The Direct Care Workforce

The

Direct Care

Workforce

YEAR IN REVIEW

Contents

1 Introduction

2 Statistical Snapshot of the Direct Care Workforce

4 How to Recruit and Retain Workers

6 A Home Care Approach for Rural America

8 Home Care Workers Speak Out

10 Federal Policy Spotlight

12 State Policy Spotlight

14 Technology and the Direct Care Workforce

17 Top 20 News Stories on Direct Care Workers

21 9 Publications for the Direct Care Sector

23 #60CaregiverIssues Campaign Recap

PHI works to transform eldercare and disability

services. We foster dignity, respect, and

independence for all who receive care, and

all who provide it. As the nation’s leading

authority on the direct care workforce,

PHI promotes quality direct care jobs as the

foundation for quality care.

In 2018, we saw many great ideas take hold

for direct care workers—a workforce that has

long served as the paid frontline of long-term

care and as a lifeline for millions of people.

Unfortunately, the poor quali of direct care jobs

continues to drive away workers, threatening

the availabili of supports for older people and

people with disabilities.

Here are some of the great ideas that

emerged in 2018:

Home care providers in Minnesota

and Wisconsin co-launched initiatives to

improve home care jobs across their states,

particularly in rural areas.

Throughout the country, advocates

successfully moved policy measures to

improve recruitment and retention, strengthen

data collection, invest in geriatrics training,

and bolster the supports oered by family

caregivers and volunteer caregivers—among

other successes.

Organizations published a range of

reports related to direct care, while journalists

deepened their investigation of this workforce,

writing about sexual harassment, transportation

barriers, and the eects of anti-immigrant

sentiment on workforce supply, to name a few.

Our award-winning #60CaregiverIssues

campaign came to an end, after generating

headline after headline on the workforce

shortage in home care, and rightfully

positioning these workers at the center of the

national discourse.

But we need more great ideas. Direct care

workers deserve jobs that properly reﬂect

the central role they play in

our country’s care system.

Older people, people with

disabilities, and their

families need quali

supports. And long-term

care merits a larger

investment with greater

equi and access.

We’re a long way from

achieving this reali–but

the next great idea will

move us one step closer.

INTRODUCTION

What are the characteristics of a great idea? Does it solve a widespread

problem that seemed intractable? Does it help decision-makers see the larger

picture and connect all the dots? Does it inspire a community or a sector

to act decisively—drawing people out of the well of defeatism?

Great Idea

The Year of the

PHI

YEAR IN REVIEW 2018

The direct care workforce totaled 4.3 million in 2017.

The home care job is among the fastest-growing occupations

and will add 1 million jobs beeen 2016 and 2026–

more than any other single occupation.

Adjusted for inﬂation, wages for home care workers have remained stagnant

in the last decade:

10.66 in 2007 and

11.30 in 2017.

Nursing assistants are more than three times

likelier to experience injuries on the job than the pical U.S. worker.

One in four direct care workers is an immigrant—

totaling 1 million nationwide.

Neglected

A Growing Yet

Workforce

The direct care workforce expands every year–a trend spurred largely by

the persistent growth in the number of older adults and increased longevi

in the general population. Unfortunately, the quali of direct care jobs hasn’t

improved commensurate to this expansion, which forces many workers

to leave the sector and leaves clients stranded without support. Here’s the

latest data on this critical workforce.

A STATISTICAL SNAPSHOT OF THE DIRECT CARE WORKFORCE

KEY FACTS

PHI

YEAR IN REVIEW 2018

SOURCE: PHI. Immigrants and the Direct Care Workforce:

2018 Update. Bronx, NY: PHI, 2018; PHI. U.S. Home Care Workers:

Key Facts. Bronx, NY: PHI, 2018; PHI. U.S. Nursing Assistants

Employed in Nursing Homes: Key Facts. Bronx, NY: PHI, 2018.

IMMIGRANTS IN DIRECT CARE

Immigrants are a valuable part of the direct

care workforce–both now and in the future–yet they

have faced intensifying scrutiny in recent years as the

climate has become more hostile on immigration.

Here are three ways for long-term care leaders to

support this segment of the workforce:

1. Generate new studies on this sector

2. Promote culturally and linguistically

competent workforce supports

3. Form community partnerships with

immigrant-focused organizations

2.1 M

600,000

87%

91%

60%

55%

11.03

12.84

40%

24%

15,100

21,200

19%

15%

A STATISTICAL SNAPSHOT OF THE DIRECT CARE WORKFORCE

KEY DEMOGRAPHICS

TOTAL

MEDIAN AGE

% WOMAN

% PEOPLE OF COLOR

% IN POVERTY

MEDIAN INCOME

% PART TIME / YEAR

MEDIAN WAGE

HOME

CARE

WORKERS,

2016

NURSING

ASSISTANTS IN

NURSING

HOMES, 2016

What is a Direct

Care Worker?

Direct care workers assist older adults and

people with disabilities with daily tasks, such as

dressing, bathing, and eating. Direct care workers

include personal care aides, home health aides,

and nursing assistants. Personal care aides also

help their clients with housekeeping and might

assist them with errands, appointments, and

social engagements outside of the home.

Home health aides and nursing assistants also

perform clinical tasks, such as blood

pressure readings and

assistance with range-of-motion

exercises.

PHI

YEAR IN REVIEW 2018

HOW TO RECRUIT AND RETAIN WORKERS

Guidance

Practical

for Employers

Across the country, home care providers are struggling to hire the right

candidates, ﬁnd enough workers to ﬁll cases, and keep strong employees in

these roles. Recognizing that the home care job needs a sector-wide

transformation to remain aractive, how can long-term care employers beer

recruit and retain home care workers? We have some ideas.

PHI

YEAR IN REVIEW 2018

Growing a Strong Direct

Care Workforce

In 2018, we published a guide to support

long-term care employers in their recruitment

and retention eorts. Here are 10 strategies

described in this guide:

1. Recruit the Right Staff

2. Improve the Hiring Process

3. Strengthen Entry-Level Training

4. Provide Employment Supports

5. Promote Peer Support

6. Ensure Effective Supervision

7. Develop Advancement

Opportunities

8. Invite Participation

9. Recognize and Reward Staff

10. Measure Progress

Expanding the Labor Pool

The pical direct care worker is a woman in her

late 30s or early 40s. To ensure enough direct

care workers in the years ahead, this sector must

aract a more diverse labor pool. Here are three

workforce segments that hold potential:

•

Younger workers. The U.S. labor force

includes 31 million younger workers aged

18 to 24. This demographic makes up 16

percent of the direct care workforce.

• Older workers. Roughly one in four direct

care workers is aged 55 and older, many

of whom bring signiﬁcant work and life

experience to these roles.

• Men. Men make up roughly half of the U.S.

labor force yet only 14 percent of the labor

force. Many men connect their experiences

as family caregivers to direct care.

HOW TO RECRUIT AND RETAIN WORKERS

Did you know?

• One in four Americans will be aged

65 and older in 2060.

• More than half of this population will

need long-term care at some point.

• Home care will add more than one

million jobs between 2016 and 2026.

• Turnover in this sector generally

ranges from 45 to 60 percent.

• The estimated cost for replacing a

direct care worker is $2,200.

PHI | YEAR IN REVIEW 2018

PHI

YEAR IN REVIEW 2018

1. PHI. 2018. Growing a Strong Direct Care Workforce: A Recruitment

and Retention Guide for Employers. Bronx, NY: PHI.

2. PHI. 2018. Younger Workers and the Direct Care Workforce. Bronx, NY: PHI.

3. PHI. 2018. Older Workers and the Direct Care Workforce. Bronx, NY: PHI.

4. PHI. 2018. Men and the Direct Care Workforce. Bronx, NY: PHI.

A HOME CARE APPROACH FOR RURAL AMERICA

PHI | YEAR IN REVIEW 2018

PHI’s Anna Ortigara and Cean

Eppelheimer (back, left to right) facilitated

a training for the providers participating

in PHI’s multi-year initiative to improve

home care jobs in Minnesota. Graduates of

the training left the week of education with

the ability to teach coaching supervision

and coaching communication to their

staff, improving workplace culture and the

quality of their jobs.

A HOME CARE APPROACH FOR RURAL AMERICA

Home Care

The Rural

Dilemma

As in many other parts of the country, Minnesota and Wisconsin are

facing a severe shortage in home care workers that threatens to worsen.

Complicating this problem are the unique challenges of delivering home

care to rural parts of these states, where health-related resources are

thinner, and the “care gap” beeen older people and available workers

grows larger every year. Nevertheless, a solution is on the horizon.

Elevating the Role of the

Home Care Worker

To meet the growing demand for care

statewide, and to support workers in making

ends meet, the quali of home care jobs must

be transformed. “Elevating the role of the

aide” in the home care system—training and

supporting them to have more expansive roles

in this sector—is a critical strategy for improving

this sector. Advanced roles and proper training

can lead to improved job satisfaction and

retention among home care workers, and to

higher quali care for consumers.

A Multi-Year Intervention,

a National Solution

PHI has brought together various leading home

care providers in Minnesota and Wisconsin to

implement a large-scale solution to the growing

workforce shortage in home care. Over the

next year, PHI is working with these providers

to implement various interventions: advanced

roles, coaching supervision, e-learning and

entry-level training, and a range of recruitment

and retention strategies. What is our aim? To

transform this sector and create a model that

informs rural home care strategies around the

country. Rural residents deserve beer.

INITIATIVE PARTNERS

PHI

YEAR IN REVIEW 2018

HOME CARE WORKERS SPEAK OUT

Own Voices

In Their

Our home care initiatives in Wisconsin and Minnesota speak to the

importance of home care workers to older people and people with disabilities

across the state, the long-term care system, and the broader economy. But

nothing demonstrates more the value of these jobs than the voices of workers

themselves. Here’s what they had to say about their roles.

“ Being a home health

nurse means you have to

think outside the box.

You care for a whole family,

not just a patient.”

— Barb Bull, Minnesota Registered

Nurse Case Manager

“ Caring for others means so much

more than what I do. It gives

others independence and choice.

They are able to make an impact

on our community because

of what I do….That’s what

caregivers do; they understand

others and help them to be the

person that they are.”

— Sam, Home Care Specialist, Wisconsin

PHI

YEAR IN REVIEW 2018

HOME CARE WORKERS SPEAK OUT

“ Making them smile, laugh, carrying

on conversations, encouraging

them to be independent, and

helping them stay at home as long

as possible–these are all things

I love about my job.”

— Janet Wilkins, Home Health Aide,

Minnesota

“ I learned from my clients

that every day is beautiful

and they live their lives to the

fullest with a little help from

their caregivers. They need to

know that they can trust you

with their well-being.”

— Becky Boldt, Program Manager

and Care Giver, Wisconsin

“ The impact of being a caregiver

was not immediate for me.

After about a month, I got it….

If you are new to caregiving…

give yourself a chance to

understand and feel the difference

you can make in another person’s

life, and the difference they can

make in yours.”

— Lynn Jenkins, Care Giver, Wisconsin

“ …becoming a Home Care

Specialist has changed my life.

Meeting new people almost

every day has given me a

new perspective…I teach my

kids about awareness and

that everyone has a story they

could learn from.”

— Priscilla, Home Care Specialist,

Wisconsin

“ I have dedicated

my adult life to the

health care eld and

it’s a very rewarding

and helpful job in

more ways than one.”

— Prema Friedlein,

Program Manager/Caregiver,

Wisconsin

PHI

YEAR IN REVIEW 2018

FEDERAL POLICY SPOTLIGHT

Offense

From Defense to Strategic

The federal landscape is essential to the direct care workforce. It shapes how these

workers are compensated, trained, and supported, as well as the extent to which the

long-term services and supports system is properly structured and funded. This year,

a varie of developments related to direct care workers went virtually unnoticed in

the public eye, obscured by more dramatic stories. Here’s what you missed.

JANUARY

Family Caregivers. Direct care

workers play a key role in sup-

porting family caregivers, many of

whom are saddled with the

nancial and psychological costs

of providing unpaid care. In

January, Congress passed the

RAISE Family Caregivers Act, which

will devise a national strategy to

support family caregivers.

MAY

Eldercare Training. Direct care

workers are a key segment of the

eldercare workforce, which could

benet from improved geriatrics

training. In May, the Geriatrics

Workforce Improvement Act was

introduced in the Senate, paving

the way for strengthening the

health care sector’s ability to

support older Americans.

JULY

Geriatrics Funding. Geriatrics

workforce enhancement programs

train health care professionals on

how to support older people. In

July, the U.S. House of Repre-

sentatives passed the Educating

Medical Professionals and Opti-

mizing Workforce Efciency and

Readiness (EMPOWER) Act, which

would continue funding for these

programs, including ones based

in home and community-based

settings and nursing homes.

JULY

Weakening Health Care. In the

four years after the Affordable

Care Act became law, half a million

direct care workers obtained health

coverage. This year, the Trump ad-

ministration continued to tear at this

legislation by de-funding and legally

challenging key elements, such as

ACA navigators and the “individual

mandate,” among others.

SEPTEMBER

Punishing Immigrants. One in

four direct care workers is an immi-

grant, and because of low-paying

jobs, 52 percent access public

benets to survive. In September,

the U.S. Department of Homeland

Security announced they could

begin denying lawful permanent

residence to immigrants who

access certain public benets.

Supporting Volunteers. Older

people and people with disabil-

ities rely on various people for

support–from direct care workers

to family caregivers, and more.

In September, the U.S. House

of Representatives provided $5

million in funding to support Care

Corps grants, which would create

a caregiving volunteer program

that provides non-medical services

to people in need.

6 Key Moments in 2018

PHI

YEAR IN REVIEW 2018

How has President Trump changed the federal

policy landscape for the eldercare workforce?

York: With any new president there is always an

adjustment period. We are fortunate that many

of the issues around the workforce that cares for

older adults are universal. However, we have seen a

signiﬁcant shift in priorities on a number of issues

that impact the eldercare workforce. Immigration

is the most drastic of changes, but we have also

seen some proposed elimination of the only federal

training program in geriatrics. We are deﬁnitely

playing defense on a number of issues.

However, I think the biggest change in this

Administration is that the daily news cycle and

Tweets drive the Congressional agenda now more

than ever. It makes it even more dicult to predict

the Congressional process. In my 25-plus years of

living in DC, I have never seen an environment like

we have today.

Is there a policy win for these workers

that stood out for you in 2018?

McReynolds: The Recognize, Assist, Include,

Support, and Engage (RAISE) Family Caregivers

Act (S. 1028/H.R. 3759) was the biggest

straightforward win for the eldercare workforce.

Appropriators funded RAISE at $300,000 earlier

this year and took nominations for the advisory

commiee. For the roughly 35 million Americans

that provide unpaid care to an older adult in the

U.S., this law would instruct the Secretary of Health

and Human Services to develop, update, and

maintain a strategy to recognize and support family

caregivers—a huge step forward in addressing a

pressing issue for us all as we age.

What’s the mood on the Hill these days

regarding eldercare workers?

McReynolds: Overall, I would say the mood is

positive. There are many lawmakers and sta

members that have a genuine passion and see

the pressing need to both address the eldercare

workforce shortage and invest in continued

training of this workforce. We were pleased to

see a $2 million increase in geriatrics workforce

programs last ﬁscal year—in a year when the

budget was a largely divisive issue. We continue

to work hard to get that number increased so we

can adequately address the workforce shortage.

Who are some of the leading champions

in Congress on this issue?

McReynolds: Rep. Jan Schakowsky (D-IL) was

the lead sponsor on the geriatrics workforce

reauthorization bill (HR 3713) in the House. She

has been an outspoken leader on these issues for

years. Rep. Doris Matsui (D-CA) and Rep. David

McKinley (R-WV) were also co-sponsors, showing

that this issue is truly bipartisan.

Most recently, Sen. Susan Collins (R-ME) and

Sen. Bob Casey (D-PA) introduced the Geriatrics

Workforce Improvement Act (S. 2888), a companion

to the House bill, to reauthorize geriatrics

workforce programs. At a time when so many

issues have become partisan, the fact that these

issues have bipartisan, bicameral support highlights

the importance of issues relating to the eldercare

workforce.

What is one federal goal you have for

this workforce beyond 2018?

York: Moving forward into 2019, we will have

a divided government again. I don’t expect any

drastic changes in the 116th Congress. However,

I am optimistic that the family caregiver panel

will jump in and begin to develop a plan to

support family caregivers.

Much of that support comes from the workforce.

We have an important mission to ensure that the

workforce and family caregivers are adequately

prepared to care for all of us as we age. This plan is

an opportuni to address these important issues.

FEDERAL POLICY SPOTLIGHT

Amy York and Brett McReynolds, EWA

The Eldercare Workforce Alliance (EWA) is a group of 31 national organizations representing consumers, family caregivers,

the direct care workforce, and health care professionals. EWA’s Amy York and Brett McReynolds shared their personal

reections on the federal landscape and what it means for direct care workers and the full eldercare workforce.

PHI

YEAR IN REVIEW 2018

STATE POLICY SPOTLIGHT

Pave the Way

States

When it comes to policy reforms on the direct care workforce, states are increasingly

assuming the mantle–creating stronger compensation and training standards,

promoting recruitment and retention, and imagining workforce solutions that meet the

unique characteristics of their states, among other measures. What are some highlights

from this year, and what’s in store for the years ahead? Here are our thoughts.

It seems that states are gradually enacting

policy reforms that strengthen the direct care

workforce. What’s driving this trend?

Stephen Campbell: Policymakers are acting now

because advocates have successfully explained

how the workforce shortage aects socie and the

economy. The new demand for care has led many

states to help people pay for services. Yet they still

don’t have enough workers, and people can’t get

the services they need.

Allison, we often tout New York as a state

that has taken impressive strides toward

strengthening the direct care workforce.

What are some of those achievements?

Allison Cook: New York has a long history of

strengthening this workforce. It has set wage

and beneﬁt minimums for certain segments of

the home care workforce, passed the nation’s

ﬁrst “Domestic Worker’s Bill of Rights,” and

implemented paid family medical leave—among

other achievements.

Stephen, is there a state-level policy

development from this year that holds

promise for the future of the eld?

Campbell: Texas will soon collect more data on

the home care workforce, which they will use

to create workforce solutions. According to the

state’s report on this topic, these interventions

could support wages, training, supervision, child

care support, and peer mentorship for workers.

That’s the kind of innovative thinking we need

right now.

Allison, what are New York policymakers

considering right now for this workforce?

Cook: They are largely trying to ﬁgure out what

to do about the workforce shortage. How do we

ensure that we have enough quali home care

workers? We oered some ideas this fall, but it’s

going to take a strong, concerted eort from

state advocates.

Stephen Campbell

and Allison Cook, PHI

Stephen Campbell and Allison Cook drive PHI’s state advocacy

around the country, monitoring and advising on key developments

for this workforce. Here they reect on the enormous potential

of state leadership in a rapidly evolving policy landscape.

PHI

YEAR IN REVIEW 2018

Are there specic New York policy approaches

for this workforce that you want other states

to replicate?

Cook: Two come to mind. The ﬁrst is New

York’s “Workforce Innovation Program,” which

dedicates Medicaid funding to support training

for long-term care workers. The second is

the state’s new advanced home health aide

occupation, which New York is beginning to

implement. By allowing advanced aides to

administer certain medications, consumers

will have beer supports and workers will have

access to a career ladder.

Stephen, you recently spoke in Maine about

the importance of state-based strategies that

make long-term care more affordable to the

state’s residents. Why are these strategies

also important for the direct care workforce?

Campbell: Maine considered a ballot initiative

that could have gone a long way toward ﬁxing

our broken system. Most people spend down

their money on care until they’re poor enough to

qualify for Medicaid. That disturbing trend also

strains state budgets, which in turn limits funding

to this sector, exacerbating the workforce

shortage in direct care. Programs like the one

proposed in Maine could save people from

pover and bolster the workforce.

Stephen, you’ve written several case studies

where state policy leaders succeeded largely

by bringing together a range of stakeholders.

What is the value of this approach?

Campbell: We can only create programs and

policies that work for everyone when everyone

has a seat at the table. At a minimum, workers,

employers, state ocials, and people who need

care should all have a say. There’s no limit to

what we can accomplish when we come together

and work toward a common goal.

As you look ahead, where would you want

you want state lawmakers to focus their

attention regarding this workforce?

Campbell: We need beer data on the workforce.

We don’t know the precise scope of the

workforce shortage, and we rarely ask workers

what they need to stay on the job. We can

only solve our problems after we have clearly

identiﬁed and understood them.

Allison, what is your biggest hope for

New York’s home care sector in 2019?

Cook: My biggest hope is for the state to establish

a Home Care Jobs Innovation Fund. It would

support pilot projects to address recruitment and

retention in this sector. Policymakers could also

use the results from these pilot studies to help

address the workforce shortage.

MINNESOTA

Minnesota launched

Direct Support Connect,

a statewide job board

that helps consumers

nd workers and helps

workers nd the right

employment t.

TEXAS

The Texas Health and

Human Services Commission

issued a report to improve

recruitment and retention

among the state’s Medicaid-

funded personal care aides.

WISCONSIN

Wisconsin launched

WisCaregiver, a

training program for

new nursing assistants

that also matches

them with employers.

MASSACHUSETTS

Massachusetts enacted a

law that will require LGBT

cultural competency training

for state-funded or licensed

providers of services to

older adults.

MAINE

Maine passed a bill

to increase Medicaid

reimbursement rates for

direct care workers, helping

to improve wages for

workers who support older

people and people with

disabilities.

ARIZONA

Arizona required Medicaid

health plans to collect data

and develop workforce

interventions that will improve

recruitment and retention

among direct care workers.

STATE POLICY SPOTLIGHT

6 KEY STATE POLICY

DEVELOPMENTS

IN 2018

PHI

YEAR IN REVIEW 2018

MAXIMIZING

COMMUNICATION

In home care, handheld devices

such as smartphones and tablets

can improve communication

among the worker, client, and

full care team. A worker can use

technology to report and manage

changes in a client’s health

condition, among other uses.

FROM THE FIELD: PHI’s

approach to “upskilling” home

care workers draws on handheld

devices to report and manage

client issues, such as health

conditions, risk factors, stressors

in the home, social connections,

and more.

BOOSTING

RECRUITMENT

Long-term care advocates have

used social media to engage

the public, and now employers

are turning to these platforms to

improve recruitment. Social

media can easily reach larger,

more targeted audiences, and

it can simplify the candidate

outreach process.

FROM THE FIELD: A Minnesota-

based digital media rm worked

with a local provider to boost

its recruitment gures–using

paid ads to target key markets

and driving them to apply online

through their mobile devices.

ENGAGING ONLINE

AUDIENCES

Through a range of technology

tools and digital media platforms,

long-term care employers are

improving communication

with their clients and workers.

Advocates are also relying on

new technologies to build public

support for pressing issues.

FROM THE FIELD: PHI worked

with providers in Minnesota and

Wisconsin to launch month-long

social media campaigns in each

state that built public awareness

of the challenges facing both

home care workers and clients.

IS OUR SECTOR PREPARED FOR NEW TECHNOLOGIES?

Technology

As technology innovations gain traction in the long-term care industry, PHI

remains clear about one stance in particular: automation and robots cannot

replace the value of personal connection and hands-on support in direct care,

and it should not displace direct care workers from their jobs. Nevertheless,

technology continues to show promise in the direct care sector–from handheld

devices to social media, and much more. Here are seven examples of

technology strengthening the direct care workforce.

and the Direct Care Workforce

PHI

YEAR IN REVIEW 2018

SUPPORTING

INDEPENDENCE

Many people with disabilities rely

on technology supports to live

independently in their homes.

These technologies include

sensors that monitor the health

and safety of individuals, remote

monitoring technology, smart

homes, voice assistants, and more.

FROM THE FIELD: In 2017, the

President’s Committee for People

with Intellectual Disabilities

issued a policy report on direct

support professionals, citing

technology supports as one of

10 core recommendations.

IMPROVING

WORK HOURS

Many home care workers work

part time because of health

conditions, because they’re caring

for relatives, or because they

can’t nd full-time work. An online

jobs platform can address these

concerns, allowing workers to

create the schedules they want.

(Matching service registries, which

are described below, also make

use of online job platforms but

are more focused on “matching”

consumers and workers.)

FROM THE FIELD: A Washington,

DC-based company created

an online jobs platform where

employers can post jobs and

search for workers based on

location, skills, and experience–

and workers can nd jobs that

meet their needs.

CONNECTING

WORKERS AND

CLIENTS

Matching service registries gather

information about the needs and

preferences of consumers, and the

availability, skills, and preferences

of workers–creating a centralized,

region-specic online resource

where both sides can “match”

with one another.

FROM THE FIELD: PHI’s

Matching Services Project houses

a state-by-state online listing of

matching service registries in the

U.S., including information on

their location, funding sources,

geographic focus, and more.

TRAINING

WIDESPREAD

AUDIENCES

E-learning methodologies have

the potential to improve learning

outcomes for large numbers

of direct care workers. These

methods can also reach workers

who aren’t able to attend training

sessions in person, and they might

be cost-effective in the long-term.

FROM THE FIELD: PHI will soon

unveil its e-learning and training

“specialty” curricula for direct

care workers, which blends our

25-year expertise on training this

workforce with best practices in

e-learning.

IS OUR SECTOR PREPARED FOR NEW TECHNOLOGIES?

Philip: The term “e-learning”

is believed to have been ﬁrst

used in the late 1990’s as part

of a computer-based training

systems seminar in Los Angeles,

California. E-learning emerged

out of the technology waves

of “personal” computing

in the 1980’s and 1990’s,

broadband availabili in the

2000’s, smartphones in the

late 2000’s, and the

widespread adoption

of social media over

the last decade.

Jerry Philip

Director of Workforce Training Solutions, PHI

E-learning has increasingly captivated long-term care leaders who want to tap

the power of technology to effectively train direct care workers, while improving

learning outcomes and achieving cost efciencies. But what exactly is its

potential for this workforce? PHI’s Jerry Philip weighs in.

Can you give us a sense of history–how did e-learning emerge?

Q&A

(continued on pg. 16)

PHI

YEAR IN REVIEW 2018

We saw schools oering online

courses in the 1990’s, businesses

beginning to use e-learning to

train workers in the 2000’s, and

e-learning formats inspired by

social media this decade. In short,

computers became smaller, cheaper, and more

widely available; the internet became a reliable

pipeline for content and transactions; and

we’ve adapted ourselves to consume content,

socialize, work, and learn online. Organizations

have been trying to make the most of these

changes through e-learning.

Can you paint a picture of how an

e-learning course works in the direct care

context? What are some of the most

popular elements?

Philip: From our point of view, eective

e-learning for direct care workers is scenario-

based, which means that we’re interested in

combining case study principles with those

scenarios. We want to introduce the learner

[the worker] to a client using a narrative

with pictures and audio to help them see the

individual and to understand their needs.

We then want to simulate scenarios that give

learners a chance to “practice” key caregiving

skills. The scenarios and the accompanying story

are designed to “unfold” in unexpected ways.

We want learners to reﬂect on their “practice”

experiences. Lastly, we want to give our learners

a chance to ﬁnish the story of their client. We’re

using the basic elements of e-learning—video,

audio, textual elements, and branching—for

storytelling, and other interactive elements to

make the experience as engaging as possible.

It seems that long-term care providers are

increasingly using an e-learning model to

train their workers, ensuring they have the

skills and knowledge to succeed in their

roles. What’s the appeal of eLearning?

Philip: It can be seen as a cost-saving strategy.

It oers a way to train workers without the

same expense of trainers, curriculum writing,

and, for some, training space. The ﬂexibili

to train workers when they need it and

wherever they have Wi-Fi is powerful when

you are dealing with scheduling and stang

challenges.

What are the benets of e-learning

for direct care workers?

Philip: The primary beneﬁt of e-learning for

direct care workers is that workers can access

training when it works best for them. This is

particularly meaningful for those workers who

face considerable transit challenges, or child

and family care responsibilities. E-learning

also oers the potential beneﬁt of training in

multiple languages for workers with limited

English proﬁciency. And it can serve as a

real-time job aid or refresher, particularly for

workers in home or communi-based seings

who have limited access to live support.

What is the appeal for businesses to

adopt e-learning technologies?

Philip: Businesses—even in sectors that are

pically late adopters of technology—have

recognized the cost and time savings of

e-learning. Workers with greater technological

literacy are well equipped to beneﬁt from

e-learning, and their success with this format

has helped justify organizational investments.

Are there any technology innovations

in recent years that have the potential to

improve training among the direct care

workforce?

Philip: Augmented and virtual reali

technologies oer the chance to narrow the gap

beeen training and real-world caregiving by

making the experience truer-to-life while building

empathy. This really maers when we are trying

to help learners combine and apply all their

new knowledge and skills to real-life scenarios,

particularly for clients with complex needs. AR-

or VR-assisted simulations give workers a chance

to feel the emotion of the case and to “see” the

impact of their actions on care. This helps the

workers retain more of what they’ve learned and

makes it easier and more likely for them to put

their new skills into practice.

IS OUR SECTOR PREPARED FOR NEW TECHNOLOGIES?

Q&A

PHI

YEAR IN REVIEW 2018

(continued from pg. 15)

“HEALTH CARE JUST

BECAME THE U.S.’S

LARGEST EMPLOYER”

In the rst quarter of

2018—and for the rst

time in history–the

number of U.S. jobs in

health care surpassed

those in manufacturing

and retail, a trend driven

largely by the growth in

older people and rising

health care costs. The

Atlantic explored this

historic development,

noting that personal care

aides and home health

aides will represent one

in 10 new jobs over the

next decade.

(January 9, 2018)

“HOW A HEATED

IMMIGRATION

DEBATE MIGHT AFFECT

GRANDMA’S CARE”

One of many articles

over the last year that

covered the role of

immigrants in eldercare,

this article from The Wall

Street Journal drew an

illustrative link between

the care received by

older people—or

“grandparents,” which

personalized the issue

for readers—and the

growing hostility toward

immigrants, many of

whom are on the front

lines of that care.

(January 22, 2018)

“FOR HEALTH CARE

WORKERS, THE

WORST COMMUTES

IN THE CITY”

Delrisa Sewell-Henry,

the New York City home

health aide at the center

of this article from The

New York Times, spends

hours every day on

public transportation to

reach her client. Long

commutes are especially

tough for home care

workers, who can lose

earnings for being

late, as well as for their

clients, who experience

disruptions in their care.

(January 22, 2018)

“HELPING EMPLOYERS

FIND SUCCESS”

While other articles

explored the negative

consequences of

anti-immigrant policies

on the direct care sector,

Provider Magazine took

a different approach. It

proled an assortment

of long-term care

providers around

the country that are

intentionally recruiting

foreign-born workers and

instituting immigrant-

friendly supports in their

workplaces.

(January 22, 2018)

TOP 20 NEWS STORIES ON DIRECT CARE WORKERS

Newspapers

How

Told the Workforce Story

Media outlets do more than relate the latest news and opinions–they shape

the public’s beliefs about major issues. Their stories frame the national

conversation and inﬂuence what policymakers consider important, bringing

pressing issues to life. This year, the news coverage on direct care workers

seemed stronger than ever, covering an array of topics–immigration,

transportation, nursing homes, and much more. Here are 20 highlights.

PHI

YEAR IN REVIEW 2018

1 2 3 4

“IF IMMIGRANTS ARE

PUSHED OUT, WHO

WILL CARE FOR THE

ELDERLY?”

The New York Times

captured the immediate

consequences of the

Trump administration’s

anti-immigrant actions

on the caregiving system:

the growing fear among

people who rely on

home care workers to

get through the day, as

well as the challenges

faced by long-term

care employers that rely

on immigrant workers

and can’t nd enough

job applicants to ll

positions.

(February 2, 2018)

“MAINE BALLOT

EFFORT WOULD

MANDATE HOME

CARE FOR ELDERLY,

DISABLED”

Long-term care is

profoundly expensive,

and people who don’t

qualify for Medicaid

have limited options.

In response, states are

increasingly considering

policy options that

would make long-term

care more affordable to

their residents.

This Associated Press

article covered a ballot

initiative in Maine that

was part of the growing

momentum for these

reforms.

(February 4, 2018)

“WHERE WILL OUR

HOME CARE AIDES

COME FROM?”

Tax and retirement

expert–and Forbes

columnist–Howard

Gleckman nicely

summarized the

pressures facing the

home care workforce:

low wages, benets, and

the challenge of lling

these marginal positions,

among others. Worse,

many people can’t afford

these services. Gleckman

wrote: “Demand for

those aides will increase

by 50% over just the

next decade, to 3 million.

But where will they

come from?”

(February 28, 2018)

“AS TRUMP TARGETS

IMMIGRANTS,

ELDERLY AND OTHERS

BRACE TO LOSE

CAREGIVERS”

When the Trump

administration

announced it would end

Temporary Protected

Status for various

countries, including

Haiti, Kaiser Health

News investigated the

impact of this change

on workers, clients, and

the broader caregiving

system, where immigrants

are substantial. Two

Boston residents form the

heart of this story: Nirva,

a Haitian immigrant,

and her client, Isolina,

a 96-year-old Italian

immigrant.

(March 26, 2018)

NY DOCTORS DON’T

PAY ATTENTION TO

HOME HEALTH CARE

PLANS”

How much time do

physicians spend

reviewing home health

care plans for their

patients? Forty-seven

percent spend less

than one minute,

and only 21 percent

spend more

than two minutes. Reuters

explored these startling

ndings, emphasizing

the importance

of strengthening

relationships between

doctors and the home

care system, among

other solutions.

(April 2, 2018)

“THE U.S. CAN’T KEEP

UP WITH DEMAND

FOR HEALTH AIDES,

NURSES AND

DOCTORS”

This article from CNN

had three alarming

statistics to substantiate

its dire claim: by

2025, the health care

system will need 2.3

million new health

care workers, including

nurses, physicians, lab

technicians, and other

workers. The largest need

will be for home health

aides, at about 423,000

jobs. And what’s the

estimated shortage for

home health aides in that

period? 446,300.

(May 4, 2018)

TOP 20 NEWS STORIES ON DIRECT CARE WORKERS

PHI

YEAR IN REVIEW 2018

“HOW TRUMP’S

IMMIGRATION

POLICIES COULD HURT

SENIOR CARE”

TIME magazine built

on previous news stories

about immigrants in

the direct care sector

by analyzing how these

workers are being

affected by the federal

administration’s recent

actions. It reported that

about 34,600 workers

originated from countries

that will lose Temporary

Protected Status in the

next two years because of

a new Trump-era policy.

The article asks: without

enough immigrants,

who will take these

poor-quality jobs?

(May 10, 2018)

“WHEN YOUR SEXUAL

ABUSER IS ALSO

YOUR PATIENT”

The #MeToo movement

reached the home care

industry this summer

when The Hufngton

Post released an exposé

on sexual harassment in

home care, centered

on a New York City

home care worker

experiencing sexual

harassment from

her client. The article

also opined on the larger

context: “All of which is

to say this is a vulnerable

group of workers, often

shouldering the triple

burden of racism, sexism

and near-poverty wages.”

(June 2, 2018)

“IT’S ALMOST LIKE A

GHOST TOWN.’ MOST

NURSING HOMES

OVERSTATED STAFFING

FOR YEARS”

Nursing home advocates

have long raised

concerns about stafng

levels at nursing homes

and the measures used

to assess those levels.

This New York Times

article blew the lid off this

topic, exploring new data

from Kaiser Health News

that showed signicant

stafng challenges

among more than 14,000

nursing homes–all

based on new payroll

records from Medicare,

as required by the

Affordable Care Act.

(July 7, 2018)

“MINNESOTA ROLLS

OUT FIRST STATEWIDE

JOB BOARD FOR HOME

CARE SUPPORT”

Online job portals–and

“matching service

registries”–are gaining

traction in states as a way

for consumers to nd

workers who meet their

needs and preferences–

and for workers to nd

jobs or employers that

match their interests.

Minnesota’s Star Tribune

reported on a new

statewide portal in

Minnesota that will do

exactly that, making life

easier for consumers

and workers.

(July 12, 2018)

“WHY DOES ONE OF

THE MOST NEEDED

JOBS PAY SO

POORLY? PT. 1”

“THE U.S. NEEDS

MORE HOME CARE

WORKERS. IS THIS

THE SOLUTION? PT. 2”

PBS traveled to

Minnesota to examine

the growing challenges

in recruiting and

retaining home care

workers. The rst part

in this two-part series

looked at the primary

reasons for high turnover

in this sector, including

a $10 wage that has

remained stagnant for

years, making it difcult

to compete with other

low-wage industries. Part

two explored solutions,

including the potential of

advanced roles in raising

compensation levels for

home care workers.

(Jul 26, 2018)

(August 9, 2018))

“MEDICARE SLASHES

STAR RATINGS FOR

STAFFING AT 1 IN 11

NURSING HOMES”

Shortly after Medicare

published new payroll

data on nursing homes,

Kaiser Health News (and

The New York Times)

uncovered severe stafng

challenges in these

homes, placing residents

at enormous risk. In July,

the Times published

a follow-up piece on

Medicare’s decision to

lower its star rating on

stafng levels, which

affected one out of

11 nursing homes–

1,400 in total.

(July 27, 2018)

TOP 20 NEWS STORIES ON DIRECT CARE WORKERS

PHI

YEAR IN REVIEW 2018

“LITTLE WAGE

GROWTH FOR HOME

CARE WORKERS IN

LAST DECADE”

PHI’s annual data on

home care workers and

nursing assistants have

provided an essential

benchmark to assess how

workers fare over time.

Home Health Care News

reported on an unnerving

statistic in this year’s

research: over the last

decade, personal care

aide wages increased

by only 95 cents, while

home health aide and

nursing assistant wages

dropped by 11 cents.

Wages in this sector are

at a standstill.

(September 4, 2018)

“AMERICANS WANT TO

BELIEVE JOBS ARE THE

SOLUTION TO POVERTY.

THEY’RE NOT.”

The New York Times

issued this searing and

illuminating essay on

poverty, challenging the

notion that employment

necessarily keeps people

out of poverty. At the

center of this article is

Vanessa Solivan, a home

health aide in New

Jersey, whose life vividly

embodies how poverty

becomes entrenched,

perhaps inescapable, for

many low-wage workers.

(September 11, 2018)

“MISSED

OPPORTUNITIES:

COULD HOME

HEALTH AIDES PLAY

A GREATER ROLE?”

Can the home care

job be re-imagined,

creating more satisfying

and expansive roles for

workers, and improving

the quality of supports

for clients? Would these

roles save the system

money? And what’s

preventing the eld

from adopting these

roles? These are a few

questions that WTVF (an

NPR afliate) examined

in its in-depth article on

home care aides and

advanced roles.

(September 25, 2018)

“A RADICAL SOLUTION

TO THE IMPOSSIBLE

COST OF CARING FOR

THE ELDERLY”

The heart-wrenching

protagonists of this story

from Mother Jones are

a working-class family

struggling to obtain paid

support as they care

for each other through

dementia, cancer, and

the frailty of old age. It

argued that “universal

home care”–an idea

emerging at the state

level–could make life

much easier for this

family, and in turn, the

rest of us. But will it

become reality?

(October 2018)

TOP 20 NEWS STORIES ON DIRECT CARE WORKERS

PHI

YEAR IN REVIEW 2018

17 18 19

PHInational.org

Learn about our consulting services,

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education campaigns

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WORKPLACE INJURIES

AND THE DIRECT CARE

WORKFORCE

Direct care work can

often lead to injuries,

including sprains, tears,

soreness, and pain.

This study showed

that injury rates are

alarmingly high for

direct care workers,

especially among

nursing assistants

who often overexert

themselves while

repositioning multiple

clients a day. In 2016,

the injury rate (per

10,000 workers) for

nursing assistants was

337, compared to 100

among all occupations.

BENCHMARKING

THE ELDERCARE

WORKFORCE: A

COMMUNITY FOCUS

How should we measure

the need for eldercare

workers in a geographic

community, taking into

account the population’s

needs, worker availability

and caseloads, and hours

of support (among other

variables)? This report

tackled this question by

devising a method that

estimated workforce

need in the Washington,

DC area, and provided

a thoughtful benchmark

that could yield more

data and better

measures in the

years ahead.

USING TELEHEALTH TO

IMPROVE HOME-BASED

CARE FOR OLDER

ADULTS AND FAMILY

CAREGIVERS

Telehealth has the

potential to lower costs

and to improve access

and care outcomes

among older consumers

in home care. This

publication examined

various telehealth

strategies in home care,

including transitional care

for heart failure, palliative

care, and more. It also

encouraged policymakers

to better reimburse

the costs of telehealth

in home care and to

limit harmful restrictions

regarding its use.

THE PART-TIME

DILEMMA FOR DIRECT

CARE WORKERS

The combination of

low wages and part-

time hours forces many

workers into poverty.

This study revealed

that one in three direct

care workers works part

time, many of whom

are supporting family

members, retired,

enrolled in school, or

dealing with health

conditions that prevent

full-time hours. One in

four part-time workers

works part time due to

conditions at their place

of work or in their local

economy.

9 PUBLICATIONS FOR THE DIRECT CARE SECTOR

Organizations

How

Examined the Workforce

Nonproﬁt and government leaders are increasingly shining a spotlight on direct

care workers, analyzing their experiences and needs, as well as their relationship

to the long-term care system. This year, a varie of reports explored the direct

care workforce across an array of topics, from workplace safe to transportation,

and much more. Here are nine reports that caught our eye.

PHI

YEAR IN REVIEW 2018

PHI

ALTARUM

AARP

PUBLIC POLICY

INSTITUTE

PHI

FILLING THE CARE GAP:

INTEGRATING FOREIGN-

BORN NURSES AND

PERSONAL CARE

ASSISTANTS INTO

THE FIELD OF

LONG-TERM SERVICES

AND SUPPORTS

The sharp growth in

older people–both

domestically and

abroad–has compelled

signicant demand for

long-term care workers

around the world. This

report examined the

potential of foreign-

born workers to ll

this gap, reporting

on workforce data

across occupations,

identifying strategies

to hire and retain

immigrant workers,

and offering a slate

of recommendations

to strengthen this

critical segment of the

workforce.

AN UNHEALTHY

COMMUTE: THE

TRANSIT CHALLENGES

FACING NEW YORK

CITY’S HEALTHCARE

SECTOR

In a given week, the

typical home care

worker in New York City

travels hours through

public transit to multiple

homes. Unfortunately,

many of these trips are

extremely long, highly

stressful, and costly—all

of which contribute to

high turnover. These

challenges also threaten

the quality of care

for consumers. This

report examined the

transportation concerns

facing healthcare

workers in the largest

city in the country.

COMPETENCY GUIDE

FOR DEMENTIA

CARE: DIRECT

CARE WORKFORCE

DEVELOPMENT

Approximately 5.7

million people in the

United States live with

dementia, a population

that requires urgent

and tailored support,

particularly from

direct care workers.

Unfortunately, these

workers are rarely

trained in dementia

care, leaving many

people without proper

care. This competency

guide outlines the

main topics and

competencies related

to dementia care, as

well as key training

elements.

ACROSS THE STATES

2018: PROFILES OF

LONG-TERM SERVICES

AND SUPPORTS

For 24 years, this

valuable reference

book has provided

annual state data,

rankings, and national

averages across a range

of topics related to

long-term services and

supports, including

age demographics and

projections, costs of

care, disability rates,

and more. One notable

nding from this year:

state Medicaid

systems are dedicating

a higher percentage

of spending for home

and community-based

services.

DIRECT CARE WORKER

RACIAL DISPARITIES SERIES:

ASIAN AND PACIFIC

ISLANDER DIRECT CARE

WORKERS

BLACK/AFRICAN

AMERICAN WORKERS

IN DIRECT CARE

HISPANIC/LATINO

DIRECT CARE WORKERS

This research series

took a closer look at

the unique challenges

facing people color

who work in direct care.

Two notable ndings:

the series found that

nearly half of Hispanic/

Latino direct care

workers are immigrants,

and U.S.-born Black/

African American

workers are more likely

to live in poverty than

white workers and

Black immigrants. This

research makes the

case for race-explicit

workforce strategies

that address these racial

inequities.

PHI

YEAR IN REVIEW 2018

9 PUBLICATIONS FOR THE DIRECT CARE SECTOR

GLOBAL AGEING

NETWORK &

THE LEADINGAGE

LTSS CENTER

@UMASS BOSTON

CENTER FOR AN

URBAN FUTURE

GEORGIA

ALZHEIMER’S

AND RELATED

DEMENTIAS

COLLABORATIVE

AARP

PUBLIC POLICY

INSTITUTE

PHI

Solutions

When we imagined #60CaregiverIssues, we sought to address one clear

problem: the worsening workforce shortage in home care. Within o years,

we unveiled 60 solutions, one idea at a time. And it worked—we

substantially grew our base of online supporters, generated signiﬁcant

media coverage, and inspired policymakers to focus on the range of

challenges facing this job sector. As this campaign comes to an end, our

country seems to understand this problem in a whole new way—as one

that affects all of us, and one that can be xed.

From a Workforce Shortage to Concrete

#60CAREGIVERISSUES CAMPAIGN RECAP

PHI

YEAR IN REVIEW 2018

Learn About the Shortage

of Paid Caregivers

Issue Brief

As the number of older people

rises, the demand for home

care workers gets larger every

year. However, the poor quali

of home care jobs keeps away

good candidates. We examined

eight aspects of this shortage,

laying the foundation for this

campaign. (Feb 7, 2017)

Use a ‘Quality Jobs’

Framework to Measure

Policy Progress In Your State

Issue Brief

In the last decade, New York

State has implemented various

policy changes to strengthen

the home care workforce.

We used our “nine essential

elements of a quali job”

framework to examine how

New York fares when it comes

to direct care workers.

(Feb 22, 2017)

Expand Health

Coverage for the Direct

Care Workforce

Research Brief

Beeen 2010 and 2014, half

a million direct care workers

gained health coverage, and

the uninsured rate across

this workforce decreased

by 26 percent. Our research

brief oered another lens on

the renewed debate on the

Aordable Care Act.

(Mar 7, 2017)

Take Federal Action

to Strengthen the

Direct Care Workforce

Report

A federal investment in the

home care workforce would

promote beer wages and

beneﬁts, enhance training,

and create advanced roles—

and it would create a vibrant

system of care. We outlined

ﬁve urgent areas where federal

policymakers could act.

(Mar 21, 2017)

Create a Funding

Pool to Incentivize

Quality Jobs

Issue Brief

In 2014, New York State

created a funding pool that

supported licensed home care

agencies that met speciﬁc

training and employment

standards, incentivizing the

ﬁeld to strengthen its home

care workforce. We analyzed

the impact of this approach.

(Apr 4, 2017)

Map the Direct Care

Workforce in Your State

Research Brief

A state-level snapshot of

the home care workforce

provides a quick, initial view

of the challenges facing this

workforce. In that spirit,

we produced a detailed fact

sheet on Illinois’ home care

workforce, including key

demographics and employment

data. (Apr 18, 2017)

Map the Home Care

Industry in Your State

Report

Our landscape studies widen

the pical lens on home care

workers–capturing critical

insights about the broader

industry. Our report on home

care in Minnesota used this

analytical approach to inform a

multi-year, state-level initiative

led by PHI. (May 2, 2017)

PHI

YEAR IN REVIEW 2018

#60CAREGIVERISSUES CAMPAIGN RECAP

Consider How Benets

Affect Earnings

Slideshow

The interplay beeen wages

and beneﬁt eligibili can mean

that many low-income workers

don’t earn higher incomes

simply by working more hours.

We studied this phenomenon

and showed how workers

might be wrongly incentivized

to limit their work hours.

(May 16, 2017)

Create an Advanced

Role to Improve Care

Video

With proper training, home

care workers can take on more

expansive roles that improve

care for clients and promote

job satisfaction. We partnered

with WorkingNation to

produce a video on a

successful advanced role

model from PHI.

(May 30, 2017)

Support Immigrants

in the Direct Care

Workforce

Research Brief

One in four home care workers

is an immigrant, and nearly

1 million immigrants work in

the direct care sector. Yet they

face unique challenges that

are made worse by increased

public hostili. We produced

new data on this critical

workforce segment.

(June 20, 2017)

Convene a Home

Care Dialogue

Issue Brief

As various trends and new

laws reshape the home care

industry, home care providers

must ﬁnd ways to engage each