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Iowa’s direct-care workforce is among the lowest-paid employment groups in the state, according to a survey published by the Iowa CareGivers Association.

The average direct-care worker in Iowa makes just $11.50 an hour, according to the 1,276 survey respondents, a group that included certified nursing assistants, home health aides, and personal care assistants.

By contrast, Iowa’s median hourly wage for all workers is $14.40.

Nearly half (49.9 percent) of Iowa’s direct-care workers live in households earning under 200 percent of the federal poverty level.

Iowa’s direct-care workers also struggle to obtain health insurance, the survey found: nearly one-forth (23 percent) of respondents said they were not insured. Overall, 12.4 percent of Iowa’s adults lack health coverage.

Additionally, only 43 percent of direct-care workers in Iowa are offered paid sick leave.

Low Pay Discouraging to Workers

According to the survey, this lack of adequate wages and benefits is driving many Iowans away from direct care. More than 20 percent of direct-care workers surveyed said that they are actively seeking to leave the field entirely in order to find better-paying jobs.

“Workers are leaving direct care at exactly the wrong time,” said John Hale, a public policy consultant for the Iowa CareGivers Association. He notes that, of the ten jobs expected to be most in demand over the next decade, three are in the field of direct care.

“We cannot meet the future demand for workers who will enter and stay in the profession unless we make these jobs better by improving their pay and benefits,” Hale continued.

Recommendations for Future

The report offers several ways that Iowa can address the issue of low pay and benefits for direct-care workers.

For example, the report says that Iowa could insure more workers by expanding Medicaid eligibility to 133 percent of the federal poverty level. The Affordable Care Act will require all states to do that beginning in 2014, but states have the option of expanding Medicaid eligibility (pdf) at any point before then.

The report further recommends that Iowa expand eligibility levels for its subsidized child care program, as well as increase the size of its Earned Income Tax Credits.

– by Matthew Ozga

The New York Times published a letter to the editor by PHI President Steven Dawson on February 11, regarding the article “As Germany Booms, It Faces a Shortage of Workers.”

Dawson reminds readers the U.S. will soon face the same problems as Germany in attracting sufficient numbers of workers to care for the growing numbers of elders.

The U.S. will need more than 1.1 million additional direct-care workers between 2008 and 2018, he explains. Yet the entire labor supply of women between the ages of 24 to 54 — the people who typically fill these positions — falls well short of that total.

Poor pay and the “low status” of Germany’s direct-care workers impede long-term care providers’ ability to attract workers, the article reports. Lifting restrictions on immigration to bolster the labor supply will not be much of a help either, it explains.

Dawson writes that similarly increased immigration will not be a solution to the U.S. “care gap.” He advises that the U.S. must make direct-care jobs far more attractive — providing better wages, benefits, training, and opportunities for advancement, which will not only improve elder care but strengthen economies — particularly in low-income communities.

– by Deane Beebe

Iowa’s direct-care workers still lack adequate wages and benefits, according to an Iowa CareGivers Association survey that is set to be released in the coming days.

The survey, conducted by the Child & Family Policy Center, is the third — and so far, most comprehensive — overview of Iowa’s direct-care workforce published over the past decade. The last survey was released in 2004.

Like the rest of the country, Iowa is facing a shortage of direct-care workers just when the demand for their services is peaking. The aging of the baby-boomer generation will create a need for an additional 10,000 new direct-care workers in Iowa alone over the next 10 years.

In that context, the need for high-quality direct-care jobs is more urgent than ever.

“The needs of persons with disabilities and aging Iowans will go unmet if we continue to ignore and undervalue this incredibly important workforce,” said Di Findley, the executive director of the Iowa CareGivers Association.

“We can no longer, as a society, get by thinking that we can compensate people poorly simply because they are nice, caring people,” she continued.

Specific Survey Findings

Among the findings in the 2010 Iowa survey:

• Iowa’s direct-care workers are among the lowest-paid in the state, earning an average of $11.50 an hour, compared with the median hourly wage of $14.40 for all Iowa workers.
• A majority of direct-care workers in Iowa work full-time hours — but nearly half (49.9%) report household incomes that fall below 200% of the federal poverty level. Nearly one out of five direct-care workers in Iowa (18.2%) are below the federal poverty line entirely. Many rely on public benefit programs such as food stamps and child care assistance to make ends meet.
• Across the board, direct-care workers are less likely to be covered by health insurance than non-elderly workers throughout Iowa.
• More than one-fifth of all direct-care workers in Iowa say they are actively trying to leave the field, mostly due to low pay and poor benefits.

The survey suggests that some of the financial difficulties faced by Iowa’s hard-working direct-care workers could be offset by expanding public services, such as Medicaid eligibility and earned income tax credits, to more Iowans.

It also recommends that the Iowa government use its position of as a primary purchaser of direct-care services (under Medicaid) to raise wages and provide more benefits.

– by Matthew Ozga

The current issue of the National Academy on an Aging Society‘s Public Policy & Aging Report is dedicated to the Community Living Assistance Services and Supports (CLASS) program.

In the introduction to the issue, entitled “Bringing CLASS to Long-Term Care through the Affordable Care Act,” Editor Robert B. Hudson writes that the long-term care provisions, including the CLASS Act, in the recently passed national health care legislation are an “enormously important yet widely unrecognized development.”

For the first time, with the CLASS Act, a “publicly administered social insurance program” has been introduced into long-term care, Hudson explains. People who enroll in the program will no longer have to be “demonstrably poor or spend themselves into penury to receive long-term care protection.”

The report covers how the CLASS act became a provision in the Patient Protection and Affordable Care Act (ACA). It also presents analyses of key long-term care provisions in the legislation, and explains hurdles that are expected during the legislation’s implementation.

Workforce Issues Featured

Two of the articles discuss direct-care workforce issues.

Lisa R. Shugarman writes that “an integrated system cannot exist without a workforce (pdf) to care for the population in need” and “in particular, there is a clear demand for a labor force that is trained appropriately to address the concerns of older adults.”

Joshua M. Wiener describes the multiple long-term care provisions in the health reform legislation, and how the ACA addresses the 800,000 direct-care workers who do not have health insurance, citing PHI research (pdf).

“I am delighted that Josh Wiener cited the expanded coverage for direct-care workers as the most overlooked aspect of long-term care under the ACA,” said PHI Government Relations Director Carol Regan.

“The number of uninsured is closing in on a million workers, and the trends toward home- and community-based services and part-time work will only exacerbate problems with the availability and affordability of employer-sponsored insurance for these women. The new law is a huge benefit for direct-care workers,” Regan said.

“Bringing Class to Long-Term Care through the Affordable Care Act” was made possible with funding from the SCAN Foundation.

– by Deane Beebe

The National Center for Gerontological Social Work Education devoted its August newsletter to the role that social workers can play in improving the working conditions of direct-care workers, and by doing so, improving the care for older adults.

The bimonthly issue of Aging Times features two articles on this topic:

Are We Prepared to Care? — PHI President Steven Dawson explains that as Baby Boomers age, many are retiring from the eldercare workforce, leaving an even greater gap in care. Dawson calls for a system reform to recruit and retain direct-care workers and increase collaboration between the direct-care workforce and social workers.

Vital Yet Undervalued: Recruiting and Retaining Qualified Direct-Care Workers — Nancy Wilson of the Baylor College of Medicine and Jane Bavineau of Care for Elders provide recommendations culled from years of practice, policy work, and research for improving the supply and quality of direct-care workers.

Aging Times also references:

Social Work — Direct Care Partnerships Would Improve Care, a PHI Quality Care/Quality Jobs Guest Commentary by Nancy Hooyman, a gerontology professor and dean emeritus at the University of Washington’s School of Social Work.

Thank You, Iman, Hugo, and All of the Nation’s Other Direct-Care Workers, a personal account by The John A. Hartford Foundation Executive Director and Treasurer Corinne Rieder on how two home health aides make it possible for her elderly parents who have multiple health conditions to live at home. This blog post in the Hartford Foundation’s Health AGEnda calls for putting an end to the Fair Labor Standards Act’s companionship exemption.

The National Center for Gerontological Social Work Education’s newsletter also includes a Direct Care Workers Bibliography (Word doc), a 10-page list of suggested readings on direct-care workers.

– by Deane Beebe

Sen. Bob Casey (D-PA)

The U.S. Senate Special Committee on Aging held a field hearing on August 2 entitled “Taking Care of Mom and Dad: Why We Need a Quality Workforce to Serve Our Older Americans.”

“I called this hearing today to address a serious problem in our Commonwealth and across the nation: providing access to a quality workforce for an aging population,” said a press statement by Sen. Bob Casey (D-PA), who chaired the hearing.

Experts provided testimony on the shortage of health care workers, including physicians, nurses, and direct-care workers. They warned that with the baby boom generation turning age 65 in 2011, there will be an even greater demand for this workforce.

Witnesses included representatives of the federal government, academic medicine, a national advocacy organization, home care, and a direct-care worker association.

Senate Companion Bill to the Direct Care Workforce Empowerment Act Introduced

The day following the hearing, Casey introduced the Direct Care Workforce Empowerment Act, the companion legislation to the House bill (H.R. 5902) that was introduced on July 28 and sponsored by Rep. Linda Sanchez (D-CA).

“The number of Americans needing long-term care is expected to double in the coming decades from 13 million in 2000 to 27 million in 2050,” Casey said in a press statement about the bill. “The vast majority, 70-80 percent, of paid care will be provided by direct-care workers.”

“As a long-time leader on issues affecting direct-care workers, Senator Casey understands in a very personal way their vital role providing compassionate hands-on care and support to elders and persons with disabilities,” said PHI Pennsylvania State Policy Director Joe Angelelli. “His leadership and concern for fair treatment of home care workers is critical.”

Fastest-Growing Occupation is a Poor Paying Job

There were 3.2 million direct-care workers in the U.S. in 2008. It is projected that an additional 1.1 million new positions will be needed by 2018 (pdf).

The median hourly wage for direct-care workers in 2008 (pdf) was $10.42, compared with $15.57 for all U.S. workers that same year.

As in the rest of the nation, home health aides and personal and home care aides are among Pennsylvania’s top 10 fastest-growing occupations (pdf).

“Despite providing care and services that help millions of older citizens and people with disabilities maintain their dignity and autonomy and often remain in their homes, most direct-care workers receive low wages, little or no benefits, and insufficient training and professional development,” Casey said. “As a result, there are high turnover rates that can compromise the quality of care our older citizens and people with disabilities deserve.”

Testimony from the hearing will soon be available at the U.S. Senate Special Committee on Aging website.

– by Deane Beebe