CRITICAL SHORTAGE OF HOME CARE WORKERS THREATENS PATIENT CARE By Clare C. Luz, PhD, Assistant Professor, Michigan State University College of Osteopathic Medicine
The problem: The U.S. population is aging at an unprecedented rate. By 2030, nearly a quarter of the population will be over age 65 and, for the first time, this age group will outnumber children under age 18. The fastest growing
they work in the privacy of personal homes where conditions may be less than ideal. There are no federal PCA competency, professional, ethical or educational requirements.
segment of the population is the old-old, those age 85 and older. With age
The good news
comes an increased prevalence of multiple chronic conditions and a need
Just as the causes of the shortage are known, so are a number of solutions. Decades of advocacy work are at long last getting traction, for multiple reasons including the boomers getting older. Efforts to address the shortage are now being aggressively undertaken, such as the work being done by IMPART Alliance, led by Clare Luz, PhD, with the Michigan State University College of Osteopathic Medicine. IMPART, currently funded by the Michigan Health Endowment Fund, aims to help build an infrastructure in Michigan to support the direct care workforce. It is scaling up an evidence-based comprehensive PCA training program, establishing a PCA Professional Association and piloting a PCA technical training program for high school students in partnership with the Grand Ledge School District. Efforts at the state level are now ramping up with Michigan DHHS convening a Direct Care Worker Advisory Committee chaired by Luz and Alexis Travis, PhD, Senior Deputy Director, Aging & Adult Services Agency. Groups such as the Capital Area Health Alliance and partnerships across all settings where healthcare is provided is what will turn this crisis around and make quality of care possible.
for supportive services to remain at home, where most people want to live. This seismic demographic shift comes at a time when there are fewer family caregivers and a drastic shortage of direct cazre workers who provide hands-on care to older adults and persons with disabilities.
What is a direct care worker and why is their work important? This workforce includes a range of positions from certified nursing aides who are trained for work in institutional settings to unlicensed personal care aides, or PCAs, who work in client’s own homes. PCAs assist clients with tasks such as dressing, bathing, housekeeping, meal preparation and medication management. They are responsible for up to 80 percent of paid, hands-on care provided in private homes, residential settings and adult day care settings. They are in a pivotal position to monitor their clients’ status, recognize and report changes, improve their clients’ quality of life and health outcomes and to avert costly life-changing events such as falls, emergency department visits and hospital stays. Without their support, clients may face a nursing home placement or death and they should therefore be considered as important members of any care team.
How drastic is the PCA shortage? Michigan currently needs 34,000 more home care workers. Further, the average turnover rate is about 82% which destroys continuity of care, keeps the system churned up and is extremely costly. Increased numbers are not enough. We need a stable home care workforce comprised of people who are skilled, care about their clients, and not only want to stay on the job but are given enough resources to do so. Michigan has a lot of good home-based programs but none of them can exist without a qualified workforce. Yet, home care workers continue to be marginalized. The average wage rate for a PCA is about $10 per hour. They receive few, if any benefits. Most do not have guaranteed hours and cannot make it on one income alone. They face a lack of respect with their work referred to as non- or low-skilled or in derogatory terms such as a “glorified butt wiper.” PCAs also face danger as
T R I A D | S P R I N G 2020
19
