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Getting real about retention

This is the fourth in a series of PHI Expert Interviews, which bring you insights from four senior PHI staff. They’re an impressive group — among the nation’s leading experts on long-term care’s direct-care workforce — and collectively they’ve spent decades studying the challenges facing the workforce and how to address them. We think you’ll be interested in what they’ve learned.

When Steven Dawson came out of the workforce development field in 1992 to join Peggy Powell in heading up the Paraprofessional Healthcare Institute, PHI’s sole purpose was to raise funds and provide technical support for Cooperative Home Care Associates. Over time, Steven led PHI into the broader long-term care arena, where its policy and practice experts work with employers and lawmakers to support and stabilize the nation’s direct-care workforce.

Steven has written about the impending direct-care workforce crisis (pdf) and the link between quality jobs for direct-care workers and quality care for long-term care consumers. Through the years, his emphasis has been on creating workplaces that are intentionally re-designed to retain direct-care staff.

“A constantly churning workforce is the enemy of quality care — ask anyone whose mother has had to deal with five different home health aides within a month, or with a blur of CNAs in the nursing home. The industry still manages to attract hundreds of thousands of skilled, caring workers every year, but once hired, these frontline staff are too often treated as if they were invisible. So, of course they leave,” he says. Read the full story

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Tuesday night at the Democratic Convention in Denver, I saw a special speaker take the floor around 6:15. Her name is Pauline Beck, and she is a home care worker in Oakland, California.

A year ago, Barack Obama spent a day on the job with Pauline, as part of the SEIU’s Walk a Day in My Shoes initiative. Pauline, who referred to the candidate as “my friend,” spoke passionately about her belief in his ability to change America and help people like herself. “I’ll never forget the day I spent working with Senator Obama, and I know he won’t either,” she said.

“My job is to help people, and I love my job, but being a home care worker is hard,” Pauline told the delegates. “The wages are low, the hours can be long, and the work can be physically challenging…. Workers need a president who stands up for us.”

As the energy and anticipation spread through the crowd, it was thrilling to see a direct-care worker take on such a prominent role. The fact that this workforce was highlighted is a very promising sign: We could be in for some significant, much-needed changes in long-term care policy over the next few years.

Allison Lee, National Campaign Manager
Health Care for Health Care Workers
alee@phinational.org

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ANCOR continues its advocacy work for direct support professionals (DSPs) with two announcements this month: It has selected the winners of its 2008 DSP TV Online video contest, and it has won the unanimous support of the U.S. Senate for its National Direct Support Professionals Week.

The six DSP TV Online winners — all both by and about DSPs and the people they work for – are now available for viewing on ANCOR’s website. (Above, see the winning video.) All six are full of heart. They convey the pride and joy dedicated DSPs take in their profession, the difference they make in the lives of the people they work with, and the mutual respect and affection that develop between workers and clients. They also contain calls for better pay and benefits, along with a lot of singing, dancing, and enthusiastic expressions of gratitude. ANCOR calls them “part of a greater effort to raise awareness of the workforce wage issue and give DSPs the ability to tell their stories in their own words, and as only they can.”

In addition, the U.S. Senate has recognized the week of September 8 as National Direct Support Professionals Recognition Week. (pdf) The unanimously approved resolution is timed to coincide with ANCOR’s annual Governmental Activities Seminar and its DSPs to DC event in Washington, D.C.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org

“There is now a consistent pattern of data showing that homecare workers receiving benefits have a lower rate of attrition and, therefore, a higher rate of stability,” says the latest report from the Los Angeles County In-Home Supportive Services (IHSS) program.

Impact of Health Benefits on Retention of Homecare Workers: Analysis of the IHSS Health Benefits Program in LA County (pdf) is a follow-up to four reports from 2003-2006, which showed that offering medical benefits to the IHSS home care workers reduced turnover.

The present study, a five-year longitudinal retention analysis, echoes those findings. It also teases out more detail, comparing work patterns for workers who enrolled in the benefits program with those who did not, identifying traits that predict who will enroll, tracking changes in enrollment over time, and more.

The findings are significant because “The success of any kind of in-home supportive services depends on having an experienced and well-trained and committed workforce – you can’t have people stay out of institutions if there’s no workforce to take care of them at home,” says Joanne Holland, a senior clinical specialist at RTZ Associates Inc. “It’s such important work, but it’s not a high-paying position. And a lot of people are able to stay in the work because of these health care benefits.”

The study found that nearly half (45%) of the workers who enrolled in the plan were still in the workforce at the five-year mark, compared with only about a third (35%) of those who were eligible for benefits but had not enrolled.

“The stability of the workforce means you have better workers because they’re been doing it longer,” adds Holland. “It also makes for better relationships with consumers, so it’s a better experience for them.” RTZ Associates wrote the report.

See below or visit PHI’s Health Care for Health Care Workers blog to read comments or add your own.

Elise Nakhnikian, PHI, Senior Online Editor
enakhnikian@phinational.org

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.

Read the full story

It’s just one sentence out of 52 pages – not including introductions and appendixes – but direct-care workers got a mention in the 2008 Democratic National Convention platform.

In a section titled Renewing the American Community, under the subtitle “Seniors,” the platform (pdf) reads:

“We will take steps to ensure that our seniors have meaningful long-term care options that are consistent with their individual needs, including the option of home care. We believe that we must pay caregivers a fair wage and train more nurses and health care workers so as to improve the availability and quality of long-term care.”

Could this be a sign that a political will is stirring to improve home care jobs?

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org