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North Carolina is grappling with a critical shortage of direct care workers, the backbone of elder and disability care. Diondre Clarke, a 60-year-old advocate with the national Domestic Workers Alliance, knows this firsthand. Starting in 2013, Clarke found passion in helping others, providing direct care in both home health and assisted living settings. Despite earning $20 an hour, she struggled financially, often requiring a second job. “It was tiring. It was a lot of work. I was stressed out,” Clarke recounted. “I was scared that I was going to get COVID and take it home.”
Clarke’s story highlights a larger issue plaguing north Carolina’s healthcare system. A recent report by the Caregiving Workforce Strategic Leadership Council underscores the severity of the shortage, emphasizing the urgent need to strengthen the direct care workforce. Defining exactly who constitutes a direct care worker,however,is the first hurdle. Does the term encompass solely home health aides, or include skilled nursing facility staff? Does it include those providing basic tasks like bathing and feeding, or extend to registered nurses? These questions, alongside concerns about fair wages, benefits, training, and support, were central themes at a January workshop hosted by the NC Center on the Workforce for Health, bringing together organizations like the NC Department of Health and Human Services, North Carolina Institute of Medicine, North Carolina Coalition on Aging, North Carolina Area Health Education Centers, and Piedmont AHEC.
The workshop marked the beginning of a series aimed at implementing recommendations from the Caregiving Workforce Strategic Leadership Council’s 2024 report. PHI, a leading advocate for direct care workers, echoes the urgency of the situation. Their statement, “Now is the time to lift up North Carolina’s direct care workers,” underscores the critical role these individuals play in providing essential care to vulnerable populations.
Addressing the direct care workforce crisis demands a multifaceted approach. Defining roles, ensuring fair compensation, expanding access to benefits, and investing in training programs are crucial steps towards creating a sustainable and fulfilling career path for direct care workers. Without addressing these challenges, North Carolina risks jeopardizing the well-being of its elderly and disabled residents.
North Carolina faces a critical shortage of direct care workers, a vital but often overlooked workforce that provides essential support to millions of individuals. With nearly 120,000 direct care workers already employed in the state, a recent study sponsored by PHI, a national healthcare policy research and advocacy organization, revealed a looming crisis. Between 2018 and 2028, North Carolina will need to fill over 186,000 direct care jobs – a staggering number driven by both rising demand and the anticipated exodus of experienced workers.
The direct care workforce is predominantly female, with women making up 92% of the sector, and diverse, with 61% of employees identifying as people of color. They are the unsung heroes of our healthcare system, providing hands-on care for individuals of all ages and abilities, from helping with daily tasks to offering emotional support and companionship.
At a recent event in January, attendees emphasized the urgency of creating a thorough framework to categorize and track this diverse workforce. Though,establishing such a system proves challenging,as the direct care landscape encompasses a wide range of roles,each with its own unique responsibilities. One participant,drawing an analogy to a tree,highlighted how the various branches represent different direct care roles,all connected by the shared core mission of providing compassionate care.
While the Bureau of Labor Statistics (BLS) classifies direct care workers into categories like personal care aides, home health aides, and nursing assistants, these labels may not fully encompass the breadth of the workforce.For instance, the BLS categories don’t adequately capture the essential roles fulfilled by professionals working in behavioral health or with individuals with intellectual and developmental disabilities.
Despite their critical role, direct care workers often face notable challenges, including low wages, limited career advancement opportunities, inadequate training, and a lack of respect from society. A 2021 report by PHI found that, even before efforts to boost salaries during the pandemic, direct care worker wages in North Carolina had been declining in real terms over the past decade.
Addressing these systemic issues requires a multi-pronged approach involving collaboration between policymakers, healthcare providers, and employers. As andy MacCracken, director of the NC Center on the Workforce for Health, noted, “It will take a collective effort to create a more sustainable and rewarding career path for direct care workers.”
Defining the Unsung Heroes: The Challenge of Defining Direct Care
The direct care workforce, the backbone of our healthcare system, faces a critical challenge: a lack of unified definition.This ambiguity hinders efforts to understand, support, and adequately compensate these vital individuals who provide essential care to millions of Americans.
Trish Farnham, programme coordinator with the N.C. Coalition on Aging, shed light on this issue during a recent workshop. “We have a lot of different titles for direct care workers,” she explained, highlighting the inconsistency across federal codes. These codes often fail to encompass essential groups like peer support specialists and supported employment specialists who play crucial roles in the lives of disabled adults.Furthermore, the traditional definition excludes independent providers, often employed by consumers through Medicaid’s consumer-directed programs, and “gray market” workers hired directly by individuals or families.
this lack of a comprehensive definition creates hurdles in accurately understanding the size and scope of the direct care workforce.
“The state lacks reliable and actionable data about the direct care workforce,” states the Caregiving Workforce Strategic Leadership Council report. This lack of data makes it challenging to address critical issues like turnover, job satisfaction, pay, and overall workforce planning.
Defining the direct care workforce is more than just a logistical exercise; it’s about recognizing the value and expertise of these individuals.
“Defining the direct care workforce should bolster ‘an emerging collective identity’ while recognizing the distinct groups within it,” Farnham emphasized.A unified definition can empower workers, enhance their professional standing, and ultimately lead to a more dignified and respected profession.
The report also underscores the need to include direct care workers in the conversation surrounding their roles and responsibilities. “Titles affect people’s perception of their status and others’ perception of their abilities,” noted [Name of speaker], highlighting the impact of labeling on professional recognition.
The challenge is compounded by societal perception. A 2021 study by the FrameWorks Institute revealed that Americans often view care work outside a hospital setting as “less skilled and less important.” Combating these misconceptions and advocating for the true value of direct care work is crucial for improving the lives of both workers and the individuals they serve.
Nailing down a precise definition won’t be easy. As [name of speaker] pointed out, “it’s a matter of ‘who is in and who is out’” and recognizes the complexities of nuanced experience that may not always align with formal titles or credentials.
Moving forward, establishing a clear and inclusive definition of the direct care workforce is essential. It’s a step towards recognizing their essential contributions, attracting and retaining qualified individuals, and ensuring a future where quality care is accessible to all.
Addressing North Carolina’s Direct Care Workforce Crisis: A Call for Coordinated Action
The direct care workforce in North Carolina faces an unprecedented crisis, a shortage of caregivers threatening the well-being of vulnerable populations. Despite the seemingly insurmountable challenges, a sense of unity and determination is emerging. As Amy Farnham observed, the crisis is prompting groups traditionally vying for limited resources to collaborate, recognizing that their collective action is paramount.
The Caregiving Workforce Strategic Leadership Council recently released a comprehensive report outlining four key recommendations to tackle this issue: a clear definition of the desired workforce, a robust data landscape to inform decision-making, the establishment of living wages to attract and retain skilled professionals, and the expansion of apprenticeship programs to develop a pipeline of future caregivers. Each recommendation will be the focus of a dedicated workshop later this year, designed not just to discuss but to develop actionable plans for implementation.
David MacCracken, of the NC Center on the Workforce for Health, emphasized the importance of translating insightful reports into tangible results. He envisions these workshops as a springboard for coordinated action, ensuring the report’s recommendations translate into concrete policy changes. The N.C. Institute of Medicine will play a vital role, synthesizing the information gathered from the workshops and presenting it in a readily actionable format for state agencies and other relevant stakeholders.
The Center on the Workforce for Health is also developing data tools to effectively monitor progress and measure the impact of implemented strategies.MacCracken acknowledged that advocating for increased Medicaid reimbursement rates for direct service providers will be a significant challenge for state lawmakers.
“It’s probably going to be a big ask of the legislature,” he admitted.
The center’s crucial role extends beyond policy advocacy. MacCracken stressed the need for sustained engagement and accountability among all stakeholders, recognizing that external factors can constantly shift the landscape. The “coordinated persistence” he envisions is vital for navigating these complexities and ensuring long-term solutions.
The current crisis has fostered an habitat of receptivity among diverse stakeholders, from educators to employers. MacCracken noted that individual employers often find themselves reaching out to individual educators in a fragmented, inefficient approach.the workshops offer a unique prospect to streamline these efforts and foster a more collaborative approach across sectors.
“For a long time, what we’ve been doing hasn’t been working collectively,” MacCracken observed. “So it’s actually not a hard sell for folks to come together and say, ‘Hey, we need to figure out a different way to approach this.’”
How does the North carolina direct care workforce contribute to the well-being of vulnerable citizens?
Archyde News: Interview with Diondre Clarke, Direct Care Worker Advocate
interviewee: Diondre Clarke, Advocate, National Domestic Workers Alliance
interviewer: Samantha Lee, Archyde News
Samantha Lee (SL): Thank you for joining us today, Ms. clarke. Let’s dive right in. You’ve been a direct care worker for nearly a decade. How would you describe the state of North Carolina’s direct care workforce today?
Diondre clarke (DC): Well, Samantha, the term “crisis” isn’t an exaggeration. We’re facing a severe shortage, and it’s only going to get worse without significant changes. The work is demanding, often underappreciated, and the wages and benefits don’t always reflect the crucial role we play in caring for some of our most vulnerable citizens.
SL: That’s a harsh reality. Can you tell us about a typical day in yoru work?
DC: Sure. My day can start as early as 6 am, helping someone get ready for their day, administering medications, preparing meals, and providing transportation.I might also assist with therapy exercises or just be there for emotional support. It’s varied,challenging,and incredibly rewarding,but it can also be physically and emotionally taxing.
SL: You mentioned low wages and benefits. Can you elaborate on that?
DC: Sadly, many direct care workers, including myself, struggle financially.I’ve frequently enough had to work a second job just to make ends meet. Benefits are limited, and training opportunities are scarce. It’s challenging to build a career in these conditions, and that’s one of the main reasons we’re seeing so many leaving the field.
SL: That’s alarming. Why do you think it’s so hard to define and track this workforce?
DC: The direct care workforce is incredibly diverse,ranging from home health aides to skilled nursing facility staff,and even peer support specialists. Customary categories often don’t capture the full scope of our roles. Plus, many workers are independent or in the “gray market,” further complicating data collection. We need a complete definition to address these challenges effectively.
SL: Absolutely. What steps do you think need to be taken to address these issues and strengthen the direct care workforce?
DC: First, we need a clear, inclusive definition to understand the workforce’s size, needs, and challenges. Then, we shoudl focus on fair wages, expanded benefits, better training opportunities, and career advancement pathways. Employers, policymakers, and healthcare providers must work together to create a more sustainable, respected, and fulfilling career path for direct care workers.
SL: That’s a tall order, but crucial for the well-being of so many vulnerable individuals. What gives you hope, Ms. Clarke?
DC: The recent workshop and the Caregiving Workforce Strategic Leadership Council’s report show that people are paying attention and eager to address these issues. If we can collaborate, learn from each other, and push for systemic change, I believe we can create a better future for direct care workers and those they care for.
SL: Thank you, Ms.Clarke, for your insight and passion. Your work is vital, and we at Archyde News support your efforts to improve the lives of direct care workers and the individuals they serve.
DC: Thank you, Samantha. It’s an uphill battle, but I’m committed to fighting for the recognition, respect, and resources these workers deserve.
