Category Archives: Home Health Workers

Why They Leave: Turnover Among Washington’s Home Care Workers

Source: Sahar Banijamali, Amy Hagopian, Dan Jacoby, SEIU Healthcare 775NW, February 2012

From the abstract:
Turnover in the long-term care industry is at a crisis point and threatens quality of care and quality of life for vulnerable adults who rely on long-term care services. A 2005 national survey found more than 76 percent of states reported that home care worker recruitment and retention were major policy issues. Even given the economic downturn and rising unemployment rates, the vast majority of states still experience significant difficulty in recruiting and retaining qualified direct care workers. These shortages are likely to worsen over time as demand increases.

This paper, developed with support from Service Employees International Union Healthcare 775NW, provides a broad overview of home care workforce issues in Washington State including findings from a 2011 survey project and interviews designed to further understanding of the needs of Washington’s home care workers and what motivates them to both enter and leave this profession.
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Executive Summary

Fiscal Incidence when both Individual Welfare and Family Structure Matter: The Case of Subsidization of Home-Care for the Elderly

Source: Haizhen Mou, Stanley L. Winer, CES IFO Working Paper No. 3731, Category 1: Public Finance, February 2012

From the abstract:
How should we construct incidence indexes for children and parents in the case of public subsidies for home-care of the elderly? What is the nature of a fiscal incidence index on a budgetary basis versus a theoretically more satisfactory index that is welfare-based? Can we find budgetary based measures that will serve as a proxy for incidence in welfare terms? Does the structure of the family including the altruism of children affect incidence indexes? How should fiscal shifting of the subsidy for home care paid to the parents be defined, in budgetary or in welfare terms, and what does simulation tell us about the distribution of benefits between the generations?

We address these issues analytically and with simulation (using data from the Medical Expenditure Panel Survey) in this contribution to the study of fiscal incidence. The definition of welfare incidence, the comparison of welfare-based incidence with budgetary incidence for non-cooperative and cooperative families, and the calculation of the shifting of program benefits between family members, some of whom may be altruistic, are key issues in the analysis. The integration of individual welfare, family structure and benefit shifting provides a new perspective on the fiscal incidence of home care programs.

The Direct Care Worker: Overcoming Definitions by Negation

Source: Thomas R. Konrad, Research in the Sociology of Health Care, Vol. 29, 2011
(subscription required)

From the abstract:
Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as they try to become a positively valued unified occupation: “direct care workers.” Before this occurs, these workers must overcome negative definitions imposed by three powerful institutions: professional guilds, employers, and states. Care workers’ legitimacy is challenged as nursing labels them “unlicensed, assistive personnel,” defining them in terms of their task relationship to nurses rather than their social relationship to clients. Care workers’ identity is obscured as corporate rationalization nullifies their unique contributions with task unbundling, part-time work, short staffing, and turnover undermining bonding with colleagues and clients. State regulation impedes care workers’ integration, segmenting similar workers under different regulatory regimes, defining workers negatively rather than by their educational attainments and competencies. Overcoming this triple negation will require not just cultural change, but also real structural changes, and can occur only through concerted actions involving coalitions. Labor market intermediaries, public authorities, labor unions, workforce investment boards, philanthropic organizations, and government interagency groups are among those supporting direct care workers’ advancement by strategically coordinating licensing, purchasing, and developing the workforce. Recent federal policy changes and health reform legislation have enhanced recognition of this occupation and are providing new resources for its development.

Can Home Care Companies Manage Overtime Hours? Three Successful Models

Source: Dorie Seavey, Alexandra Olins, Paraprofessional Healthcare Institute (PHI), 2012

From the summary:
A new PHI report examines how three home care companies have successfully managed to control their overtime costs while maintaining their reputation for high-quality care.

The report, Can Home Care Companies Manage Overtime Hours? Three Successful Models, discredits home care industry claims that the Obama Administration’s proposal to revise the companionship exemption to extend minimum wage and overtime protections to home care workers would dramatically increase agencies’ overtime costs, since any overtime worked by aides would have to be compensated at time and half

Caring for Caregivers: Latinos in the Direct-Care Workforce

Source: National Council of La Raza, Monthly Latino Employment Report, February 3, 2012

Due to the aging baby boomer population, America’s older population is projected to experience significant growth over the next several decades. Already, families responsible for finding appropriate long-term care for elderly relatives find their options severely limited; as a result, many turn to home health or personal care aides to provide care. While direct-care industry revenues have climbed, benefits are not shared by workers who provide care, many of whom work long hours at low wages. This Monthly Latino Employment Report offers an overview of Latinos in the direct-care industry and highlights new U.S. Department of Labor regulations that could help improve employment conditions for these workers.

Home Health Care Industry Growth in Indiana

Source: Srikant Devaraj, Michael J. Hicks and Rohit Ravula, Ball State University, Center for Business and Economic Research, January 2012

There are around 1.1 million employees working in 25,686 establishments in home health care services industry in the United States as of 2009. When compared to the year 2000, this sector experienced an increase of 40.5 percent in terms of number of jobs and 59.6 percent in establishments. Figure 2 shows the structure of the industry in the United States. In 2009, 36.6 percent of S-corporations in this industry have employed 36 percent of employees, followed by 30.3 percent corporations employing 33.3 percent employees.

This report provides the background economic information about health care and social assistance sector (NAICS 62) in Indiana and its counties, followed by information about ambulatory health care services (NAICS 621) and home health care industry (NAICS 6216). The industry/commodity
balance sheet, wages of health care occupations, and economic impact estimates are also discussed in this report.

As elder care grows, so do labor battles

Source: Michael Lawson, American university School of Communication, What Went Wrong blog, January 23, 2012

The pay is low, and injuries are common, but nursing care is a rare bright spot in the gloomy economic landscape, adding jobs at a steady clip. As the field has grown, so, too, have efforts to unionize.

Those unionization campaigns are being fought on a shifting battleground, from massive chains to private homes. With baby boomers moving into retirement and beyond, the tensions aren’t likely to abate any time soon.

Cost of Long Term Care Study

Source: Northwestern Mutual, November 2011

From the summary:
In November 2011, the Long Term Care Group, Inc. conducted customized Cost of Care research on behalf of Northwestern Long Term Care Insurance Company of nearly 2,000 home healthcare providers, assisted living facilities and nursing homes in specific regions of the United States.

This research is important in the understanding of accessibility and affordability of different types of care services by geographic location. The findings help consumers make informed decisions about their long-term care options and costs, which may allow them to stay in their homes or within their local communities in the event of functional limitation or cognitive impairment.

Frontline Caregivers: Still Struggling

Source: Eileen Boris and Jennifer Klein, Dissent, Vol. 59 no. 1, Winter 2012
(subscription required)

These workers are America’s frontline caregivers. They number over 1.7 million nationwide. Home care workers earn just a little but more than the minimum wage and historically have had little or no job security, health benefits, or even workers’ compensation. Government programs began subsidizing home care in the 1930s. Yet in every decade since then, policymakers and welfare administrators have acted on the presumption that the intimate labor of caregiving should be the loving and unpaid duty of wives, mothers, and daughters. So home care aides, defined as elder companions rather than workers, are still excluded from the Fair Labor Standards Act, more than seven decades after it was enacted in 1938. Moreover, because they are often poor women taking care of people receiving public assistance, the suspicion and taint of “welfare fraud” has been used to cut their hours of service or pay in times of fiscal anxiety.