Jan 28, 2009 front page
A New York Times editorial titled “Caring for the Caregivers” makes the link between quality care and quality direct-care jobs — calling for improved labor protections in an area that is “one of the fastest growing” but “one of the lowest paid and most exploitable.”
The piece calls home health care “a 21st-century growth industry,” pointing out that, at a time when record layoffs are being reported, the health care sector continues to add jobs — with 32,000 positions added in December 2008 alone.
Referring to federal labor laws that permit home care aides to be exempted from overtime and minimum wage requirements, the editorial says, “It is unconscionable that workers who are entrusted with the care of some of the nation’s most vulnerable citizens are themselves unprotected by basic labor standards.”
PHI Director of Policy Research Dorie Seavey was pleased to see main points from PHI’s analyses reiterated in the Times’ piece saying, “These jobs are the second fastest growing in the economy and a wake-up call to the nation is in order. These jobs can be an engine for economic recovery, but they must be quality jobs with wages and benefits that can support a family.”
In 2007, Seavey testified before Congress in favor of the Fair Home Health Care Act, a bill that would extend federal wage and hour protection to home care aides.
Seavey says the 35-year-old exemption to the Fair Labor Standards Act concerning domestic workers now “only serves to straightjacket the industry.”
The Times also points out how high turnover leads to lower quality of care and ends up costing the taxpayer.
“Turnover… drives up the cost of providing home care — a needless drain on Medicaid, which pays for many home care services. And that is not the only way that poor quality home care jobs end up costing taxpayers. Nearly half of home care workers rely on food stamps or other public assistance, so taxpayers ultimately compensate for their low pay and inadequate benefits.”
Momentum appears to be building for investment in the direct-care workforce as a means to hasten our nation’s economic recovery.
More on labor standards and the Fair Home Health Care Act:
- PHI’s Nov. 2008 letter to Obama Administration (pdf)
- Text of the Fair Home Health Care Act (pdf)
- Testimony (pdf) offered at an Oct. 25, 2007 hearing
- PHI’s Fair Home Health Care Act analysis (pdf)
More on the economic recovery and direct-care jobs:
- Download the PHI issue brief (pdf)
- View the PHI press release
- Listen to the PHI podcast
- Additional resources on the PHI homepage.
Aaron Toleos, Online Communications Director
atoleos@phinational.org
I am pleased to see recongition of the need to have standards that will encourage workers to enter and remain in this critical position in the health care industry. Given the aging population, the trend toward earlier hospital discharges, and numerous other developments, it is not surprising that there exists an overwhelming need for home care workers. Shortages of these workers result from the low wages, lack of benefits and poor work conditions that exist in this occupation, which is a direct result of failure to regulate this critical industry and protect its workers and their clients.
The irony is that low reimbursement rates by Medicare and Medicaid keep wages in homecare artificially low. The law of supply and demand would dictate that increased need for homecare would result in higher wages. Homecare wages should be in the $15-$16/hour range. The ridiculously low reimbursement rates set by Medicare and Medicaid is the 800 pound gorilla that suppresses wages for everyone in home based care. In effect, the government forces caregivers into the ranks of the working poor.
If we as a nation really care about our seniors, we would care about their caregivers. As I learned in public policy classes, what you spend your money on reflects your real priorities. The elderly and people with disabilities are not a priority. Nor are their caregivers.
Hopefully this will make more Americans aware of the impending shortage of direct care workers and the increasing need for them. As the baby boomers enter the long term care system it is going to become more overwhelmed that it already is.
We as a nation need to get our priorities in order. We need to take care of our elderly and disabled citizens the way they should be taken care of. Given a choice I believe that most would prefer to age in place where they are familiar with their surroundings and be comfortable in their own home. The lack of workers may make that impossible. We need to wake up and give direct care workers the respect they deserve, paing them a living wage and be able to offer them benifits like overtime and health insurance would be a start. Direct care workers also need to be better trained to meet the need they are expected to meet. We as a nation are living longer and with that it brings a whole new array of needs that need to be met.
I speak from experience I am a Certified Nursing Assitant and have been doing direct care for twelve years. In that time I have seen the needs of the people I care for become more challenging. I have tried to keep up the times by attending different trainings that are available, but how do you do that with low wages and long days. I am fortunate that I work for one of the few companies in the US that is caregiver owned. We run the business and share in the profits at the end of the year. We are a Cooperative and is very empowering to caregivers. I can tell you I am not in this field for the money. I do this job because I care and people deserve to be taken care well.
Thank you for the national exposure about this serious issue.
Many good agencies who provide service to individuals with developmental or behavioral health disabilities want to pay better wages to Direct Care Professions, because they understand the negative effects of staff turnover and vacancy on the quality of service.
Ironically, many of the current leaders at almost all levels of this issue; leaders in agencies providing service, at state and local government and even at CMS have come up through the ranks and know the dynamics of deinstitutualization. An “out of sight, out of mind” approach led to poor quality and then deplorable conditions in large institutions. Community based services and supports were created, which we hailed as a new design and commitment…and then under funded it.
I believe that we have a fundamental problem that is causing us to potentially repeat history. Our leaders…actually all of us should realize that someone in our own family or even us ourselves will need to rely on these caregivers one day. We need to improve the reimbursement structure, pay better wages to direct staff, acknowledge and professionalize their responsibility and assure responsiveness and quality to those who deserve better.
“Caring for the Caregivers” points out some important issues in a segment of the labor force that have long been overlooked. These issues and others impact millions of individuals who rely on quality direct support staff to assist them in their daily routines. They impact agencies with the costly replacement and retraining of staff, and they also impact those who like what they do and want to stay in the profession.
The Center for Community Living and Careers at the Indiana Institute on Disability and Community is conducting a 3 year project that looks at the issues regarding the recruitment and retention of Direct Support Professionals. The project has successfully developed and implemented a training curriculum in a select group of agencies, and is currently evaluating best practice in recruitment and retention strategies.