If you talk to direct care workers about what they do for a living, you will discover within the first five minutes of your conversation that they are proud of the care they provide. Talk to them a little longer and you will probably also hear how conflicted they are about their work, largely because of how underappreciated and disrespected it is by the rest of us.
Growing up I can vividly recall my mother, a 30-year career CNA (now retired), exemplifying that dichotomy when she spoke to me and my brothers about her work. While she certainly enjoyed the care side of direct care work, I could hear the disappointment in her voice when she talked about how the work she and fellow direct care workers provided was rarely appreciated or talked about with respect by others within the nursing home and VA hospital she worked at.
Clearly, those who disregard direct care work have never observed the deep bonds that are so often established between caregivers and care recipients. Even today, I am amazed by the lasting relationships my mother developed with her former patients, some of which continue into her retirement. This was never more apparent than when I accompanied her to a former patient's widow's 87th birthday party. The guest of honor expressed her gratitude several times to my mother for taking the time to celebrate her birthday, and each time she introduced my mother to other guests, she made sure to mention the special care my mother had provided to her late husband. Hundreds of thousands of other direct care workers have stories like that of their own.
Now in its 37th year, National Nursing Assistants Week recognizes the unique contributions of nursing assistants and other direct care workers who provide daily care in nursing homes, homes, and other long-term care settings. As stated by William Painter, past president of the board of the National Network of Career Nursing Assistants, which founded the celebration:
Recognition for direct care workers has seemed to grow slightly in the past few years. What really changes things is when people come to a genuine understanding of the fundamental role that direct care workers have in creating quality in long term care in this country. Real change for the better only starts when people begin to understand the actual skills it takes to do this work.
"Why I Loved Direct Care and Why I Quit It," a recent post on the Direct Care Alliance blog, highlights both the rewards of direct care work and the personal challenges faced by workers who are underpaid, undertrained, and under-respected. Another post, "On a Treadmill Going Backward: Surviving on a Home Care Worker's Wages," illustrates the daily grind of living on about $10 an hour in a profession with fluctuating hours and the crippling additional burden of unpaid and often pricey travel time.
Direct care workers generally make not much more than minimum wage (they averaged only $10.63 an hour in 2012), leaving many families supported by a direct care worker's wages right on the edge of poverty, relying on public assistance benefits like Medicaid and food stamps to make ends almost meet (49% of direct care workers live in households that use public benefits). One reason pay is so low is the huge misconception that anyone can do direct care work because it requires no/low skills. Not so! Direct care workers provide an estimated 70 to 80 percent of the paid hands-on long-term care received by elders and people with disabilities.
Clearly, not just anyone can do this job, let alone do it well. Direct care workers provide various components of skilled care, ranging from intimate personal care to medical tasks like taking vital signs or clearing trachea tubes. Just as important as the skills needed to be an effective direct care worker are a number of characteristics (soft skills) direct care workers also embody, like being resilient, caring, empathetic, attentive, dedicated and resourceful.
Low pay, coupled with poor or no benefits like paid sick days and affordable health care and virtually no career advancement opportunities, often deters people from choosing direct care work as a profession. At a time when the U.S. population is growing older rapidly, we need to show direct care workers more respect if we want to ensure that there are sufficient numbers of qualified, trained people to provide high-quality care. By 2030, it is predicted that 72 million Americans will be 65 years and older. Also that year, the number of those 85 and older will start to grow rapidly.
How can we genuinely acknowledge the vital care direct care workers provide? Celebrating National Nursing Assistants Week, which is June 12-19 this year, is a good place to start, but we can't stop there. We must increase the pay of direct care workers to be on par with the work they perform. Other meaningful ways to improve direct care work as a profession include:
- Making sure direct care workers have affordable health care
- Providing true career advancement opportunities
- Strengthening training requirements to ensure that all direct care workers get the training they need to do the job well
Increasing direct care worker salaries and institutionalizing these other changes could ensure there will be adequate numbers of direct care workers to meet future demand. And it will heighten the tradition of honoring the vital work of direct care workers, demonstrating our respect and gratitude not just for a week but 365 days a year.