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What Direct Care Workers Like Most and Least about Their Jobs

November 16, 2022

Direct care workers are the best experts on the nature of their jobs. They hold extensive knowledge of how to perform their complex work and how their employers can help resolve the many barriers they face They are also acutely aware of which interventions would create a genuinely satisfying job for the long term and make a difference in providing them with lasting economic security.

Unfortunately, despite their crucial wisdom, direct care workers are rarely formally asked to describe how their on-the-job experiences can both improve their jobs and care for their clients—lessons that would help stabilize a precarious long-term care field.

In this context, PHI held a series of focus groups earlier this year with a diverse mix of home care workers and residential care aides from different parts of New York State. We offered them anonymity and encouraged them to be as candid as possible, and they described their daily work, how COVID-19 has impacted their jobs, their thoughts on training and advancement opportunities, and what has kept them in this field and what might push them out eventually. 

This article is the second in a three-part series that shares the highlights of these powerful and insightful conversations.*

ON WHAT THEY LIKE MOST ABOUT THEIR JOBS

The direct care workers that we spoke with cited their clients as their favorite part of their jobs— building relationships with them, supporting them through the day, and knowing that their work makes a real difference in their clients’ lives. These workers also appreciated the opportunity to build relationships with other staff members. For example, one worker mentioned that they highly valued their “peer coach” (i.e., a staff member assigned to help this worker manage questions).

WORKER 8: “What I like best is, I’ve grown close with the people that I work with, so I enjoy supporting them every day, enjoy helping them reach their goals and dreams, and things like that they aspire to do.”

WORKER 1: “My favorite thing about this job is… I love being with the individuals. And specifically, right now, I’m working with a lot of teenagers. So, what I’m focusing on now is, I want to integrate them a little more with our adult groups.”

WORKER 9: “In terms of positives… it’s the most rewarding thing, I think, I’ve ever done. Any time one of my guys [clients] learns how to do something or just accomplishes something they weren’t sure they could or just anything like that, it’s incredible. It’s very, very rewarding now.”

“My favorite thing about this job is building relationships with staff and the individuals [clients], and the sense of freedom that the individuals have. That we’re not telling them what they have to do, and things like that.” ~ Worker 3

WORKER 5: “I feel like I’m taking over someone’s guardianship. I’m helping them set appointments. I’m helping them with their medications. I’m helping them enjoy their life, going out. Some houses that I’ve worked at, I’m helping them bathe, making sure they feel good about their self on a day-to-day basis. That’s good knowing that I can make someone still feel like they’re a regular human being. They don’t feel like they’re someone different.”

WORKER 7: “I work in the school setting. I’m there to teach them independence and try to teach them to do things on their own. That is fulfilling, and it’s very rewarding… The outcome and reward of seeing how happy they are getting out, and to do things on their own, and try to integrate them into society, because they won’t feel so bad, helps. It makes my job very rewarding.”

WORKER 10: “I like the satisfaction of helping the people I support and having those positive relationships.”

WORKER 6: “I’ve had clients that break down crying, expressing their gratitude, saying they don’t know what they would do without me… But you know when I hear that, and when their family calls, too, yeah, it makes me feel like I did something right.”

WORKER 6: “I feel like one of the best things about my job, as far as like the upper management, is the mentors… When you first get hired, you get like a peer coach, so somebody that works within the company—they call, they check up on it [you], they take you. I feel like that was very helpful, because my first day I cried so hard. I’m like, ‘What did I do wrong?’ She’s [the peer mentor] like, nothing. ‘It’s just some things that happen that are not in the book.’”

ON WHAT THEY LIKE LEAST ABOUT THEIR JOBS

In terms of what these direct care workers like least about their jobs, they cited inadequate compensation, extensive work hours, the frustration of not always being able to reach a supervisor quickly when a need emerges, and staffing challenges in general. Workers also suggested that their supervisors and senior staff might not fully understand what it takes to be a home care worker, which they said can result in poor management decisions and insufficient workplace supports.

WORKER 8:”I feel like I should get paid more because I’m like a counselor. I’m the doctor. I’m all that in the house.”

WORKER 14:”When clients don’t value our jobs and treat us like their maids sometimes. There’s a lot of cases in which the clients need us and our services, because family are unable to take care of them due to their jobs or live far, or other personal issues.”

WORKER 2: “[We] do need to get paid a little bit more than what we are right now, because you can go flip a burger right now, and make [$20/hour]. And don’t got to deal with getting spit on, dealing with behaviors, fighting, the individuals trying to fight you, do anything crazy. Showers, and all of that. You can go flip a burger and get 20. You got to be a nurse here, a maid, an Uber driver. You got to be all these things. Just, not get paid.”

WORKER 1: “[Upper management] sit in rooms and they’re like, ‘Oh yeah, we’ll just make this decision. But you guys have to do it.’ And it’s like, ‘Yeah, but that’s not going to work.’ ‘Well, you’ll make it work. You’ll be fine.’ And it’s like, ‘No. No, it won’t be fine.’ And I constantly tell them, I’m like, ‘You’re going to set your stuff up for disaster, and that’s not fair to them. It’s not fair at all.’ And then they wonder why staff leave. And it’s because you set them up for disaster.”

“I think there are a lot of people who work in the supervisor role… and the higher-up positions who don’t quite understand what it’s [the job] like, and they take a lot of things for granted. It’s just also lack of communication.” ~ Worker 7

WORKER 1: “Because you [their supervisor] don’t know, and you don’t care to know. I swear, if you would just take one day and come down, and you be the DSP [direct support professional] for the day. You take six people out into the Salvation Army, and you do volunteer work with them for the day. Or you take that person with high behavior needs, and you do that activity with them. You do that stuff. You would see that it’s not as easy as you may think it is.”

WORKER 5: “I mean, the only thing that I really dislike about the role, is just extensive hours. With this role and what’s going on with the world right now, a lot of people don’t want to work. They don’t want to put their self in because of what’s going on. For the people that do still work, it’s a lot of our time being taken.”

WORKER 10: “What I like the least, would be having to pick up the slack for other staff members that don’t do their part.”

WORKER 6: “I don’t like [seeing my clients in] pain, and I don’t like how, when there’s an emergency, and I have to call the 24-hour after-care on the weekend or after hours, it takes a long time to answer. Sometimes I waited over an hour, and I didn’t get an answer, and you know sometimes it’s not just if it’s an emergency… But it makes me worried if there really were an emergency, and there was something that only a nurse could do… Maybe this client could have died because they’re not answering the phone on time.”

WORKER 1: “I think, at least in my agency, they try to offer things like… ‘Hey, did you know that there are relaxing music videos you can watch on YouTube?’ And it’s like, ‘Yeah, okay, well, how is that supposed to help me not be stressed out at work, when I have to work 13 hours today?’… Or it’s like, ‘Did you know that eating chocolate can de-stress you?’ And it’s like, ‘Okay, but I have to work 50 hours this week. And we have 20 individuals and two staff, how is that… ?’ I see what you’re trying to do. You’re trying to help, but that’s not helpful.”

ON WHAT KEEPS THEM IN THEIR JOBS

Overwhelmingly, what these direct care workers said they like most about their jobs is also what motivates them to stay: their clients and the value of their work. But the challenges they face were also driving many of them to consider leaving their jobs–or had already pushed them out. Echoing the earlier quotes, these challenges include: low pay, burnout, feeling unappreciated, experiencing disrespect from other staff, the intensified pressures of COVID-19, long work hours, and the constant struggle to find shifts and clients that align with their scheduling needs and family responsibilities.

WORKER 3: “I’ve been with my agency for almost seven years. I’ve been there for the good days, the bad days, and everything… I had plenty of different roles, but the burnout… And the unappreciated, like they don’t appreciate us, the work we do. I don’t feel appreciated. I feel like I’m giving my all, and I’m coming here and I’m working sometimes 17, 16, 20 hours. And then I get a call to come back because they know I’m going to come, because the way I feel about the individuals. I definitely feel unappreciated.”

WORKER 1: “…She [their supervisor] told me at my personal meeting that, ‘Well, if you can’t hack your job, then maybe you should go find another one.’ And it’s like, ‘I’ve been here longer than you’ve been here.’ I do the job of three different people, sometimes. I take no days off. I’m picking up everyone else’s slack, and you have the audacity to tell me that if I can’t hack my job.’… I don’t deserve that. I’m a loyal worker.”

WORKER 8: “I’ve had thoughts of quitting my job, going through this pandemic, it’s kind of hard. That’s number one. And it was something new, but I’ve been at the agency that I’m at for eight and a half years, and I take pride in all the years that I put in. Of consistently taking myself to work every day, and being in good standing while I’m working, as well. So, I might think about it sometimes, but I’m not going to really do it [leave the job]. I enjoy my job, even though there are things that could be better.”

“I done thought about quitting this job multiple times, and not care. And just leave. But it’s like, the turnover rate is so high because, at the end of the day, yeah, we all love the individuals, but loving the individuals don’t pay our bills. And that’s just how I look at it. It don’t pay my bills. I can love them to death, but it’s not going to pay my bills. Love don’t pay my bills.” ~ Worker 2

WORKER 5: “Within the last year I actually have left my role. I haven’t fully left the role. I’m still in the role. I’m just relief. I’m not full time or part time anymore. The reason why I left is, when COVID began, I had my first kid. It was the spike of COVID, and then when I got off from maternity leave, I was working crazy hours. I mean, I was working anywhere between 16 hours to almost 24-hour shifts. I’m telling you, 6am to 6am the next day… Not getting any sleep. I’m not seeing my family. I had a [spouse] at home. I just had a kid. There was no sense of stability, and I felt like I wasn’t valued as an employee. I felt like I was just there because they didn’t have nobody.”

WORKER 4: “For me, I wasn’t thinking about leaving, but because of cost of living these days, it’s very, very, very hard. I had the luck to live in one of these low-income houses. I’m living in a private house, $1,800 a month. Yeah, you have utilities bills by itself. You have your own transportation. I cannot work for $15-an-hour anymore. I’ve got to move on. I like the job, I like what I do, but I am sacrificing myself.”

WORKER 6: “Sometimes clients die, and then you have to wait a while to try to find another client that works within your lifestyle. You know your hours right now. I’m struggling to get another client six hours during the same timeframe as the client that I had. That’s in the hospital. I’m having a hard time finding a new permanent client, so that I’ll be able to go to school.”

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*Editor’s Note. In presenting these comments, we aimed to preserve the original voice as much as possible. However, in some instances, we made minor edits for clarity.

Methodology. The quotes in this report derive from two focus groups hosted by PHI in April 2022 and one individual interview in September 2022. Each session lasted approximately one hour. Direct care workers were recruited through their employers and were asked to provide written informed consent and were offered $25 for their time. In total, 14 home care workers participated, including eight direct support professionals (DSPs, who support individuals with intellectual and developmental disabilities), four home health aides, one respite provider, and one personal care aide. All conversations were conducted over Zoom, recorded, transcribed using Rev.com and the Zoom transcription feature, and edited to remove all names and identifying features in order to preserve anonymity.

Contributing Authors
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