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Long-Term Care Providers Earn a Little Respect — and Minimum Wages

The demand for long-term care providers makes pay and benefits critical factors in recruitment and retention, experts say.

February 10, 2014
Related Topics: Minimum Wage, The Latest, Compensation, Talent Management

The U.S. Labor Department’s decision last fall to extend minimum wage and overtime benefits to direct-care workers was hailed by supporters as a big step toward offering some respect for an occupation that is demanding and low paid yet increasingly critical to the care of a rapidly growing elderly population.

Much has been written about the need for primary-care doctors and nurses, but the demand for home health aides, personal-care aides, and nurse aides is skyrocketing at a time when the labor pool for these occupations is dwindling. This makes pay and benefits critical factors in recruitment and retention, experts say.

“The needs are acute,” said Robyn Stone, executive director of the Center for Applied Research at LeadingAge, a national nonprofit association of organizations that serve the elderly. “Will we have a supply of workers on the front line and will be able to attract them? The other question is around retention. There’s tremendous turnover in nursing homes, and it’s very taxing on the system. It’s expensive, it’s bad for the quality of care, and it’s extremely difficult for the workers who remain. There is a lot of attention on how we will recruit and train, and we will create a healthy work culture on the pay and benefits side.”

Up to 80 percent of those providing hands-on help for elderly are direct-care workers, a broad occupational category that includes nursing assistants or nurse aides, home health aides, home-care aides and personal-care workers. They help the elderly and those with disabilities with daily life activities, like dressing. While many are self-employed, most work for home-health agencies and nursing homes.

The direct-care workforce could become the largest occupational group in the country by 2020, with demand increasing by 48 percent between 2010 and 2020, according to the U.S. Bureau of Labor Statistics. There is a projected need for 5 million workers, more than K-12 teachers or police officers, the data show. Yet, most direct-care workers are women between the ages of 25 and 54, and their numbers in the workforce are expected to grow by just 1 percent.


Most direct-care workers are women between the ages of 25 and 54

In 2011 the average pay for home health aides was $9.91 an hour, down from $11.14 in 2001

The federal minimum wage is $7.25

Last December, the Senate Special Committee on Aging held a hearing to consider ways to build and strengthen the direct-care workforce. The committee reviewed recommendations made in the fall by the federal Commission on Long-Term Care. The recommendations address standards for wages, training and career development, among other issues.

Stone said HR departments could play a big role in recruitment and retention efforts.

“There has to be more resources put into training,” Stone said. “From an HR perspective, what does your orientation program look like, what kind of training does your staff get? Do you just sit them in front of a video? Is it just online? How do front-line workers recognize the difference between dementia and delirium?”

However, low wages and few benefits pose huge recruitment challenges. In 2011 the average pay for home health aides was $9.91 an hour, down from $11.14 in 2001, according to the Paraprofessional Healthcare Institute, and less than half of home health aides receive health care benefits. By comparison, the median hourly wage for all workers is $16.71.

But the biggest obstacle the occupation faces is the negative perception people have of these providers, according to Carla Washington, executive director of the Direct Care Alliance Inc., a nonprofit group that advocates for direct-care workers. “There is a lack of respect for direct-care work, which of course leads to all those other issues, like pay and training. It’s looked at as unskilled labor when, in fact, many skills are required to do the job in a quality way and in a dignified manner.”

Until now, the law viewed these workers as “glorified babysitters” not deserving of fair pay no matter how long or hard they worked, Washington said. FLSA was passed in 1938 to establish a minimum wage, overtime and other worker protections but excluded domestic workers. In 1974 the law was amended to include maids, chauffeurs and other hired help, but not those who care for the sick and elderly. They were considered companions.

The new regulation, which takes effect on Jan. 1, 2015, provides direct-care workers with the same basic protections given to most employees — a minimum wage and overtime pay. The federal minimum wage is $7.25. Fifteen states already extend state minimum wage and overtime protections to direct-care workers, and an additional six states and the District of Columbia mandate state minimum wage protections. However, the federal provision only applies to workers who provide medically related services and not just companionship, according to the Labor Department.

“That’s one win, and it will help in changing the mindset of the public toward the worker and the work itself, and it’s a big step for professionalization,” Washington said.

Rita Pyrillis is a Workforce senior editor. Comment below or email Follow Pyrillis on Twitter at @RitaPyrillis.

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