers, I have to show lots of facts and figures about direct-care workers not having health insurance and figure out how to “make the case” that this issue matters. At this conference, people listened intently when I opened my presentation with the story of Iya’ Negra, a direct-care worker in Maine. Iya’Negra was diagnosed with fast-growing fibroid tumors after she was kicked by a consumer with Alzheimer’s and the pain from the kicking did not subside. Because she had no health insurance, her health problem turned into a crisis for her whole family.

Sure, the fact that one in four direct-care workers is uninsured was a new and shocking statistic to many at the conference, but what struck them most was how that issue impacts the day-to-day lives of workers, the consumers they assist, and their families.

DCW Calls for an End to Management-Sanctioned Discrimination

Licensed Nursing Assistant Patti Green just notified me about a strong piece she’s written about a widespread and little-discussed problem: racial discrimination against direct-care workers in long-term care and the role management plays in allowing it.

“Under the guise of resident/patient rights, aides of color are constantly victims of resident harassment and disrespect. Management bars these aides from caring for said residents - and this leads to resentment and bad morale among all the aides,” she writes in The Quiet Discrimination.

This is an issue that everyone who cares about the quality of direct-care jobs needs to be aware of. As Patti said in her email, this industry-wide pattern of discrimination is “an important issue and one more reason why many aides just leave the work.”

IOM Report “Major Step Forward” for DCWs

“It is clear that a change in culture is needed - that both health care workers and health care organizations need to change the way they think about direct-care workers and, in particular, that the direct-care workers need to be seen as a vital part of the health care team,” says Retooling for an Aging America: Building the Health Care Workforce, a new report from the Institute of Medicine (IOM). The institute is part of the National Academy of Sciences.

The report, from the IOM’s Committee on the Future Health Care Workforce for Older Americans, also calls for concrete improvements in the quality of direct-care jobs. It advocates a three-pronged approach:

  • More, and more effective, education and training;
  • Increased wages and benefits; and
  • Improvements to the work environment, such as empowerment strategies and culture change.

When the IOM talks, Congress generally listens. Past IOM reports have led to major improvements in our health care system - like the Nursing Home Reform Act of OBRA 1987, which grew out of an IOM report on long-term care. The current report is focused on how we can prepare for the coming baby boomer “age wave” by ensuring that the nation has an adequate and capable geriatric care workforce.

Martha Stewart, Institute Of Medicine Testify At Aging Hearing On Expanding Health Care Workforce

Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing to address the impending severe shortage of health care workers who are adequately trained and prepared to care for older Americans. The committee reviewed key factors that are contributing to the deficiency, such as the lack of geriatric training in the medical education system and the need for federal and state training requirements for direct care workers, such as home health aides and personal care attendants. The panel also heard from family caregivers that enhanced education and training would help them develop the necessary skills to provide the best possible care for an ailing family member. Currently there are over 44 million Americans serving voluntarily as the sole source of care for an older family member or loved one. Chairman Kohl announced his plan to incorporate lessons from today's hearing into legislation to expand, train, and support all sectors of the health care workforce, including doctors, nurses, direct care workers, and family caregivers.

"By the year 2020, it is estimated that the number of older adults in need of care will increase by one-third," said Chairman Kohl. "The United States will not be able to meet the approaching demand for health care and long-term care without a workforce that is prepared for the job. Fortunately, understanding what we need to change is half the battle, and this hearing provides us with that knowledge."

The hearing was the first in which Congress reviewed the Institute of Medicine's (IOM) major recommendations for improving and expanding the skills and preparedness of the health care workforce in their report, "Retooling for an Aging America: Building the Healthcare Workforce," released Monday. Dr. John Rowe, Chairman of the IOM's Committee on the Future Health Care Workforce for Older Americans, focused his testimony on the report's recommendations. Joining him on the first panel was Dr. Robyn Stone, Executive Director of the Institute for the Future of Aging Services at the American Association of Homes and Services for the Aging. Dr. Stone's testimony highlighted the weaknesses and limitations of the current health care system in meeting the needs of aging boomers.

On the second panel, businesswoman and author Martha Stewart testified on the role of family caregivers in providing essential services and support to loved ones. Ms. Stewart shared with the committee her experience as a caregiver for her mother, and how it shaped her decision to establish the Martha Stewart Center for Living, a model clinic for coordinated outpatient geriatric services at Mount Sinai in New York. Dr. Todd Semla, President of the American Geriatrics Society, made the case for using existing law to increase the number of trained geriatricians practicing in the U.S.

Patti Green: We Have to Learn to Speak Up

“Most of the people that get into this work are women, and they have kids,” says Patti Green of her fellow direct-care workers. “A lot of them are single. They need to earn a decent hourly rate of pay, and they need to have health insurance.”

“That would attract more people, and then if they had the good screening and training we could weed out those that don’t really have a heart for it.”

“They listened to me - I was kind of surprised”
A natural leader, Green has become an expert on the state of direct-care work in America by running what amount to online break rooms for direct-care workers. Nursing Assistant Resources on the Web, the blog she started 10 years ago and now runs with the help of two other direct-care workers, is a trove of free articles, thoughtful blog posts, FAQs, and useful links. And at NursingAssistant@yahoogroups.com, the online community Green launched around the same time and still moderates, 750-plus members engage in a lively exchange of ideas, asking questions, venting frustrations, and offering each other affirmation and support.

Anna Ortigara on Learning from Direct-Care Workers

“There has been a lot of paternalism about direct-care staff – the notion that they are not really adults,” says Anna Ortigara. “People wonder: Are they really capable of being in a lead role? Can they be trusted to make good decisions? Are they capable of self-direction?”

Instead of these questions, Ortigara believes, we should ask ourselves: “How can we possibly think we are going to improve long term care without involving frontline workers? We need them at the table in order to achieve cultural transformation - and why wouldn’t we want them at the table?”