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What Direct Care Workers Say about Their Daily Work

November 8, 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 first in a three-part series that shares the highlights of these forthright and insightful conversations.*

ON THEIR DAILY WORK

The direct care workers we spoke with observed that while they provide similar types of support for their clients, their work also often varies from client to client and from one day to the next. Overall, these workers stated that they find what they do rewarding and are deeply motivated by knowing they are supporting their clients in need. However, they also said that the work is exhausting and fear that it will ultimately impact their physical and mental health.

WORKER 1: “You have to be able to come in to work, have a plan for the day, but also be able to change it. If you come in and, okay [you learn that] we don’t have enough staff, or someone’s sick, or there’s an injury, or there was a behavior or… Anything could happen.”

“It’s not ever consistent. So, it always change up, every day. Every week. It is never the same. So sometimes, it gets tiring, mentally tiring, too. Just being burnt out, overworking… not enough staff, some staff got to work 13-hour shifts, three, four days in a row.” ~ Worker 2

WORKER 4: “Although you are working, and you are not well compensated for what you do, we still go out and do it, because that’s our nature, especially migrant. You are accustomed back in my home country to show love. That’s what we do. Many days you get up, you too don’t feel too well, but there’s someone waiting on you there, just maybe to give them breakfast, something to eat. Tell them what’s been going on in the news or something. They look forward to you coming. At the end of the day, you feel good.”

WORKER 3: “You meet, every day, somebody else… They’re waiting for you. They’re smiling for you. They say, ‘Wonderful,’ for me. When I go to my [client’s] house, and I leave from my patient’s [client’s] house, and I got something real in my life, because I work with my heart. I like my job. I enjoy it when I work with patients.”

WORKER 4: “Now that I’m doing it, I find it very rewarding. Not only for helping seniors, as well as young folks, too, because sickness doesn’t have age. Accidents, and so on, it happens to anyone at any time. You find some of your clients got to start all over [in] life as though they’re newborn. Learn to eat. You got to tell them, ’Okay, you’re going to swallow now. They look at you, and you do little gestures, and they understand. Learning to walk again, to do personal care for themselves, and everything. You’re their eyes and their ears for everyday living.”

WORKER 5: “I always want to be there to help, so I go the extra mile, pretty much. I’m always at work. It’s a little tiring, because other people don’t want to do their part, but if they’re not going to do it, who’s going to do it?”

WORKER 6: “Well, it really depends on the client. But overall, you have like the same basic needs for most of them. You come in, you ask them, have you ate? Have you slept properly? How do you feel today? Is there anything that I can help you with?”

ON THE IMPACT OF COVID-19

In these conversations, direct care workers described several ways that COVID-19 has impacted them and their co-workers. They noted that many direct care workers have stopped coming to work because of illness or fear of catching the virus, while others have left their jobs altogether, which has been upsetting to those who remained. Workers also feel challenged by staffing constraints, the number of extra hours they’ve been working to support clients, and the confusing and sometimes limited communications and protocols that have been in place to navigate this ongoing health crisis. Some workers shared that they are committed to staying in their jobs because of their clients, while others are concerned that the intense daily pressures will convince them and their co-workers to quit. These workers noted the need for better communication from their employers regarding future actions—and they want to be asked how they’re doing and consulted on how they would improve their daily jobs.

WORKER 5: “Yeah, I feel as though the pandemic really made the health care field itself really, really hard on the people that continued to stay in the field. I’ve been in this role for about five years now, and from when I started to now—how many hours I’ve put in from the beginning to now—is totally different. I went from when I first started to working normal 40-hour weeks, just working full time, to going anywhere between 80 hours to 100 hours in one work week. That’s only seven days in a week.”

WORKER 7: “In the last year, no, I have not thought about leaving. It’s made me want to get closer to them [their clients] during COVID. I know they don’t have anyone else. They look to us as someone close to them. Being that we lost a couple of people [staff], I’d rather stay with them, because that’s all we know. They’re so used to us, and we’re like their family. To leave them now would just be not right for me, so I wouldn’t think about leaving.”

“So it definitely has impacted the staff, because we’ve had high turnover since COVID. A lot of people don’t want to work. A lot of people are not able to work. So, a lot of the individuals have been sad since COVID has come, because they lost some of the staff they were close to.” ~ Worker 3

WORKER 1: “I think, too, on top of the whole staffing issue, there’s a lot of confusion, too, about who’s doing what…So I think that, too, has been a big problem with COVID, aside from the staffing and all that stuff, and how it’s impacted the individuals. But just the sheer confusion about what protocol we follow. ‘Oh, it changed this week, and it changed last week.’ Oh, it’s just, it’s a mess sometimes.”

WORKER 1: “Yeah, I feel there are a lot of things that have been changing since the pandemic… Obviously, lack of staff is an issue, but I also feel that they [employers] could be doing more to support us and in understanding what we’re going through. I always feel that there’s a constant lack of communication where things are flying so quickly. We’re not told about certain things, and it just makes everything so much more complicated than it needs to be.”

WORKER 2: “It really impacted the job. People don’t want to come to work at all, no more. It is hard. Some people say like, ‘Oh, I got a cough. I have COVID, I’m not coming to work this week.’ Now we got to accommodate for that, that loss to the staff, for the week.”

WORKER 3: “…[When] COVID came, everybody getting COVID, it was just so much happening at one time where I felt, ‘You know what? Is it worth going to work?…  My kids like, ‘Why are you not here as much as you at work?’ Or, ‘You’re always at work,’ there was just so much going on. And then, you got to call in, you feel like you the bad guy, but you’ve been sitting there picking up everybody else’s slack. And then, I don’t know, it is definitely the burnout. The burnout for me is what made me want to quit.”

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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
PHI
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