A LABOR OF LOVE

A Tri-County Office on Aging Sponsored Report

Based on Surveys of Employers and Direct Care Workers

EXECUTIVE SUMMARY

From the spring of 2004 through January 2005, a series of surveys was administered to long term care direct care workers (DCWs) and their employers in the tri-county area of Clinton, Eaton and Ingham counties of Michigan . The surveys were carried out through the funding and leadership of Tri-County Office on Aging and at the behest of the Tri-County Long Term Care Collaborative, a group of public and private agencies involved in various aspects of providing long term care. Since its formation in 1999, the Collaborative has been interested in the growth and maintenance of a quality direct care workforce. The survey was designed to establish a baseline profile of the area workforce and identify potential areas for advocacy on behalf of the workforce, especially in the areas of recruitment, training and retention.

Modifying a survey format employed by the Mickus, Luz and Hogan study, Voices from the Front , the Collaborative mailed surveys to over 200 employers of DCWs. Fifty-eight employer responses covered 68 agencies and settings, employing over 1500 DCWs. Surveys were sent to 1246 DCWs, who returned 435 usable responses. An additional mailing was sent to 1651 Home Help DCWs, of whom 252 responded. There are an estimated 5000 DCWs in the tri-county area. Responses corresponded roughly to the population distribution of the counties in the 2000 Census.

Employer responses came from 27 adult foster care facilities, 5 of which were special mental health homes; 4 nursing homes, 10 private duty or other home care agencies, 3 certified home health agencies, 4 assisted living facilities, 2 homes for the aged and a comprehensive brain injury rehabilitation program. There were 21 facilities that served 10 or fewer persons in a typical year, and 11 employers who served over 50 annually. Twenty-two employers indicated they had 5 or fewer full time employees, while 6 had more than 50. Employers said the average starting salary for a DCW was $8.26, the average salary was $8.97, and the average highest salary was $10.38. Forty –five percent of the employers offered fringe benefits such as health insurance, and 31.4% had retirement plans. None of the employers reported that DCW staff turnover was a big problem, despite state and national studies that show it is a major problem everywhere.

The most successful recruitment strategies used by employers were flexible hours, paid training, newspaper ads, competitive pay rates and pre-employment orientation sessions. The retention strategies reported as most successful were flexible hours, competitive pay rates, paid training, regular pay raises, involvement of DCWs in care planning, and recognition events. Most strategies in both categories are “bread and butter” strategies, although some employers reported using “culture change” strategies that recognize and involve DCWs in the care process.

Employers attribute very positive motivations to DCWs for choosing their jobs. From a list of motivations, where multiple choices were possible, approximately 60% or more of the employers said that DCWs took their jobs because they enjoy working with older people, they want to help people, they enjoy working directly with people, they wanted to work in health care, they have experience caring for a family member, they feel they can do the job well and they like the work schedule.

When asked what they could do to help their DCW employees do a better job, the most frequent responses by employers were increase pay (47%), improve benefits (37.2%) and improve training and support for DCWs (35.3%). When asked why DCWs leave the job, employers listed: pay is too low (68.6%), family obligations (49%), no car or transportation problems (43.1%) and not enough hours (41.2%).

The average age of the Home Help workers who responded to the survey was 49 years, and for other DCWs was 38 years, with the average for all workers being 42 years . Nearly 88% of the DCWs were female, 35% were married, and 57% had no children under age 18 in the home. Nearly 16% were African American, 69% white. Only 9% had less than a high school degree, while over half had some college or a college degree. About half of the DCWs reported total annual family income of less than $20,000.

When asked about their motivations to take a DCW job, the workers' top responses were similar to those given by employers, although less emphasis was given to many of the top reasons and more other reasons were selected. And, while over 21% of the employers assumed that workers took the job because they were not qualified for other work, only 4.4% of the workers checked this reason. Over 25% of employers thought workers were on the job to meet welfare requirements, but less than 2% of workers agreed on this.

While about 33% of the DCWs have two years or less in the field, about 22% of them have 12 years or more experience. Nearly 35% hold down another job besides their DCW work, and about a third of those with a second job work in health care. About 10% reported working over 40 hours per week in their DCW job, while 24% said they worked over 40 hours per week in all jobs combined. The average hourly wage reported by Home Help DCWs was $6.87, while the average for all other DCWs was $9.13; the average for all workers combined was $8.60. Only 16% reported having a retirement plan, and only 21% had health insurance, through their employers. Nearly 60% of the workers reported stress, when they sometimes, usually or always had too many job demands.

When asked whether they needed training in several areas, about 50% of the workers thought they needed no more training at all, but about 25% expressed a desire for some training to cope with either their job or their family situations. Employers' views differed from those of workers most dramatically on this issue, expressing a desire for much more job-related training, especially in the areas of dealing with challenging behaviors, dealing with stress, communication on the job, depression in older adults, and death, loss and grief.

When asked about the major sources of job dissatisfaction, the top reasons were pay, lack of opportunity to advance, lack of benefits, and not enough hours, although nearly 20% said they were not dissatisfied at all. When asked what their employers could do to help them do a better job, at least 20% of the workers listed: increase pay (63%) and benefits (41%), increase opportunities for promotion or advancement, improve communication, staff recognition and feedback, improve training and support of DCWs and offer more hours of work. Workers put more stress on both the wage and benefits areas and the improved workplace environment than did employers.

When asked why they intend to stay on the job, workers stressed the personal relationships with the persons they cared for and the satisfaction of doing a job well, as well as such practical factors as closeness to home and flexible work schedules. Over 87% of the workers expressed satisfaction with their jobs, despite feeling that they were underpaid and without adequate benefits. Their responses indicate that they have chosen their work for positive reasons, not because there were no other options available to them.