July 3, 2007 - “The eldercare field, to a very large degree, now knows how to recruit and retain paraprofessional workers,” Steven L. Dawson, president of the Paraprofessional Healthcare Institute (PHI), told the Institute of Medicine (IOM) Committee on the Future Health Care Workforce for Older Americans. “There is no mystery here: If tomorrow we paid these individuals a livable income, offered them health insurance, trained them better, supervised and supported them—listened to them—we would solve this unnecessary ‘workforce crisis’ in a matter of months.”

So why the shortage of the home health aides, certified nurse aides, and personal care attendants who provide at least 80 percent of our paid long-term care services? The problem, says Dawson, is that we’re used to seeking out “best practices,” when what is needed is systems change.

The IOM committee is gathering expert testimony and conducting research for a consensus study on the optimal health care workforce for older Americans in an aging society. Its report, which will include sections on how best to educate, recruit, and retain workers, is due next March. Dawson was invited to speak at a June 28 meeting of the 15-member group in San Francisco.

The real barriers to recruiting and retaining a stable and adequate direct-care workforce, Dawson told the committee, are lack of implementation capacity and lack of political will. Dawson cited:

• A dearth of trainers who know how to deliver adult-centered learning;
• Limited numbers of nurse supervisors who know how to guide and support paraprofessional workers; and,
• An absence of administrators who know how to create a work environment that is truly person-centered—for both consumers and workers.

Noting a lack of motivation on the part of policymakers to solve the workforce problem, Dawson suggested that there may be multiple reasons for this failure of political will: “Policy makers may falsely believe that there still exists an endless supply of women willing to work for low pay and few benefits. Or it might be due to the fact that 70 percent of long-term care is paid for by third-party government programs, and we know that those third-party payors are not only under great pressure to control costs, but that structurally they also respond very slowly, if at all, to market forces. Personally, I believe a central cause is that policy makers are usually of a different race, class and gender from the low-income workers who typically provide this care, and therefore these workers are, simply, invisible.”

Dawson told the committee about nine Essential Elements of a Quality Job that PHI has identified, through its work in the field and its analysis of existing research. A 15-page insert in Dawson’s presentation details the strong evidence-based research establishing the impact of these nine elements on paraprofessional workers and the people they assist.

Dawson also laid out a set of recommendations to address the lack of implementation capacity and political motivation, including:

• Call for a public investment in the training of those who shape the quality of paraprofessional jobs, including educators, supervisors, and administrators
• Call for investments in state-based training systems to prepare paraprofessionals for both home- and facility-based care settings, create career ladders for paraprofessional, and support statewide requirements and core competencies
• Acknowledge the full value and importance of the paraprofessional workforce for elder services.
• Support the use of national job quality/workforce indicators such as turnover rates, staffing levels, wages, and benefits to create incentives for adequate and safe staffing, better education and training, and greater workforce stability.
• Call for a full and realistic public investment in the long-term care workforce, adequate to support the nine Elements of a Quality Job.

To read Dawson’s presentation and recommendations, go to http://www.paraprofessional.org/publications/Dawson_IOM_6-28-07.pdf.