A LABOR OF LOVE: ASSESSING THE STATUS OF THE DIRECT CARE WORKFORCE IN THE TRI-COUNTY AREA

A Project Sponsored by the Tri-County Office on Aging

Conducted by Ronald Eggleston, Ph.D., for the Tri-County LTC Collaborative

Problem : The recruitment, training and retention of an adequate LTC direct care workforce impacts the quality of care, as well as the local economy. Most “hands on” long term care is provided by Direct Care Workers (DCWs), who work under such job titles as nurse aide, personal care aide or attendant, homemaker, or home health aide. While the future supply of DCWs is projected to decrease, the demand for their services is expected to grow with increases in the numbers of elderly persons and persons with disabilities.

Purpose of Project: Develop a local DCW profile for Clinton, Eaton and Ingham counties and examine and compare the views of DCW employers and workers on recruitment, training and retention. Provide a knowledge base for policy planning and advocacy.

Project Design: Deploy a survey tool, with comparable questions, to employers and workers in the Tri-County region. Survey MI Choice Home and Community-Based Services Waiver providers (private duty and other home care agencies), Home Help providers and licensed or certified LTC entities (nursing homes, AFC – including special mental health homes, Homes for the Aged, Home Health Agencies). Respondents: 51 employers, representing 68 settings, and 687 DCWs (252 Home Help) out of an estimated 210 LTC providers and 5000 DCWs in the area.

Baseline DCW Data:

• Average age of workers was 42; Home Help average age was 49
• Only 2 DCWs under 20; 222 (32%) over 50; 26 (2.6%) over 70
• 88% are female; 42.3% have children under 18, 17% have children under 5
• 69% are Caucasian, 15.9% African American, 6.6% Hispanic/Latino; 2000 Census figures for Tri-County area: 84.4% Caucasian, 8.1% African American, 4.7% Hispanic
• 89.6% have at least high school diploma; 54.2% have had some college courses
• 50% live in households where total income is less than $20,000, with 23% under $10,000; 2003 Federal poverty level for a family of four is $18,400
• Home Help providers are significantly poorer than other DCWs
• 33% have worked less than 3 years; 22% have worked 12 years or more
• 34.5% have a second job, 36.3% of them in health care
• 25% drive less than 5 miles to work daily; 28% drive over 25 miles daily
• 35% work 36 hours/week; 13.5% work over 50 hours/week, all jobs
• Average wage is $8.60 (for Home Help, average is $6.87, for other DCWs it is $9.13)
• Through work, only 21% have health insurance, only 16% have a retirement plan

Key Findings From Responding Employers

• Attribute positive motivations to workers' choice of DCW jobs
• Report most successful recruiting strategies to be flexible hours, paid training, competitive pay rates, newspaper ads, pre-employment orientation and websites
• Report most successful retention strategies to be flexible hours, competitive pay rates, paid training, regular pay raises, involvement in care planning, recognition events
• Listed changes they could make “to help employees do their job better” as: increase pay, improve benefits, improve training and support of DCWs, offer more hours of work and increase opportunities for promotions/advancement (workers generally agreed on list)
• Frustrated with reimbursement rates which limit their ability to increase pay and benefits
• Think most DCWs need some, more or better training on most basic care topics
• Cited main reasons DCWs leave jobs as: pay is too low, family obligations, no car/transportation problems, not enough hours, lack of advancement, lack of child care

Key Findings From Responding Workers

• Rank order of reasons for selecting DCW jobs similar to employers' estimates, “I wanted to help people,” “I felt I could do the job well,” “I enjoy working directly with people,” “I enjoy working with older people,” “I wanted to work in health care”
• Choices are altruistic or vocational, not forced by circumstances (only 7.3% said “It was the only job available,” 2.8% said “To meet welfare requirements”).
• About half of the DCWs believe they need no more job training, but nearly 45% said they would like some, more or better training on various topics.
• Home Help DCWs were more likely to say they needed no more training.
• 59% of the DCWs reported “too many demands” on the job, a sign of stress
• 60% of the DCWs list “pay is too low” as major dissatisfaction with job; between 26% and 29% of workers list “lack of opportunity to advance,” “not enough hours,” “no or inadequate health insurance offered”
• Despite stress and some areas of dissatisfaction, between 66% and 90% of workers expressed strong positive affect toward job on various statements. Over 83% agreed with statement, “If I had it to do over again, I would still take this job.”
• Five of seven top reasons given for staying on the job are altruistic or non-materialistic (“I enjoy the personal relationships with clients,” “ I feel I do the job well,” “My clients need me,” “ I feel valued,” “I like my supervisor”)
• Over 87% of workers said they were satisfied with their DCW job, while only 5% were “very dissatisfied.”

Other Key Points

• While workers choose DCW jobs for “good reasons,” employers attribute more altruistic motivations to workers' job choices than do workers themselves.
• Employers see more need for job-related training than do workers (more than 33% list “improve training and support for DCWs” as a change that would help their employees do their jobs better). Employers' most cited DCW training needs: dealing with challenging behaviors, dealing with stress, communication on job, depression in older adults, and death, loss and grief.
• While employers properly cite need for increased pay and benefits to attract and retain workers, they are less likely than workers to see need for changes in promotion patterns, communications with staff, and recognition and feedback to staff.