In response to a recent solicitation for comments from the federal government, PHI recommended changes to the three main categories used to track direct-care workers at the U.S. Department of Labor’s Bureau of Labor Statistics (BLS). The government considers revisions to its Standard Occupational Classification (SOC) categories every ten years.

PHI also asked the government to address the exclusion of direct-care workers who are “independent providers” from federal/state employer surveys, which PHI believes results in a serious undercount of workers counted as Personal and Home Care Aides. Independent providers refer to direct-care workers who are either self-employed or who are directly employed by consumer households.  

Workforce data can play a critical role in assessing things like the effectiveness of state initiatives to attract and retain greater numbers of direct-care workers, or the impact of policies designed to improve direct-care worker wages.

PHI recommends that the government’s three occupational categories for direct-care workers be changed as follows:

• Nursing Aides, Orderlies and Attendants. Split this category into two, separating those who provide hands-on patient care under the direction of nursing staff (nursing aides) from those who do not (orderlies and attendants).
• Home Health Aides. Change the description of their duties to reflect increased responsibilities, including monitoring of health status, feeding, toileting, ambulation, medication management and administration, and also sometimes non-health care related tasks such as preparing meals, housekeeping, and laundry.
• Personal and Home Care Aides. Update the description of their duties to reflect the broader range of tasks they perform, and to refer to the range of populations they serve: older adults, people with chronic illnesses, people who are convalescing, and people living with intellectual, developmental, and physical disabilities. Also, change the occupational title – to Personal Care Assistants – to make it more current with the terminology that is developing within the long-term care industry.

PHI also urges the government to revise its employer sampling frame in order to capture the hundreds of thousands of personal and home care aides who are employed directly by an individual or family or who are self employed. For example, more than 400,000 personal and home care aides are employed through public authorities in five states – California, Massachusetts, Michigan, Oregon, and Washington – but the current count leaves them all out. 

Why it matters to get the facts right

The proposed updates are needed for several reasons. First, as the report notes, there is “considerable confusion on the part of workers, consumers, employers and policy makers concerning just which workers are captured by each of the three SOC codes.” The sheer size of the workforce, which is already more than 3 million strong and expected to grow to 4 million by 2016, makes it important to get these facts right.

Second, the tasks performed by home- and community-based direct-care workers are evolving in important ways as they care for more nursing-home-eligible clients with complex care needs. These new demands translate into “a much greater need for skill, judgment and personal accountability,” says the report.

The proposed changes would result in more accurate employment and wage estimates for “federal and state policymakers who currently find themselves hampered by a lack of ongoing, reliable state-based information about their direct-care workforce,” the report notes.  

Given the truly historic growth expected to occur over the next decade in demand for direct-care workers, this is a critical time to update the title and task definitions found in the official direct-care worker occupational codes. Aligning these codes and definitions more with actual practice, and upgrading the sampling frame for employer and worker surveys using these job codes, could help us get more accurate counts of these workers and more accurate estimates of their wages. And that, in turn, could substantially improve the value of the federal and state data we generate about this workforce.

Read PHI’s submission to the SOC Policy Committee. (pdf)

e Seavey, Director of Policy Research
dseavey@phinational.org