The paid caregiver shortage: too much talk, too little action
You’ve probably heard this saying: The first step in solving any problem is recognizing that there is one.
When it comes to the challenges in recruiting and retaining the necessary direct care workforce — paid caregivers such as certified nurse aides, home care and home health aides, personal support attendants, etc. — we’ve certainly recognized the problem. We’ve been, as a state and as a nation, recognizing and talking about the problem for decades.
Governments, researchers, advocacy organizations and others have studied and convened and discussed and reported and commissioned and done about everything imaginable to describe the problem and propose solutions.
We’ve had lots of talk. What we’ve lacked is action that leads to results.
So what is the problem?
Not enough people are applying for direct care jobs, and too few stay in them once hired. Turnover in direct care occupations runs more than 50 percent annually.
The demand for direct care workers has been growing much faster than the supply. The best estimates are that Iowa has 75,000 direct care workers and will need 95,000 in the next decade. Demand is fueled by the burgeoning number of aging Iowans, and those with disabilities, who are living longer lives and needing help.
Why does the supply problem exist?
Direct care is tough work — it’s physically demanding and emotionally draining work. The risk of on-the-job injury is high, as are the stress levels and job burn-out rates.
Direct care jobs are not viewed as good jobs. The pay is low, the benefits are few, the training is inadequate, the workloads are heavy, no career ladder exists to reward good work and encourage taking on more responsibility, and those who do the work don’t get the recognition and respect they deserve.
How bad is the problem?
It’s dire. Thousands of vacancies exist in direct care jobs around Iowa. The consequences are serious: Some nursing homes are not admitting new residents. Call lights in hospitals and nursing homes go unanswered. People with disabilities are left lying in bed or confined to a chair at home. Medications aren’t being taken timely, meals are being missed, and basic hygiene needs aren’t being met.
Your family, your friends, your neighbors — and you — deserve better.
I’ll be blunt. I’ve been consulting and advocating on direct care workforce issues for a decade. I’m tired of writing about them. I’m tired of attending meetings about them. I’m tired of testifying on them. And I’m tired of hearing all the reasons why we can’t, or won’t, do anything to address them.
If we really, truly want a better Iowa it's time to stop saying no we can’t and to start saying yes we will.
I’m writing about this topic again now because I see signs that a critical mass is developing that can lead to the action so desperately needed.
Consider the following:
The Iowa CareGivers, the organization that has kept these issues alive over the years, has worked closely with the United Way, the Elevate Aging Collaborative, the Skills to Compete Coalition and others to build an advocacy army that is calling for action.Some legislative leaders are stepping up to talk about the issues and are calling for action. The Iowa Department of Public Health recently convened a direct care workforce “summit” that brought consumers, workers, employers, educators, government agencies and advocates together to talk candidly about the issues. Summit attendees called for action.
The report of that “summit” is expected soon. If it is as candid as the conversation was, there is a good chance that it can be a catalyst for action, rather than being yet another well-intended document that gets filed and forgotten.
The timing of this report is ideal. Election season soon will be over. That means that it’s time to get beyond the talk and get down to business.
The direct care workforce needs to be a priority.
Iowans can help make that happen by speaking up and letting elected leaders know that further delay is not an option.
It may be a cliche but it’s also a reality: In politics and public policy, the squeaky wheel gets the grease. Let’s make some real noise about the direct care workforce that’s so loud and so frequent it cannot be ignored.