Apr 302019
Portrait of Sarah Slocum
Sarah Slocum

By Sarah Slocum

Across the U.S., we see more and more reports about a shortage of well-trained staff who are committed to providing in-home and other long term supports and services. The pinch of the shortage is apparent in many communities where it’s difficult to execute in-home service plans, and residential providers struggle to stay adequately staffed. We all see this problem, but what are we doing about it?

An upcoming Michigan Department of Health and Human Services Long Term Care Study, including Workforce, is described in legislation http://www.legislature.mi.gov/documents/2017-2018/billconcurred/Senate/pdf/2018-SCB-0848.pdf Altarum and PHI, will lead the workforce component of the study that will formally quantify the current workforce and its future and make recommendations for how to meet the growing need for recruiting new caregivers. Some have asked, “Why study this again? We already know it’s a problem.” By now, everyone agrees – it has become urgent to develop consensus around an action plan and move rapidly to implement solutions. That is the mission of our study – to analyze what causes shortages; to agree on what can make entry-level caregiving jobs economically competitive and to create a plan that outlines continuing education, training, promotion, and mentoring practices that can transform currently dead-end jobs into rewarding and sought-after careers.

One issue to tackle is inadequate pay. When entry-level caregiving jobs compete with retailers, it is no surprise that those less complicated and less personally stressful retail positions are filled first. So raising pay levels in stepwise increments is one obvious answer. But beyond pay, we can already see a need for skills-based, value-focused career ladders that motivate direct care staff to stay and advance as they gain experience, take extra training, and acquire new competencies. Proposals like Advanced Care Aides, Mentor Caregivers, and Lead Direct Care Workers (see a summary at: https://phinational.org/service/advanced-roles/) are gaining momentum as avenues for professionalizing the field of direct care into one that encourages entry-level employees to be part of larger care teams – to take partial responsibility for good patient outcomes that are in turn linked to the possibility of greater recognition and reward.

In California, the California Future Health Workforce Commission (https://futurehealthworkforce.org/) has a plan to eliminate the state’s shortage of care workers by 2030. A state investment of $3 billion over the next 10 years will support changes in education, training, and recruitment of workers, and includes strategies to address care worker shortages in rural areas with particular focus on the needs of people of color. California chose to take a hard look at the worker shortage and created a bold, multi-faceted set of solutions that can serve as a template for action in other states.

In Michigan and elsewhere, issues we already know about include the need for employee supports in areas like benefits, paid time off, childcare, transportation support and better training. How do we actually address these issues? Again, studies are an important first step – but they must be structured to lead to follow-up and implementation. Altarum and PHI (see PHI’s 2018 report on workforce at https://phinational.org/resource/the-direct-care-workforce-year-in-review-2018/) will collaborate to quantify typical benefits packages for direct care workers today and estimate costs for improving them. We’ll also focus on the costs and possible return on investment for employers opting to offer ongoing training programs to help their staff accumulate new skills. And we will endeavor to examine whether a case can be made that a well-trained and well-supported workforce can lead to better patient outcomes.

As one care worker in Michigan recently said, “It is my mission to care for people, and I don’t quit even though there are many hardships. Just a little help – a little more support, can keep me and my co-workers providing care. But we need the help now!”

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  7 Responses to “HELP WANTED: Better-paid, better-trained, caring workers to provide long term supports and services!”

  1. PLEASE PLEASE include in your analysis consideration of the adequacy of the equipment available to homecare workers (AND BY EXTENSION, FAMILY CAREGIVERS) to care for those with mobility-related disabilities. This too impacts how they think about their work, and how able they believe they are to provide care for their patients. Note these references:

    Beer, J.M., McBride S.E., Mitzner T.L., Rogers W.A. (2014) Understanding Challenges in the Front Lines of Home Health Care: A Human-Systems Approach, Appl Ergon.45(6): 1687–1699.

    King E, Holliday P., Andrews G.J. (2016) Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients’ Homes, Journal of Applied Gerontology, May.

    We know that the probability of functional limitations increases with age. From a low of 14% of people between the ages of 65-74 reporting difficulty with one or more activities of daily living to more than 40% of those 85+, these limitations can be mitigated by the use of assistive devices. Vicki Freedman, via the National Health and Aging Trends Study (NHATS), has found that only one-third of adults reporting the use of assistive devices are able to function independently. It is alarming that two-thirds either report difficulty with using the device, perform the task less often, or continue to need personal assistance – even with a device. In some way, the design of the products is ill-suited to fully meeting their functional needs. The result is that far too many people are unable to achieve their highest level of Functional Independence.

    The cost of under-designed HME is not only borne by older adults using this equipment. From the NATIONAL OCCUPATIONAL RESEARCH AGENDA FOR HEALTHCARE AND SOCIAL ASSISTANCE (HCSA). February 2019:
    “Home healthcare is the fastest-growing segment of the Healthcare and Social Assistance Sector. In fact, home health aides and personal care aides are the 3rd and 4th fastest growing occupations in the U.S. [BLS, 2018], yet very little research on safe patient handling and mobility in home healthcare have been conducted. In a NIOSH survey of 744 home healthcare workers from diverse geographic regions, (predominantly manual) patient handling was a significant predictor of musculoskeletal symptoms, even after adjusting for other potential predictors such as workers’ age, weight, non-work-related physical activities, smoking status, medical conditions, work durations, and non-work-related caretaking of children and disabled family members [Waters et al. 2006]. Safe patient handling and mobility equipment and training are the exceptions in home healthcare settings. Research is needed to address the many obstacles to safe patient handling and mobility for home healthcare employers, workers, patients, and their families, which may include financial, personal and professional legal liability, and structural barriers.”

    Please don’t stay in the “compensation and benefits” silo as you proceed with your work. Check out the

    • Hello Peg,
      Thank you for your detailed comment. The safety of workers has long been a concern of mine and you are right to point it out. We certainly don’t want to be “siloed” into looking at only compensation and benefits – we know there is a lot more to the picture. While the funding for this study will likely not allow us to look at all the issues, we will continue to work with partners like PHI, Caring Across Generations, The Michigan based IMPART Alliance, the Michigan Caring Majority and others to work for safe jobs, training, compensation, career ladders, and more improvements.
      Best, Sarah

  2. Great article! Having real data will be a big help in figuring out next steps towards helping an aging MI population. Knowing we will have enough home health care workers is the basis of helping people age at home which is what I have seen to be the desire for most people. Again, data to back this up would be great. Helping the profession to be one that is certified with some sort of course to know a person is qualified and esteemed for the tough and loving work they do would also be wonderful.
    Margie Stinson

  3. I have been a CNA for 16 years. I have worked in long-term care, rehab, Assisted Living homes for the Aged, as well as Home Care, which is where my heart currently resides. The pay is awful but it does not deter me from helping those who need it. The need especially in Michigan is so great for home care workers and it is only increasing. Unless something changes with Staffing ratios and the pay scale our nursing community will continue to struggle, feel burnt out, and this will continue to greatly affect our elderly population in a negative way! Please help us!

  4. It was refreshing to hear your presentation at last week’s Alzheimer Association legislative advocacy day! Optimistic that your study will provide the foundation we need to support our continued claims that the “direct care workforce” is indeed in crisis!

    Thank You!
    Annette Jeske
    Advocate for older adults and people with disabilities, formerly associated with the Region VII Area Agency on Aging and currently looking for new work.

  5. Great job, Sarah, and to all those who will work on the study. Public policies must react to real issues and reflect public priorities. And be based on accurate data and information. Otherwise, we risk harmful personal and community outcomes.

  6. I’m in Oregon currently in a nursing home I’ve been here almost two years in October all I have seen is CNAs leaving by The Groves all the time understaffing the nurses leaving new administrators new head nurses it is a crisis in this country all over the keep telling me the public needs to know because the state doesn’t seem to be doing anything are the states they see the problem but they don’t correct it all they do is charge fees and tag them in as soon as they show a change of action and pay the fine and that are good for a while and then go right back to the same behavior it’s not working please your your elderly nice better care the ones who can’t speak up for their self with Alzheimer’s and Dementia and completely disabled where they can’t get up on their own have to rely on caregivers to do everything for them some do it with very very good hearts and some don’t please fix the problem your grandparents your aunts or uncles your parents deserve better

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