New Hampshire will lose far more direct caregivers for older adults and people with disabilities in the next decade than it needs new research by PHI, a national non-profit organization focused on elder care and disability services. And difficulties related to low wages and career advancement will make it difficult to reverse.
Amy Robins, director of advocacy at PHI, conveyed that message Monday to the New Hampshire Commission on Aging, which is investigating how to increase the long-term care workforce.
Many states are in a similar position.
There are currently just over 15,000 direct caregivers in the state, including those who work in nursing homes and assisted living facilities, as well as in private homes. Over the next decade, the state will have about 24,400 job openings as people leave the field, Robins said.
Recruitment will be challenging without compensation changes. The median hourly wage for direct care workers in New Hampshire is $15.79, low enough that 28 percent of workers do not have affordable housing and 27 percent live at or near the poverty line, Robins said. Ninety-one percent of direct caregivers are women.
New Hampshire has a specific trend to consider, Robins said. The state has slowly shifted from nursing homes and assisted living facilities, where residents need medical care, to in-home services, where individuals can stay home with help with everyday chores like bathing, dressing, and hygiene.
“It’s just something to keep in mind,” said Robins. “Both institutional setting staff (e.g.) nursing assistants, home health workers and personal care assistants are important in providing this continuum of care. But keep in mind that the number of home care and personal care workers is really increasing.”
While the State Commission on Aging is addressing workforce challenges here, Robin’s joint initiatives by other states have attempted to reconsider long-term care funding and certification and advancement opportunities for workers.
Washington state, looking for an alternative to inadequate Medicaid and Medicare funding, has introduced an income tax that will help ensure that all residents receive $36,500 annually for long-term care costs by 2025.
“We all know the cost of long-term care is probably a lot more than $36,500,” Robins said. “But it’s really important just to acknowledge that the state has really put long-term support infrastructure on the map, as it’s a social responsibility for everyone to contribute to solutions in this context.”
Arizona increased the minimum wage for direct caregivers by requiring that a certain percentage of their employers’ state reimbursement rates be used for pay increases. Colorado raised the base wage for direct caregivers to $15 an hour with funds from the American Rescue Plan. The state budget provides funds to continue this initiative when the federal money is exhausted.
Maine reduced its entry-level training requirements for certified nursing assistants from 180 hours to 130 hours. Robins said it has also made it easier for direct caregivers to receive universal training to increase opportunities for advancement. Finding a way for individuals to earn a paycheck while pursuing certification is also beneficial, according to Robins.
“I think there’s room for more creative thinking around competencies and how we evaluate and evaluate experiences, especially for workers who are entering the field but may have previously held a mentoring role,” said Robins. “How can we assess their competency so they might not have to commit to full certification?”
There are also low-cost approaches, Robins said, like teaching the value of direct care work. This could include involving direct caregivers in the patient’s care team so that they can participate in the assessment and decisions. Wisconsin and Arizona launched a campaign to encourage direct care work, in some cases using worker stories.