Making direct care more appealing

The care needs of an aging population and the low pay of some of those tasked with fulfilling those needs intersected in a documentary airing last night on HBO.

“Paycheck to Paycheck: The Life and Times of Katrina Gilbert” follows the financial and other struggles of a 30-year-old single mother of three making $9.49 an hour as a certified nursing assistant (CNA) in a Tennessee extended care facility. (If you missed it last night, the documentary is available online at no charge through March 24 on, and YouTube and also will be televised again on HBO and HBO2 several times through the end of the month.)

“Even nurses say a CNA’s job is the backbone to the nursing field,” Gilbert says as the camera shows her performing the various duties of her position. As much as she enjoys the work and the residents she helps care for, “I don’t want to be a CNA for the rest of my life,” she says, later adding, “It wears you out. It wears your body down. I feel like I’m 60 years old.” She plans to return to school to further her career in healthcare.

The film is just one part of a multiplatform initiative, The Shriver Report: A Woman’s Nation Pushes Back from the Brink, conducted in partnership with the Center for American Progress. The focus of the effort is not healthcare, but poverty, especially as it relates to working women and their families. Nonetheless, healthcare figures prominently in the issue, not only because the documentary’s subject is employed in long-term care but also because of the challenges Gilbert faces related to paying for doctors’ appointments and prescriptions and the effects that those challenges have had on her life.

“Katrina’s story is typical of the nation’s more than four million direct-care workers—nursing assistants, home health aides and personal care aides,” Paraprofessional Healthcare Institute President Jodi Sturgeon wrote in a related blog. “These workers provide 70 to 80 percent of hands-on, long-term care to elders and people with disabilities living in nursing homes, assisted living facilities, community settings and their homes. Direct-care workers like Katrina are the invaluable backbone of our nation’s long-term care system, yet they earn poverty-level wages.”

Those aren’t surprising words to hear from the head of an organization that has a goal of promoting fair pay for those in the direct care workforce. As Sturgeon also points out, however, Americans need to figure out how to address the issues that drive direct care workers to depend on Medicaid, food stamps and subsidized child care—and drive them to look elsewhere for employment at the precise point in time when our country’s growing older population needs them more than ever. The U.S. Department of Labor predicts that demand for direct-care workers will increase by 37 percent over the next 10 years, Sturgeon notes.

Turnover in long-term care currently is around 50 percent annually, she adds. Addressing the reasons for staff departures and other staffing issues could help ensure quality and control costs in your facility while improving the lives of your employees.

Of course, the side effects of work and wages are not confined to the healthcare field. In a general Shriver Report poll of 3,000 adults (about half of whom were women) conducted in late 2013, jobs were cited as the second-greatest source of stress in participants’ lives, after bills and expenses. This finding was true of all respondents as well as all women respondents.

So what can we do?

These problems don’t have easy solutions, but the Shriver Report website offers several ways that women and others can get involved in efforts related to the documentary and initiative.

What can employers do? When asked, poll participants rated these steps as most useful:

  • Increasing pay and benefits (Sturgeon says that one-fourth of nursing assistants and one-third of home care workers go without health insurance),
  • Providing up to 10 days of paid time off to cover sickness in themselves or a family member, and
  • Providing paid time off after the birth of a child, to care for a seriously ill family member or to recover from their own serious illness.

And does government have a role? When asked what the government can do, the steps most favored by poll respondents included:

  • Ensuring equal pay for equal work and
  • Guaranteeing that pregnant women and new mothers can’t be fired or demoted when they become pregnant or take maternity leave.

Those are some of the solutions offered by the Shriver Report (click here [PDF] to see all poll results). What do you think of them, and what would you add? What do you need? Please comment below (click on the appropriate blue box) or send me an email.

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Topics: Executive Leadership , Facility management , Staffing