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We Must Respect and Recognize the Direct Care Job

November 16, 2020

On October 26, PHI introduced its new framework—The 5 Pillars of Direct Care Job Quality—which is meant to guide employers, policymakers, and industry leaders in designing high-quality jobs for direct care workers. The framework covers 29 elements across five pillars: quality training, fair compensation, quality supervision and support, respect and recognition, and real opportunity. The excerpt below on respect and recognition, the fourth pillar, is taken from Would You Stay? Rethinking Direct Care Job Quality.


A quality direct care job should honor the expertise, contributions, and diverse life experience of workers.

Direct care workers reflected in organizational mission, values, and business plans

In a quality direct care job, an organization centers direct care workers in all the documents that shape its direction and communicate its core values, such as its mission statement and business plans. As one example, Cooperative Home Care Associates, a worker-owned home care agency in the Bronx, includes in its mission statement a central role for workers: “to give workers opportunities to learn and grow as members of a health care team.” Organizations should also incorporate these worker-centered ideals in its values and daily practices.

Diversity, equity, and inclusion formalized in organizational practices

Given the diverse demographics of this workforce and the historical impact of social injustice on this sector, an intentional approach to diversity, equity, and inclusion is central to direct care job quality. As described in PHI’s research series on racial disparities in the direct care workforce, employers should implement race-explicit workforce interventions that collect race-related outcomes data and set hiring and retention goals to diversify their workplaces, among other strategies. Research also shows that diverse and equitable organizations experience improvements in recruitment, retention, employee job satisfaction, innovation, reputation, and financial performance, among other benefits.

Consistent feedback is given on work performance and retention is celebrated

As described in the previous installment of this report series, direct care workers’ contributions often remain invisible and, in turn, unrecognized by employers. Direct care workers should be recognized for their strong performance and for their commitment to the job. This recognition works best when it honors workers for specific outcomes (communicating precisely why a worker is being recognized), and when employers develop formal recognition programs so that less visible employees are not left out (which may happen when recognition is provided only on an informal or ad hoc basis). Further, employers can create methods for employees to honor each other, such as through bulletin boards in public spaces. Moreover, they should share recognition widely—through newsletters and social media, for example. Companies with “recognition-rich” cultures experience 31 percent lower turnover than their peers—an example of how formal recognition approaches benefit the entire organization.

Opportunities for direct care workers to influence organizational decisions

Given their unique knowledge and insights, direct care workers should be integrated into an organization’s decision-making processes. Whether through advisory bodies, workgroups, topic-focused committees, or other mechanisms, workers should be able to bring their unique wisdom from the field to an organization’s operations and business strategies, particularly operations matters that directly impact their work and job quality, such as communication workflows. Less formal approaches to engaging workers can also be effective, as long as they include clear structures for ensuring that workers’ voices are heard. Ultimately, empowering direct care workers benefits the entire organization—from workers to consumers to the overall business.

Clear communication about changes affecting workers, with opportunities for feedback

A quality direct care job acknowledges that workers should be informed of changes that affect them and their employers, while also being afforded the opportunity to offer feedback on those developments. Long-term care organizations must regularly adapt to changes in the landscape, including new laws and regulations, economic shifts and additional pressures, and changes in priorities or direction. All these changes impact workers, and they should be updated and allowed to respond along the way. From our experience in the field, the COVID-19 crisis has shown that providers who have kept their workers in the loop when new developments have emerged—to avoid confusion, gather input, and foster solidarity across the organization—have been more successful in weathering the moment and maintaining quality care.

Direct care workers empowered to participate in care planning and coordination

A quality job in direct care empowers workers to participate in care planning and coordination, maximizing their roles and delivering better care to consumers. Regardless of the long-term care setting, workers should be trained and supported to observe and record changes in clients’ health and wellbeing—and successfully report that information to the full care team. Integrating direct care workers in care planning and coordination can improve worker retention, optimize health outcomes for consumers, and lead to cost savings for the health system.

Other staff trained to value direct care workers’ input and skills

To ensure a quality job for direct care workers, staff across the organization should be trained to value these workers’ ideas and skills. As already stated, direct care workers should be trained, supported, and integrated into the care team to deliver optimal care. But if other staff in the organization do not recognize these workers’ insights and experiences, workers feel devalued and care quality is compromised. As a best practice, employers should adopt an organization-wide approach to valuing workers that includes training for all staff members and the creation of cross-functional teams that foster a culture of respect for all employees’ strengths and experiences.

Download The 5 Pillars of Direct Care Job Quality here.

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