Issue Brief 1: Inadequate Wages and Benefits
The Problem:
Inadequate wages and benefits for frontline paraprofessionals make it extremely difficult for these workers to sustain themselves (and their families) for any extended period. Many of the best caregivers must eventually leave direct care for other better-paying, less-demanding jobs, and the number of new workers willing to replace them is dwindling.
Low wages: Many direct caregivers either live below the poverty line or must work multiple jobs to support their families. Average nurse aide wages in nursing homes are $6.70 per hour-yielding a full-time income of less than $14,000 a year. In home care, average wages are even lower and the work is often part-time work, yielding incomes of less than $10,000.
Lack of health insurance: Although some nursing homes and home care agencies offer health insurance to full-time employees, many paraprofessionals cannot afford the premiums required to utilize the coverage. In settings like home care, where part-time work is the norm, health insurance is not even offered to paraprofessionals, who are then forced to rely on public systems for health care, or go without.
Consequences: Diminished Quality of Care for Beneficiaries
Diminished Quality of Care: When inadequate wages and benefits cause direct care workers to work with too few colleagues and supports, carry more than one job, live without health insurance, and consequently leave their jobs, residents and consumers are denied good care from a stable, experienced work force.
High Turnover: Having continuity with a direct caregiver is an important component of high quality care to home care and nursing home clients. Yet, paraprofessionals move to other jobs for small increases in hourly wages because of their immediate needs to feed their families. This exodus contributes to annual turnover rates of 40-60% in home care and 70-100% in nursing homes. High attrition rates disrupt continuity of care, forcing clients to constantly re-adapt to new direct caregivers, re-explain their individual needs, and attempt to re-establish a pattern of caregiving. Because of low wages, experienced aides who are needed to mentor the newer paraprofessionals are eventually driven out of the system.
Lack of Experience: Quality hands-on caregiving is a skill best learned through years of practice with a wide range of clients. Poverty wages preclude all but a few members of the paraprofessional workforce from ever achieving the tenure necessary to become experienced care providers.
Labor Shortages: Low wages and benefits make paraprofessional healthcare work unattractive to workers who have any other options to meet their family's income needs. The current shortage of workers will be magnified when baby boomers will cause a bulge in the elderly population, while the number of younger women available for caregiving remains flat.
Spreading Caregivers Too Thin: Paraprofessionals must often work double shifts or for multiple employers to make ends meet. This leaves them tired and fragmented-not at their best in caring for their clients. Because of the need to respond to multiple employers, frontline workers are at times unable to honor commitments to both employers. This forces other workers to work harder to pick up the slack when shifts are short-staffed.
Replacement Costs: High direct caregiver turnover rates carry high replacement costs for long-term care providers, thereby re-directing resources away from services to consumers. Employers have the choice to rely on high-priced temporary agencies and pay for repeated recruitment and training of new entry-level caregivers, or pay health insurance and adequate wages that would attract and retain experienced, loyal workers.
Unstable Reliance on Medicaid & Welfare: Low-income caregivers without health insurance have often turned to Medicaid, and have relied on public assistance benefits to supplement their below-poverty incomes. However, with welfare reform, these supports for underpaid healthcare workers are now disappearing, thereby further destabilizing the paraprofessional workforce.
HCFA and other public stewards of our healthcare system must encourage an environment in which qualified, competent, and trustworthy individuals can be kept in the important work of caregiving. With adequate salaries and benefits, paraprofessional workers could be self-supporting, develop long-term healthcare careers with advancement opportunities, and provide better, more continuous care to their clients.
See Also:
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