Poor Job Quality Cripples Nation’s Ability to Provide Quality Long-Term Care
When the Shriver Report wanted to put a face on the 42 million low-income working women and the 28 million children who depend on them for its HBO documentary, Katrina Gilbert, a certified nursing assistant (CNA) and single mother of three young children, was the perfect choice.
Gilbert, featured in Paycheck to Paycheck: The Life & Times of Katrina Gilbert, works fulltime in a Tennessee nursing home, often picking up extra shifts and working on holidays to bring home a bigger paycheck. Yet despite her tireless efforts to earn a decent living to support her family, with an hourly wage of $9.63, she cannot make ends meet.
Katrina’s story is typical of the nation’s more than 4 million direct-care workers -- nursing assistants, home health aides, and personal care aides. These workers provide 70 to 80 percent of hands-on, long-term care to elders and people with disabilities living in nursing homes, assisted living facilities, community settings, and their homes. Direct-care workers, like Katrina, are the invaluable backbone of our nation’s long-term care system, yet they earn poverty-level wages.
Katrina struggles daily to pay rent, put food on the table, meet daycare expenses, pay her car loan and insurance, and put gas in her car. She has no health coverage. Visits to doctors and filling prescriptions are luxuries despite having a thyroid condition, chronic headaches, and other health problems. Birthday presents and parties for her children are too prohibitive for this hardworking and loving mother.
At work, Katrina feeds, bathes, grooms, dresses, toilets, lifts, ambulates, and transports those who can no longer do these basic tasks themselves. Being a nurse aide is back-breaking work with the distinction of being the single occupation with the highest injury rates. The job also requires a lot of compassion. Katrina is seen comforting a resident with dementia, promising another that she will be his buddy “always,” and assuring another that she will be back first thing in the morning. She knows exactly what the residents in her care need and has developed strong relationships with them.
Despite the satisfaction Katrina gets from caring for the residents, she doesn’t feel she can continue to be a nursing assistant anymore. She would like to find a different occupation because there is little to show for the work that she does: “A roof over our head with heat is all I can do.”
Direct-care workers -- primarily women, more than half of color, and one fifth immigrants -- bring home paychecks that are so low that half of this workforce relies on public assistance to support their families. Like Katrina, they depend on food stamps, subsidized child care, and Medicaid for their children. A quarter of nursing assistants have no health insurance. One third of home care workers – a workforce expected to outnumber facility workers by more than two to one by 2022 -- lacks coverage. These personal care aides and home health aides earn median hourly wages of $9.57 and $10.01, respectively.
It is no surprise the long-term care industry is plagued by high turnover, with annual rates hovering around 50 percent. Turnover is costly to employers -- and consumers suffer, too. High turnover takes a toll on quality of care.
With the aging of the baby boomers, direct-care jobs top the list of the fastest-growing occupations in the nation. The U.S. Department of Labor projects that demand for direct-care workers will increase by 37 percent over this decade, adding 1.3 million new positions by 2022 -- making it the second largest occupational group in the nation.
Who is going to fill these jobs?
If, like Katrina, direct-care workers seek other careers with better wages and benefits like health insurance and paid sick days, who will provide the long-term services and supports that boomers expect to be available when they need them? The traditional labor pool from which direct-care workers are drawn – women age 25– 54 – is shrinking, creating a “care gap.”
Quality care depends on quality jobs. To build the stable direct-care workforce that our nation needs to meet the rapidly increasing demand, we must treat these workers with the dignity and respect they deserve. It time to make direct-care jobs better jobs: better wages, benefits, training, and opportunities for career advancement. Until then, dedicated direct-care workers, like Katrina, will continue to flee theses critical jobs for occupations that don’t lead to poverty.