Defining the direct care workforce is first step to strengthening it

Written by Grace Vitaglione

Diondre Clark, 60, started working as a home health direct care worker in 2013. She cared for her parents and grandmother when they were sick and found a “passion for helping people.”

When the COVID-19 pandemic began, Clark began working in nursing homes and skilled nursing facilities, colloquially known as nursing homes. Although she was making $20 an hour, she still had to work another job to make ends meet.

“I was tired. It was a lot of work. It was stressful,” she said. “I was scared that I would catch COVID-19 and bring it home.”

Clark, who lives in Mecklenburg County, now works as an advocate for workers. National Domestic Workers Alliancethe advocacy organization for millions of nannies, house cleaners, and home care workers. In addition to higher wages, direct care workers also need benefits such as health insurance and more training and support, she said.

The first step in advocating for these changes is to define who actually is a “direct care worker.” Are you someone who works at a facility such as home medical care or a nursing home? Does it refer to someone who only assists patients with daily activities such as bathing or eating? Are certified nurses counted as direct care personnel, or does it vary depending on their license and qualifications?

These were all questions raised during a workshop we hosted on January 15th. NC Center on a Healthy Workforce In collaboration with the North Carolina Department of Health and Human Services, North Carolina Institute of Medicine, North Carolina Coalition on Aging, North Carolina Community Health Education Center, and Piedmont AHEC.

This workshop was the first in a series focused on taking action on the 2024 Recommendations. Report by the Care Workforce Strategic Leadership Council Strengthening the state’s direct care workforce.

Leaders at these organizations have found that understanding who is included in their direct care workforce is the first step to addressing their most important problem: talent shortages. Ta. PHI, a long-term care policy research and advocacy organization; found that from 2018 to 2028, North Carolina will need to fill more than 186,000 direct care vacancies. This includes approximately 21,000 new jobs to meet increased demand and 165,500 jobs that will become vacant as existing employees leave or retire.

North Carolina provides direct guidance on wages for long-term care workers ahead of efforts to raise salaries during pandemic decreased over the past 10 years Adjusting for inflation, PHI Found In 2021.

A lack of professional advancement and benefits, inadequate training, lack of respect, and an aging population all pose challenges to growing the direct care workforce, according to the Leadership Council report. are.

Council members have come up with recommendations to address these barriers, but achieving change will require collaboration from all sides, said Andy, director of the N.C. Center for Health in the Workforce.・Mr. McCracken said.

Who is the direct care workforce?

North Carolina has approximately 120,000 direct care workers. According to PHI-Sponsored research. Women make up 92 percent of the workforce, and people of color make up 61 percent.

Participants at the January 15 event agreed that creating an effective framework for classifying and tracking direct care workers is important, but that is easier said than done.

Clark suggested looking at the workforce like a tree. Many departments make up all the different roles that could fall under the label “direct caregiver,” she said, all connected by the trunk of providing human care. .

of Bureau of Labor Statistics The categories of direct care staff have been organized as follows. Personal care aide, home health aide and nursing assistant. All three assist patients with activities of daily living, such as eating and dressing, but each role is differentiated by the additional tasks they perform.

The agency said personal care aides may assist with community living and employment, as well as activities such as housework and medication management. Home health aides may also perform clinical duties, such as wound care and blood pressure measurements, and are supervised remotely or intermittently on-site by a qualified professional. Nursing assistants may also perform certain clinical tasks under the on-site supervision of qualified professionals.

Some event attendees who work with people with intellectual and developmental disabilities in the behavioral health field said the government’s list did not include important roles such as: peer support specialist Trish Farnham, program coordinator for the North Carolina Coalition on Aging, said in a workshop presentation that she supports employment professionals who help adults with disabilities find and maintain employment.

Federal law also excludes independent providers and care workers hired directly by consumers through programs such as: What is provided through Medicaid? – Consumers will be able to choose their own care providers instead of receiving services through an agency. Agents are also not included in “”.gray market” – workers hired by people or households with private funds.

PHI research Split groups based on settings: Home care workers who work in private homes. Residential care aides employed in places such as group homes and assisted living communities. and a nursing assistant at a nursing home.

“New collective identity”

Farnham told the workshop that defining the direct care workforce needs to strengthen a “new collective identity” while recognizing the different groups within it.

According to , the comprehensive definition also allows NCDHHS to create a workforce inventory. Care Workforce Strategy Leadership Council Report. This allows for better data collection and analysis.

Currently, the state “lack reliable and actionable data” on its direct care workforce, the report said. Addressing workforce challenges requires data focused on turnover rates, job satisfaction, pay, and whether employees leave for other fields.

Still, Farnham said clarifying the definition means drawing a line between “who can participate and who can’t.”

It is also important that direct care workers are included in the conversation. Titles influence people’s perceptions of their status and the abilities of others, Clark says.

Lack of respect is already a workforce challenge, the report said, as the services provided by direct care workers are often undervalued. 2021 Research by the Frameworks Institute, a social science think tank, They found that Americans often view care work outside of the hospital as “low-skilled and of low importance.”

The report also recommended that NCDHHS partner with public and private employers to standardize job descriptions and qualifications, but the nuances that often arise with experience make that a difficult task. I also acknowledge that it is possible.

Some people may have been working for 30 years and have experience in a particular job, even if their title, certifications or licenses don’t correspond to it, Clark said.

“Adjusted Persistence”

Ms Farnham said the workforce crisis seemed “insurmountable” but she was encouraged by the spirit of cooperation at the event. Many groups in the direct care field are used to having to compete with each other for limited funding and resources, but that scarcity is bringing people together, she said.

of Nursing Care Human Resources Strategy Leadership Council‘s report includes four recommendations to address the crisis. It’s about defining the workforce, advancing the data landscape, creating a living wage, and expanding apprenticeship programs. Each will hold their own workshops later this year.

MacCracken, of the NC Center on the Workforce for Health, said insightful reports are often released, but once the report is published, “the conversation is over.”

He aims for this to be different. The goal of the four workshops is to find ways to better implement the report’s recommendations. The North Carolina Medical Research Institute will ultimately compile the information and make it actionable to state agencies and other organizations responsible for implementation.

The center is also working on building data tools to measure progress.

Other actions could include advocating for state lawmakers in the North Carolina General Assembly to increase Medicaid reimbursement rates for direct service providers, which could be a “big ask” for Congress is high, McCracken said.

While the dynamics of the outside world may change, it is also necessary to hold various stakeholders accountable, he said. That’s what the Center for a Healthy Workforce is all about.

“We’re not going to solve all these problems within a two-year legislative period. So our ability to create spaces that are designed to have tailored permanence over time is critical. ,” McCracken said.

Meanwhile, stakeholders from educators to employers have accepted the crisis because everyone is aware of it, he said. Individual employers are used to reaching out to individual educators at a local or regional level, which is less efficient than bringing everyone together.

“For a long time, what we’ve been doing hasn’t worked collectively. So it’s actually not hard for people to come together and say, ‘We need to come up with a different way to approach this.’ ” McCracken said.