Wages Adjusted for Inflation: Over the past decade, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in North Carolina increased by 12 percent, from $7.88 to $8.81. Real wages for Personal Care Aides and Home Health Aides stagnated over the same time period.
Employer-Sponsored Insurance: Compared to the national civilian workforce, fewer of North Carolina’s direct-care workers have access to and use employer-sponsored insurance. Some work for employers that do not offer health insurance. Others work for employers that limit eligibility for health insurance to full-time employees. This creates a barrier for many direct-care workers, especially those in home and community-based settings, who often work only part-time due to the episodic nature of direct-care work. Even workers who do have access to insurance from their employer may find the co-pays and premiums unaffordable.
PHCAST Grant: North Carolina is one of 6 states awarded a 3-year grant by the federal government to develop a training and credentialing program for PCAs, as part of the federal Affordable Care Act.
WIN A STEP UP: WIN A STEP UP, a workforce intervention for nursing assistants and their frontline supervisors in nursing homes in North Carolina, aims to reduce turnover of nursing assistants by providing training, education, and monetary rewards. The program is now available to non-participating nursing home, home health, and adult care homes for a fee.
North Carolina’s Peer Support Specialist Program: North Carolina’s Peer Support Specialist Program, at the University of North Carolina School of Social Work, provides a peer support training program and is developing a curriculum for peer support supervisors.
Direct Service Workforce Resource Center – Intensive Technical Assistance: With CMS-funded intensive technical assistance in 2007, the Department of Mental Health, Developmental Disabilities and Substance Abuse Services (MH/DD/SAS), in collaboration with the Commission on MH/DD/SAS, and with the support of a grant from the North Carolina Council on Developmental Disabilities, developed a state plan for the workforce supporting MH/DD/SAS consumers, including direct support professionals.
Caregivers are Professionals, Too: The Caregivers Are Professionals, Too! demonstration project was funded through a 2003 CMS Direct Service Community Workforce Demonstration Grant. With the goal of improved recruitment and retention among direct service workers, 3 interventions were piloted: subsidized health insurance, career ladder (later renamed “professional development”), and merit-based recognition. Concluding in 2007, project outcomes included decreased turnover and increased job satisfaction.
Better Jobs Better Care (BJBC): Beginning in 2002, the Robert Wood Johnson Foundation and Atlantic Philanthropies funded a 4-year demonstration and research project that aimed to improve the direct-care workforce in 5 states: Iowa, North Carolina, Pennsylvania, Oregon, and Vermont. A variety of studies and publications are available.
Considering the Employee Point of View: Perceptions of Job Satisfaction and Stress: This 2007 article from the Journal of the American Medical Directors Association examines the sources of stress for nursing aides in 25 North Carolina nursing homes. The major stress contributors leading to turnover were staff shortages, heavy workloads, and time pressures.
North Carolina Medical Journal March/April 2010 Issue: This journal issue contains a suite of articles on long-term care, including 2 about North Carolina’s direct-care workforce.
Direct-Support Professional Workgroup Report (pdf): The North Carolina Council of Community Programs established a stakeholder group to meet and reach consensus on recommendations to address the need for workforce interventions in regard to DSP turnover, vacancies, retention, and competence. This report was issued in 2007.