New Hampshire will lose far more direct care workers for older adults and people with disabilities than it needs in the next decade, according to new research from PHI, a national nonprofit focused on elder care and disability services. And difficulties around low-pay and career advancement will make that hard to reverse.
Amy Robins, director of advocacy at PHI, delivered that message Monday to the New Hampshire Commission on Aging as it explores how to increase the long-term care workforce.
Many states are in a similar position.
There are currently just over 15,000 direct care workers in the state, a number that includes those working in nursing homes and assisted living facilities and in people’s homes. In the next decade, the state will have approximately 24,400 openings as people leave the field, Robins said.
Recruitment will be a challenge without compensation changes. The median hourly wage for direct care workers in New Hampshire is $15.79, low enough that 28 percent of workers lack affordable housing and 27 percent live at or near poverty levels, Robins said. Ninety-one percent of direct care workers are women.
New Hampshire needs to consider a particular trend, Robins said. The state has been slowly shifting away from nursing home and assisted living settings, where residents require medical care, toward home-based services, where individuals can remain home with help with daily living tasks like bathing, dressing, and hygiene.
“That’s just something to keep in mind,” Robins said. “Both the institutional setting workers (such as) nursing assistants and home health aides and personal care aides are important to have that continuum of care. But just keep in the back of your mind that home health aides and personal care aide worker population is really on the rise.”
As the state Commission on Aging takes on workforce challenges here, Robins shared initiatives other states have tried that rethink funding for long-term care and certification and advancement opportunities for workers.
Washington state, seeking an alternative to insufficient Medicaid and Medicare funding, adopted an income tax that will help provide all residents $36,500 annually for long-term care costs beginning in 2025.
“We all know that the cost of long-term care is probably a lot higher than $36,500,” Robins said. “But it’s really significant just acknowledging that the state really put the long-term support infrastructure on the map in terms of this being a social responsibility of everybody to contribute to solutions around this.”
Arizona increased the minimum wage for direct care workers by requiring that a certain percentage of their employers’ government reimbursement rate go to wage increases. Colorado increased the base wage of direct care workers to $15 an hour using American Rescue Plan funds; the state budget includes funding to continue that initiative when the federal money is gone.
Maine reduced its entry level training requirements for certified nursing assistants from 180 hours to 130 hours. Robins said it has also made it easier for direct care workers to have universal training to increase options for advancement. It’s also beneficial, Robins said, to find a way for individuals to earn a paycheck while pursuing certification.
“I think there’s room for some more creative thinking around competencies and how we value experiences and assess experience, particularly for workers that are coming into the field but who may have been in a caregiving role previously,” Robins said. “How can we assess their competency so that they don’t have to maybe engage in a full on certification?”
There are also low cost approaches, Robins said, such as communicating the value of direct care work. That could include incorporating direct care workers into the patient’s care team so they can participate in assessment and decisions. Wisconsin and Arizona launched a campaign to promote direct care work, in some cases with stories from workers.
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