The need for senior care at multiple levels (home care, assisted living, skilled nursing and hospice) continues to grow despite the continuing drag of low wages, limited training, career development dead ends and staggering turnover. These problems aren’t new and won’t just go away until major improvements are made for direct-care workers (nursing assistants) in each area of care. There may be some new ideas on the horizon that may improve recruitment, job satisfaction and retention for millions of professionals working in senior care.
Direct-Care = Essential
Senior care would come to a screeching halt without the army of nursing assistants across the country. Direct care workers are essential in the everyday care needs of 1.4 million seniors living in nursing homes and over 800,000 in assisted living communities. They’re essential because the support they provide is indispensable for enabling residents with personal assistance needs to fulfill daily tasks to maintain their health and well-being, functional abilities and quality of life.
Hard Physical & Emotional Labor
Being a good direct-care professional isn’t easy. As a matter of fact, it’s downright painful, physically and emotionally. Direct care is associated with high rates of physical injury and musculoskeletal wear-and-tear. Acuity has increased in skilled nursing facilities, making direct care more complex. More than half of the nursing home population is diagnosed with dementia-associated diagnoses, like Alzheimer’s disease. This means that direct-care staff have to be on their game with communication, interpersonal skills and emotional resilience. It also involves technical understanding of dementia, related behaviors and best practices for providing care.
Workforce Challenges
Besides the physical and emotional tolls, the overall quality of the job remains persistently low making recruitment and retention challenging. Wages are fairly low, workloads are usually high, and scheduling remains complicated. Many direct-care workers leave due to their direct supervisor, due to interpersonal issues or just bad management. Training is limited and at times non-existent and opportunities for advancement are far and few between.
Trickle-Down Effect
Such problems don’t stop at the direct care work, but tend to spread to residents, families, fellow workers, overall quality of care and the reputation of the organization. These challenges cause more problems including:
- Poor morale
- Low job satisfaction
- High rates of turnover
- Poor resident and family satisfaction
- Unstable workforce
After so many years of facing the same problems in senior care, why hasn’t there been real change or improvement? This is a difficult question, since facilities that accept Medicaid reimbursement operate on tight margins which don’t allow much wiggle room for significant raises.
Opportunities and Solutions
First and foremost, each state around the country could take a hard look at their reimbursement rates and set a new baseline wage for direct-care workers as well as implementing higher compensation for hazard pay, as was provided during the pandemic. The average cost of living should also be taken into consideration. Money is just one solution. Companies could also try one or more of the following:
- Hire managers and supervisors for their people-skills
- Offer flexible scheduling, especially for staff with young kids and aging parents
- Provide a career path or some development program so that direct-care staff have one or more positions they can rise to (tuition to go to nursing school)
- Offer a living wage with enhanced benefits
- Develop new recruiting methods that attract younger candidates
- Streamline hiring and onboarding
- Mentor new hires for several weeks until they are comfortable
- Engage staff in continual learning and training
Final Thoughts on Responding to the Current Direct-Care Workforce Crisis
A great imbalance exists in the senior care industry among direct-care workers, and unless improvements are made, the same old problems will continue in the future. Despite the difficult physical and emotional impacts of their work, they receive relatively few rewards, other than perhaps their own intrinsic rewards. With the incredible numbers of seniors needing care now and in the future, hopefully federal or state legislatures will hear the call for action and improve employment conditions for millions of direct care workers.