"Cheating Dignity" - AFSCME Press Conference

August 13, 2001
Speech by Steven L. Dawson, President
Paraprofessional Healthcare Institute

We are here to pose a very personal question: When your loved one falls ill or becomes too frail to manage alone—and you cannot always be with her—who will provide her dignified care?

The answer is this: Whether your loved one is cared for in her home, or an assisted living facility, or nursing home, the person providing eight out of every ten hours of “hands on” care will be not a doctor, or a nurse, she will be a “direct-care” aide.

These are the more than two million paraprofessionals—home health aides, personal care attendants, or certified nurse aides—who are the “hands, face, and voice” of health care for millions of America’s long-term care clients.

These caregivers bathe, toilet, feed, and transfer from bed to chair the frail elderly, the chronically ill, and those who are disabled. All provide comfort and companionship—they become for our loved ones a lifeline to the outside world.

The typical direct-care worker is a low-income woman between the ages of 25 and 54, often a woman of color, who is a single mother of young children. Many were, or still are, dependent on some form of public assistance.

Yet today your loved one will be fortunate to find any direct-care staff at all. Rates of staff vacancies and turnover are now so high that many health care agencies report that they are unable to provide adequate care due to an absence of direct-care staff.

And if your loved one is lucky enough to obtain service, her aide may well be overworked and dangerously rushed: Health officials in more than 40 states now report critical shortages of direct-care staff. Annual turnover rates range between 40 and 100 percent, and nurse aides now report the third highest rate of on-the-job injuries in the U.S.

There is no mystery here. Our nation is facing a direct-care crisis for one simple reason: Wages are so low—averaging $7.97 per hour, often in part-time jobs—that nearly half of all direct-care workers live at or below 200 percent of poverty. Our report, Cheating Dignity, details how these essential health care jobs typically earn less than 70 percent of the median wage for all other occupations.

Even the U.S. General Accounting Office (GAO) now reports that the median income of nursing home aides is $13,287 per year, while home-based direct-care staff earn even less, at $12,265 per year. And we are indeed cheating dignity when we ask direct-care workers to serve our health care system, yet we refuse those same workers access to health insurance.

In an attempt to compensate for the low quality of their jobs, direct-care workers are often forced to rely on public assistance to make ends meet. Their incomes are so low that many are eligible for public assistance such as Medicaid health benefits for themselves and their children.

Most tellingly, the GAO has confirmed that direct-care workers are two to three times as likely to receive food stamps as other American workers. For example, a single mother with two young children who works full-time as an aide earning $17,000 annually would still be eligible for a monthly allotment of $341 in food stamps for herself and her children.

Clearly we are fortunate to have any direct-care workers at all—they return to work each day not because they love their jobs, but because they love to care for others.

Unfortunately, the truly bad news is that, if we fail to act now, the staffing crisis will deepen: Over the next three decades we face a widening “Care Gap” caused by the Baby Boom generation growing old, followed by a relatively smaller “Post-Baby Boom” generation—too many elderly, cared for by too few younger workers.

Again, there is no mystery here: the way to solve the direct-care crisis is to improve the quality of paraprofessional jobs, making them more attractive within an increasingly competitive labor market. A labor market in which file clerks (at $8.94/hour) and receptionists (at $9.26/hour) have jobs that are safer and easier—and yet pay more than—direct-care jobs (at $7.97/hour).

In response , AFSCME and the Paraprofessional Healthcare Institute call for health care benefits for all health care workers, and wages that will provide a “self-sufficient” income in which a family can pay for adequate housing, food and other essentials—without relying upon public assistance.

We also call upon state and federal governments, as well as our health care delivery system:

• To provide improved training and adequate staffing levels;
• To respect the right of direct-care workers to organize; and
• To re-build our governments’ Medicaid and Medicare programs around the needs of both clients and their direct-care workers.

Direct-care workers have always been a precious resources—now they are a scarce resource as well. To solve the direct-care crisis, states have no alternative but to help create jobs that will attract a stable workforce. To do so will end the crisis.

If we fail, then the wealthiest health care system on earth will continue to perpetuate poverty-level jobs, offering to its most vulnerable citizens—your loved ones and mine—care that is hurried, care that is delayed, and increasingly, care that is denied.