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COACH’S CORNER: Addressing the Difficult Issue of Money

May 5, 2015

Money. A topic I don’t usually address, but is so basic. And with low-wage workers rallying across the country for better pay and a higher minimum wage, I want to take the opportunity to talk about the money we pay direct-care workers.

How many times have we heard people say “It’s not about the money” when it comes to direct-care worker jobs? I think it’s time we acknowledge that this attitude undermines the best of intentions for quality in our field. It’s true that we seek to employ individuals who are motivated by a desire to make a difference in people’s lives. But too many employers, policymakers, and members of the general public seem to believe that the fulfillment of this desire is sufficiently rewarding for direct-care workers. Of course it isn’t — direct-care workers deserve a living wage for the hard work they do. But rarely do they get what they deserve.

Here are the facts: The median annual earnings of all direct-care workers nationally are just $13,800, while 22.2% of direct care workers fall below 100% of the federal poverty line and a staggering 43.9% of these workers live in households that rely upon public benefits. Meanwhile, direct-care jobs in home care are growing at a rapid pace; home care is creating more new jobs than any other field in the country. These facts lead to one simple question: How do we expect to hire and retain adequate numbers of direct-care workers when the job simply doesn’t pay enough for people to make ends meet?

This is not an easy situation for sure! Some may assume that employers have plenty of profit to be shared with direct-care workers. While there may be some for whom this is the case, our experiences at PHI have usually been with deeply values-driven employers who are struggling to get their agencies out of the red. Faced with inadequate reimbursement rates, wage adjustments are very difficult to achieve.

Low wages for direct-care workers has a trickle-down effect on the elders and people with disabilities for whom they provide care. We know that care continuity correlates strongly with care quality, but low wages encourage high turnover rates. Organizations that continually must hire — and train — new staff members likely aren’t providing the best possible care. We talk a lot about culture change as a way to improve long-term care and honor elders. Surely a living wage for direct-care workers is just as important to that mission as person-centered care and staff empowerment.

But, as previously explained, unless reimbursement rates are raised, many employers cannot simply raise employees’ wages without cutting costs somewhere else. So what can be done?

It all starts with raising awareness. Open discussion with employees, consumers, family members, policymakers, and the general public has to occur. For example, PHI hosts “Come Care with Me” days where elected officials shadow a home health aide to learn about what they do and gain a deeper understanding of the level of skill required for this work. Organizations that are willing to discuss operating budgets with transparency have been very successful in inviting employees, consumers, and family members to testify at hearings that impact reimbursement rates and other decisions affecting workers. Our Coaching & Consulting Services team collaborates with providers to implement practices that support direct-care workers to grow and advance in their craft. It is time now to raise our voices in the policy arena. Only then can we get at the larger systems issues that impact wages.

Above all, there must be a shift in the way this country values direct-care work. Direct-care work is real, and increasingly important, work, and those who provide it must be paid fairly. PHI, with our unique ability to bring policy and practice together in support of improving wages — and quality of care — will continue to work to change the way Americans think about direct-care workers. We hope that you will join us in this important work.

— by Susan Misiorski, PHI National Director of Coaching & Consulting Services

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