It’s not easy being a home-care aide. Besides providing the care prescribed by doctors or RNs for clients’ medical conditions as well as physical and cognitive disabilities, a typical workday also involves handling all the mundane tasks of daily living.
Home-care aides support people with disabilities, assisting them with personal needs, general health care, medications, preparing and eating meals, dressing, mobility and handling daily affairs. Medical assistance can include such life-sustaining functions as suctioning and tube feeding; other responsibilities may include such diverse services as transportation, emotional or behavioral support, and even financial management.
But despite the multitasking, special temperament and wide range of talents the job requires, the pay is low (locally, the average wage is $8.68 an hour), the hours are often difficult, and there are few benefits. Pay is determined by state-level Medicaid-reimbursement rates; over the past five years, North Carolina’s reimbursement rate has increased by only 20 cents an hour, according to Kathy McGuinn, co-owner of Advantage Home and Community Care of Asheville.
Perhaps not surprisingly, the combination of hard work and low pay is driving many dedicated workers out of the field and making it harder to recruit new ones, owners of local home-care agencies say. Nationally, turnover rates for home-care workers range from 40 percent to more than 75 percent. And though local rates are slightly better, they are nonetheless a cause for major concern, agency owners say.
Meanwhile, the state is expected to add several million new residents over the next few decades—including a further influx of retirees to Western North Carolina. That population boom threatens to severely strain this already-troubled health-care sector.
Projections aside, even the current situation is a shame, says Roy Burnett of Pathways to the Future and SAIL Home Care, a Sylva-based assisted-living center and home-care agency. And if agencies such as Pathways can’t retain enough workers to keep up with the booming demand, patients will ultimately be forced into nursing homes—which, on average, cost at least 30 percent more in North Carolina than in-home care, he says.
“The problem is finding enough competent, direct-care workers to meet the growing need,” says Burnett. “It takes a special kind of person to take care of an individual at home, because you have to be very, very compassionate. You have to have a health interest, you have to have a person interest, and you absolutely have to have a compassion interest.”
A ray of hope
A recently concluded, local demonstration project called “Caregivers are Professionals, Too!” suggests that giving workers more support could go a long way toward addressing the situation, proponents say.
CAPT found that giving home-care aides health insurance, opportunities for professional development, and merit-based recognition programs drastically reduced employee turnover (which, in turn, boosts recruitment efforts), Project Director Linda Kendall-Fields reports.
Professor John Sherlock of Western Carolina University says his findings support that conclusion. “These people are consummate professionals and really seem to love their work, despite the fact that they do not receive much pay or benefits and often do not have access to professional development or are recognized for the incredible work they do daily,” says Sherlock, a professor of human resources who’s charged with surveying participants and quantifying the program’s results.
More than 1,000 home-care aides in WNC took part in the three-year project administered by Pathways for the Future, the lead grantee, and its subsidiary SAIL Home Care, as well as Advantage Home and Community Care of Asheville, Sawyer’s Healthcare of Robbinsville and Hearthstone Healthcare of Candler. Funded by a $1.4 million grant from the U.S. Department of Health and Human Services, CAPT was one of about 10 such demonstration projects nationwide aimed at bolstering the industry’s work force.
In the wake of a 1999 Supreme Court decision that affirmed the right of people with disabilities to get the services they need to live independently, President George W. Bush signed an executive order establishing the New Freedom Initiative, with the Department of Health and Human Services as the lead agency. In 2006, HHS announced it was making $6 million available to address work-force issues.
The surveys of CAPT workers show a link between overall job satisfaction and increased access to benefits—particularly health insurance, says Kendall-Fields. And though Sherlock’s number-crunching isn’t finished, preliminary data shows that workers in the project had 14 percent less turnover than those who didn’t take part. Meanwhile, the overall turnover rate for the four participating home-care agencies has dropped from 30.3 percent rate in 2003 to 12 percent today.
“The thing that really struck me is that these people do everything for their clients, from providing care to cleaning and washing, and providing companionship to the clients under their care,” notes Sherlock.
Although the grant funds that paid for workers’ health insurance are now spent, these local agencies hope to maintain CAPT’s momentum, vowing to continue efforts to expand career training, development and recognition programs. Most private employers in the field can’t afford to provide employee health insurance, Kendall-Fields explains, and the state prohibits employer groups from forming risk pools that would make insurance coverage less expensive.
“Policy-makers in Raleigh and in Washington, D.C., too, would do well to heed the results of this program and take the steps necessary to stabilize the work force,” says Kendall-Fields. “The result would be a healthier, happier and more stable work force that, in turn, would help attract more dedicated and high-performing people to the field.
A bill now before Congress, the Direct Support Professionals Fairness and Security Act of 2007 (H.R. 1279), would reimburse states that undertake a long-term plan to increase wages for home-care aides. Introduced in March and now in committee, the bill is the successor to a failed attempt to pass such legislation in 2005.
“These employers genuinely care about their work forces and strive to do right by them—and this program has proven that other direct-care employers can take positive, proactive steps to create a highly effective and motivated work force,” says Kendall-Fields. “But in terms of health insurance, reimbursement rates and other areas out of their control, now is the time for lawmakers and policy-makers to … step up to the plate. These wonderful folks may be taking care of our parents and loved ones some day, and they deserve our highest attention.”