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By 2020, the direct-care workforce — nursing assistants, home health aides, and personal care aides — is projected to be the nation’s largest workforce at 5 million workers, according to a new PHI analysis available in PHI FACTS 3: America’s Direct-Care Workforce (pdf).

Home care jobs — both home health aide and personal care aide positions — are the nation’s fastest-growing jobs, projected to increase over the decade 2010-2020 at an astounding 69 and 71 percent, respectively. Nursing aide, orderly, and attendant positions are expected to increase by 20 percent. Together these jobs will add an additional 1.6 million jobs to the economy.

Comprising nearly a third (30.6 percent) of the entire U.S. health care workforce, direct-care workers far outnumber other health care practitioners, including physicians, nurses, and therapists. These workers also outnumber all those employed in allied health occupations, such as medical and dental assistants, and physical therapy assistants and aides, by nearly three to one.

Shift Toward Home and Community-Based Settings

The analysis found that there were at least 4 million direct-care workers in 2011, with the majority employed in home and community-based settings. The workers employed in these settings are expected to outnumber facility workers by more than two to one by 2020.

PHI researchers estimate that there are at least 800,000 independent providers who provide personal care services for consumers who are enrolled in public programs. These workers, who are employed directly by consumers and their families in home and community-based settings, are not tracked by the U.S. Bureau of Labor Statistics and have been heavily undercounted in government surveys, the researchers explain.

Wages and Benefits Worsen

The PHI analysis also found that the wages and benefits of direct-care workers continue to worsen.

The median wage of $10.59 in 2011 for all direct-care workers is far below $16.57, the median wage for all U.S. workers that year. Moreover, adjusted for inflation, wages for all direct-care workers have declined over the last decade.

In addition, more than one third of aides employed by home care agencies and one quarter of nursing home aides lacked health care coverage.

Poverty Increases

With wages and benefits declining, an increasing number of direct-care workers live in poor households. Since 2008, direct-care workers living in households with incomes below 200 percent of the federal poverty line have increased from 44 percent to 47 percent.

At this income level, many of these workers are eligible for — and rely on — public benefits such as Medicaid and food stamps to support their families.

To learn more about the direct-care workforce, download PHI FACTS 3: America’s Direct-Care Workforce (pdf).

– by Deane Beebe

(L-R) E.J. Dionne, Marki Flannery, PHI President Steven Dawson, Laine Romero-Alston

The Aspen Institute Workforce Strategies Initiative (Aspen WSI) convened an audience of 100 long-term-care and workforce development stakeholders in Washington, D.C., on May 3, for an expert discussion on the challenges that direct-care workers face and strategies workforce development leaders can use to improve the quality of these long-term-care industry jobs.

Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers, the thoughtful and lively discussion, was moderated by E.J. Dionne, a Brookings Institution senior fellow and Washington Post columnist, and featured:

• Steven Dawson, PHI President
• Marki Flannery, Partners in Care President, and
• Laine Romero-Alston, Ford Foundation Program Officer.

Maureen Conway, executive director of the Aspen Institute Economic Opportunities Program, framed the conversation by explaining that 40 percent of the jobs created since 2010 are low-wage jobs and direct-care occupations are the “lowest-paid jobs” with “uncertain hours.” She asked whether poor quality, direct-care jobs had “to be that way?”

Low-Wage, Not Low-Skill Jobs

Dawson explained the employment and income characteristics (pdf) of the direct-care workforce and that personal care aides and home health aides were projected to be the first and second fast-growing occupation in the nation by 2020.

He highlighted the particular challenges of home care workers, such as working in isolation and the need to have “emotional intelligence” to navigate a client’s home and the relationships within it.

“These are low-wage jobs but certainly not low-skill jobs,” Dawson said.

Valued and Respected

Flannery reported that her agency employs 9,800 home health aides — the largest licensed home care agency in the country — and described the profile of people seeking jobs as home health aides since the economic downturn.

Partners in Care has a turnover rate of 23 percent — significantly lower than the 60 percent national average, Flannery said. She attributes her agency’s high retention rate to its training partnership with PHI.

Using the PHI Coaching Approach^SM, Partners in Care’s managers, supervisors, and aides were trained in communication techniques that made the aides feel “valued and respected,” she explained, adding that the training also led to improved worker satisfaction and better patient outcomes.

Flannery also discussed the challenges of being a “high road employer” that pays aides a decent wage while reimbursement rates from public funding and private insurers go down.

Multi-Prong Strategies

Romero-Alston spoke on the importance of using “multi-prong strategies” to both “raise the floor” of direct-care jobs and “create opportunities for career pathways.” She identified a specific barrier to a good job that needed to be overcome: the exclusion of home care workers from basic labor protections such as minimum wage and overtime pay.

Romero-Alston added that the Obama Administration has “taken great strides” over the last few months to revise the so-called “companionship exemption” through a rule change proposed by the U.S. Department of Labor.

Video and Handout Available

To watch the discussion, including audience questions, an 80-minute video is available on the Aspen Institute website along with its overview (pdf) of the direct-care workforce.

“Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers” was the Aspen WSI’s second discussion this year in a series entitled, “Reinventing Low-Wage Work: Ideas That Can Work for Employees, Employers and the Economy.”

– by Deane Beebe

The Centers for Medicare and Medicaid Services (CMS) announced the first round of recipients of the Health Care Innovation Awards on May 8.

The Health Care Innovation Challenge, launched last November, was designed to generate creative approaches to health care delivery that improve health, enhance health care, and lower costs for individuals enrolled in Medicare, Medicaid, and CHIP.

The 26 awarded projects total $122.6 million, approximately 10 percent of the $1 billion in grant funding to be administered through the Centers for Medicare and Medicaid Innovation (CMMI).

The recipient programs span a wide range of topics, including interventions to:

• improve chronic disease management for underserved populations,
• enhance primary care outcomes through the use of community health workers,
• reduce emergency care admissions, and
• lower re-hospitalization rates.

The 26 awardees were selected based on their unique approaches to addressing health care challenges, as well as their integration of workforce development and cost savings benefits for local communities.

In a call with stakeholders the day that the grants were announced, CMMI Director Richard J. Gilfillan said that the next round of awards will be announced in early June. Gilfillan would not confirm whether the second round would feature a similar number of awardees, or whether there will be a third round of funding.

The awards were originally scheduled to be announced in March, but CMS delayed the announcement in order to more thoroughly consider the 3,000-plus applications submitted at the start of the year.

– by Angelina Del Rio Drake, PHI Development Writer

The National Network of Career Nursing Assistants in Akron, Ohio, is sponsoring the 35th Annual National Nursing Assistants Week, which will take place this June 14-21.

Information about the week, which aims to honor and promote the hard work of nursing assistants, is available at the organization’s website.

People interested in organizing events in their communities, for example, can download a free planning guide (pdf).

In addition, National Career Nursing Assistants Day will be held June 14.

– by Matthew Ozga

Caring Across Generations (CAG) will hold a New York Care Congress on June 3 at New York City’s Pace University.

At the Care Congress, participants will be able to share caregiving stories and learn how to take action on state and local CAG campaigns.

The New York Care Congress is one of several taking place across the country this year. Upcoming Congresses will be held in Chicago, Los Angeles, Las Vegas, and Philadelphia.

CAG is a coalition of 200 organizations that promotes quality care and dignity for aging Americans and their caregivers. (PHI is a member of CAG’s leadership committee.)

For more information, visit CAG’s New York Care Congress website or contact Melanie Willingham-Jaggers at Melanie@ALIGNny.org or 212.701.9478.

– by Matthew Ozga

For Immediate Release
May 10, 2012

Contact:

Deane Beebe, PHI Media Relations Director
718-928-2033; 646-285-1039 (cell)
DBeebe@phinational.org

Workforce Expected to Add 1.6 Million New Jobs to the Economy, Job Quality Continues to Worsen

 
Bronx, NY — By 2020, the direct-care workforce — nursing assistants, home health aides, and personal care aides — is projected to be the nation’s largest workforce at 5 million workers, according to a new PHI analysis available in PHI FACTS 3: America’s Direct-Care Workforce (pdf).

Direct-care occupations are expected to add an additional 1.6 million jobs to the economy over the decade from 2010-2020. Yet the wages for these jobs continue to decline and the number of the workers without health care coverage has increased.

“It’s quite striking that probably the largest workforce ever produced by our economy is largely made up of women who struggle with inadequate conditions of employment as they try to make ends meet,” said PHI Policy Research Director Dorie Seavey, who conducted the analysis with Policy Research Analyst Abby Marquand.

Home care jobs — both home health aide and personal care aide positions — are the nation’s fastest-growing jobs, projected to increase over the decade from 2010-2020 at an astounding 69 and 71 percent, respectively.

Home health aides and personal care aides rank third and fourth, respectively, on the list of occupations expected to generate the most new jobs to the economy over this period.

Direct-care workers far outnumber other health care practitioners, including physicians, nurses, and therapists, comprising nearly a third (30.6 percent) of the entire U.S. health care workforce in 2011. These workers also outnumber, by nearly three to one, all those employed in allied health occupations, such as medical and dental assistants, and physical therapy assistants and aides.

Shift Toward Home and Community-Based Settings

The PHI analysis found that in 2011 there were at least 4 million direct-care workers, with the majority employed in home and community-based settings. By 2020, the workers employed in these settings are expected to outnumber facility workers by more than two to one.

PHI researchers estimate that there are at least 800,000 independent providers who provide personal care services for consumers enrolled in Medicaid-funded programs. These workers, employed directly by consumers and their families in home and community-based settings, are not tracked by the U.S. Bureau of Labor Statistics. Consequently, independent providers have been heavily undercounted in government surveys, the researchers explain.

“There are two basic models for delivering in-home services and supports in the U.S. today: an agency model and an independent provider model,” Marquand notes. “The latter has two broad variants: private and public. The size of the private strand is extremely difficult to measure since so many private arrangements are not reported, but publicly funded arrangements can and should be accounted for — substantial numbers of workers and consumers are involved in this sector.”

Wages and Benefits Worsen

The median wage of $10.59 in 2011 for all direct-care workers is far below the median wage for all U.S. workers that year ($16.57). Moreover, adjusted for inflation, wages for all three direct-care occupations have declined over the last decade.

Personal care aides and home health aides earned a median wage of $9.49 and $9.91 per hour, respectively. The wages for these home care occupations are significantly less than the median hourly wages of $11.63 for nursing aides, orderlies, and attendants.

The number of direct-care workers without health care coverage in 2010 increased to 950,000, up from 900,000 the previous year.

More than one third of aides employed by home care agencies and one in four nursing home aides lacked health care coverage in 2011.

Poverty Increases

With wages declining, an increasing number of direct-care workers live below the poverty line or just above it. Since 2008, the proportion of direct-care workers living in households with incomes below 200 percent of the federal poverty line has increased from 44 to 47 percent.

At current income levels, nearly half of these workers are eligible for — and rely on — public benefits such as Medicaid and food stamps to support their families.

Demographic Characteristics

The PHI researchers also identified these demographic characteristics of direct-care workers in 2010:

• Gender: 88 percent women; 12 percent men.
• Average age: all direct-care workers, 42; employed in nursing care facilities, 39; employed in home health care, 43; and self-employed or working directly for private households, 49.
• Immigration Status: 80 percent born in the U.S.; 20 percent foreign-born.
• Education: 46 percent some college or advanced degree; 54 percent high school or less.

“Carework in America is at a crossroads,” Seavey said. “We can continue the status quo, adding direct-care positions that are poorly supported and poorly compensated, and then backfill them with public assistance. Or we can acknowledge this workforce as a key underutilized asset in our healthcare system and exploit its enormous potential as one of the strongest job engines that our economy has to offer.”

For more information on the direct-care workforce, see PHI FACTS 3: America’s Direct-Care Workforce (pdf), and also visit PolicyWorks and the Chart Gallery on the PHI website. For state-by-state data on the direct-care workforce, visit the PHI State Data Center.

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PHI, the Paraprofessional Healthcare Institute (www.phinational.org), works to transform eldercare and disability services, fostering dignity, respect, and independence -– for all who receive care, and all who provide it. The nation’s leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality care.