Category Archives: Home Health Workers

Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers

Source: U.S. Government Accountability Office (GAO), GAO-16-718, August 16, 2016

From the summary:
Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide long-term services and supports (LTSS), but limitations and gaps affect the data’s usefulness for workforce planning. Some states have collected data in areas where federal data are limited, but these have been one-time studies. Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation’s health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing. Some states, in coordination with the federal government or on their own, have conducted studies about direct care workers and collected detailed information. These studies showed that a majority of independent providers worked for a family member or someone else they knew.

Caregiving Crisis Highlighted in PHI Fact Sheets

Source: Paraprofessional Healthcare Institute (PHI), September 6, 2016

From the blog post:
Two fact sheets from PHI highlight the low wages, high injury rates, and high demand that characterize nursing assistant and home care aide jobs, two occupations at the center of the U.S. caregiving crisis: – U.S. Home Care Workers: Key Facts
U.S. Nursing Assistants Employed in Nursing Homes

Key Facts Among the findings:
– 633,000 additional home care workers are needed by 2024, more new jobs than any other occupation in the U.S. economy.
– Low wages, limited work hours, and low annual earnings cause one in four home care workers to live in poverty, compared to one in ten U.S. workers.
– This high poverty rate means one in two home care workers relies on some form of public assistance, such as food stamps, Medicaid, or cash assistance.
– Nursing assistants are more than three times as likely to be injured on the job than the average U.S. worker.
– Due primarily to poor job quality, 52 percent of nursing assistants leave their jobs each year, and 50,000 nursing assistant positions nationwide cannot be filled.
The fact sheets, which provide comprehensive analyses on workforce demographics, size and composition, job quality indicators, and employment projections, will be released on an annual basis.

New Business Models Demand New Forms of Worker Organizing

Source: Ai-jen Poo, Palak Shah, New Labor Forum, Vol. 25 no. 3, September 2016
(subscription required)

We welcome the opportunity to discuss the merits of the Good Work Code (GWC) and engage with Jay Youngdahl’s critique. As we read it, Youngdahl poses three main objections to the GWC: (1) the values framework articulated is aspirational and unenforceable, (2) it “greedwashes” companies engaged in bad labor practices, and (3) it is based on the notion that “Good Capitalism” can be mobilized to solve the problem of worker exploitation. In the course of his critique, Youngdahl also targets what he calls the “Philanthropic Labor Movement,” that is, those of us with the temerity to organize workers outside the frame of traditional labor unions.

Digital technology and on-demand hiring platforms are rapidly transforming how workers engage with various sectors of the labor market and their terms and conditions of work. Domestic work is among the many occupations affected by new technology. Increasingly, workers and employers are matched online for child care and elder care jobs through companies like, and the on-demand economy has penetrated the housecleaning market through companies like Handy and TaskRabbit.

National Domestic Workers Alliance (NDWA) turned its attention to Silicon Valley not because, as Youngdahl implies, we were bedazzled by the bright, shiny objects dangled by tech companies, but because, the fact is, these models are transforming labor markets. Increasing numbers of domestic workers, and other low-wage workers, access work through these companies. This phenomenon is in its infancy, and our expectation is that it will grow. We believe these workers deserve the best wages and conditions of labor. We assume that Youngdahl agrees with us, at least on this point.

The labor movement is still in the early stages of determining how best to meet the multiple challenges posed by companies that aggregate and deploy workers through digital platforms. Mechanisms for exploiting labor are proliferating and changing far more rapidly than our capacity to organize workers and represent their interests. Tech companies are building new business models, often creating ever more precarious conditions of life and labor, lowering wage floors and job quality. …. At the same time, those who follow the gig economy know that it has been tech companies, not unions or labor advocates, driving the national conversation. By releasing a simple values framework, we have successfully inserted the demands and voices of workers into a narrative dominated by tech companies, with the intention of creating space for a conversation about what better employment practices could look like in the digital economy…..

Underpaid, unpaid, unseen, unheard and unhappy? Care work in the context of constraint

Source: Donna Baines, Sara Charlesworth, Tamara Daly, Journal of Industrial Relations (JIR), Vol. 58 no. 4, September 2016
(subscription required)

From the abstract:
Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., 2015). Due to its close association with gendered expectations of elastic, uncomplaining work undertaken by women across the continuum of home, community and residential places, care work continues to be undervalued in numerous ways (Baines, 2004; England, 2005; Folbre, 2008). Indeed, care workers often work in conditions in which they are underpaid, unpaid, unseen, unheard and unhappy (Daly and Szebehely, 2012; Palmer and Eveline, 2012). These conditions are related to government austerity models; how care work is regulated within employment relations; state, market and private roles providing and funding care; and how care work organisation is shifting in the context of austerity strategies, policies of constraint, continued high demand, decreased union density and increasing standardisation.

These conditions and the women who work within them and around them are the focus of this Special Issue: Care Work in the Context of Constraint. The Special Issue draws together international researchers and scholars in a close investigation of the complexity of care work in the era of austerity policies.
Government bodies that fund care work have been under increasing pressure to cut costs, expand accountability and contribute to austerity agendas (Brennan et al., 2012; Cunningham et al., 2014; Grimshaw and Rubery, 2012). This impacts at the level of care organisations in the form of decreased financial resources and increased obligations to provide documentary and statistical evidence of the care provided to service users…..

The community dimensions of union renewal: racialized and caring relations in personal support services

Source: Louise Birdsell Bauer, Cynthia Cranford, Work Employment & Society, Published online before print July 20, 2016
(subscription required)

From the abstract:
Union renewal research calls for moving beyond broad terms, like community unionism, to specify how social relations of work shape renewal for different workers, sectors and contexts. Analysis of interviews with union officials and union members in publicly funded, in-home personal support reveal two community dimensions: both caring and racialized relations between workers and service recipients. Scholarship on care workers emphasizes empathy and coalition with service recipients as a key aspect of union renewal, yet says little about racialized tensions. Studies of domestic workers emphasize organizing in response to racialization, but provide little insight into caring social relations at work. This article develops arguments that both positive and negative worker–recipient relations shape union organizing and representation in the service sector by specifying the ways in which racialization contributes to this dynamic. It suggests that anti-racist organizing at work, alongside coalition building and collective bargaining, are important renewal strategies for this sector.

Disability Rights and Labor: Is This Conflict Really Necessary?

Source: Samuel R. Bagenstos, University of Michigan Law School, Public Law Research Paper No. 509, June 15, 2016

From the abstract:
The relationship between the American labor movement and identity-based social movements has long been a complicated one. Organized labor has often been an ally of civil rights struggles, and major civil rights leaders have often supported the claims and campaigns of organized labor. Recall the reason Dr. Martin Luther King was in Memphis on the day he was assassinated — to lend his support to a strike by unionized sanitation workers. But unions and civil rights groups have found themselves on the opposite sides of intense battles as well. The relationship between the labor movement and the disability rights movement is just as complicated. Organized labor has often been an ally of disability rights efforts. But in some of the highest stakes battles for workers and individuals with disabilities, many unions and disability rights groups have opposed each other. Although many commentators have written about the tensions and collaborations between labor unions and civil rights groups promoting race or sex equality, the very similar dynamics of the relationship between unions and disability rights groups have largely escaped comment.

In the past several years, though, the tensions in the labor-disability relationship have become especially acute. As unions (particularly the Service Employees International Union) have pushed for increased wages and benefits for direct-care workers who provide home and community-based services, and state Medicaid cuts have placed pressure on the budgets available to pay those workers, many disability rights activists have worried that labor’s agenda will lead to the (re-)institutionalization of people with disabilities. This tension stood in the background of the litigation in Harris v. Quinn, in which the Supreme Court addressed the collective bargaining system some states had set up for personal-assistance workers. And the dispute between unions and (some) disability rights activists broke out in a particularly sharp and nasty way in response to the Department of Labor’s recent rules expanding Fair Labor Standards Act protections for home care workers. Although some disability rights groups supported the new rules, which had been a major priority of organized labor, particularly vocal and influential activist groups opposed them. These tensions are nothing new. Disability rights activists have long challenged the paternalism of those assigned to “help” or “care” for them, and the unions that represent those workers are thus a natural target for suspicion if not antagonism. And many (though not all) elements of the American labor movement have strongly opposed the deinstitutionalization of people with mental disabilities. The current labor-disability tensions cannot be understood outside of the context of that history.

This essay, which was presented as the Stewart Lecture on Labor and Employment Law at the Indiana University Maurer School of Law in April 2016, attempts to do two things. First, it puts the current labor-disability controversy into that broader context. Second, and perhaps more important, it takes a position on how disability rights advocates should approach both the current controversy and labor-disability tensions more broadly. As to the narrow dispute over wage-and-hour protections for personal-assistance workers, this essay argues both that those workers have a compelling normative claim to full FLSA protection — a claim that disability rights advocates should recognize — and that supporting the claim of those workers is pragmatically in the best interests of the disability rights movement. As to the broader tensions, the essay argues that disability rights advocates go wrong, both normatively and pragmatically, in treating the interests of individuals with disabilities as inevitably superordinate to those of individuals who do the work of providing community-based services and supports. Although this wrong turn is completely understandable in light of the history of paternalist subordination of people with disabilities at the hands of the helping professions, today’s situation calls for an accommodation of the legitimate claims of each side.

A Special Issue on Work and Employment Relations in Health Care

Source: ILR Review, Vol. 69 no. 4, August 2016
(subscription required)

From the introduction:
Editorial Essay: Introduction to a Special Issue on Work and Employment Relations in Health Care
Ariel C. Avgar, Adrienne E. Eaton, Rebecca Kolins Givan, and Adam Seth Litwin

…..This special issue of the ILR Review is designed to showcase the central role that work organization and employment relations play in shaping important outcomes such as the quality of care and organizational performance. Each of the articles included in this special issue makes an important contribution to our understanding of the large and rapidly changing health care sector. Specifically, these articles provide novel empirical evidence about the relationship between organizations, institutions, and work practices and a wide array of central outcomes across different levels of analysis. This breadth is especially important because the health care literature has largely neglected employment-related factors in explaining organizational and worker outcomes in this industry. Individually, these articles shed new light on the role that health information technologies play in affecting patient care and productivity (see Hitt and Tambe; Meyerhoefer et al.); the relationship between work practices and organizational reliability (Vogus and Iacobucci); staffing practices, processes, and outcomes (Kramer and Son; Hockenberry and Becker; Kossek et al.); health care unions’ effects on the quality of patient care (Arindrajit, Kaplan, and Thompson); and the relationship between the quality of jobs and the quality of care (Burns, Hyde, and Killet). Below, we position the articles in this special issue against the backdrop of the pressures and challenges facing the industry and the organizations operating within it. We highlight the implications that organizational responses to industry pressures have had for organizations, the patients they care for, and the employees who deliver this care……

Articles include:
Nurse Unions and Patient Outcomes
Arindrajit Dube, Ethan Kaplan, and Owen Thompson
The authors estimate the impact of nurse unions on health care quality using patient-discharge data and the universe of hospital unionization in California between 1996 and 2005. They find that hospitals with a successful union election outperform hospitals with a failed election in 12 of 13 potentially nurse-sensitive patient outcomes. Hospitals were more likely to have a unionization attempt if they were of declining quality, as measured by patient outcomes. When such differential trends are accounted for, unionized hospitals also outperform hospitals without any union election in the same 12 of 13 outcome measures. Consistent with a causal impact, the largest changes occur precisely in the year of unionization. The biggest improvements are found in the incidence of metabolic derangement, pulmonary failure, and central nervous system disorders such as depression and delusion, in which the estimated changes are between 15% and 60% of the mean incidence for those measures.

How Do Hospital Nurse Staffing Strategies Affect Patient Satisfaction?
Jason M. Hockenberry and Edmund R. Becker
In this article, the authors evaluate the role of the nurse staffing mix on hospital patient satisfaction. Using three years (2009 to 2011) of hospital patient satisfaction data linked to data on the productive staffing hours of registered nurses (RNs), licensed vocational nurses, nurse’s aides, and contract nurses for 311 California hospitals, the authors analyze how nurse staffing levels affect 10 dimensions of patient satisfaction. The findings indicate that a higher level of RNs per bed appears to increase overall patient satisfaction. Conversely, hospitals with a higher proportion of nursing hours provided by contract nurses have significantly lower levels of patient satisfaction on scores related to overall patient satisfaction and nurses’ communication with the patient. The results have implications for RN staffing strategies and inform the broader literature on worker-skill mix and employment arrangements.

Who Cares about the Health of Health Care Professionals? An 18-Year Longitudinal Study of Working Time, Health, and Occupational Turnover
Amit Kramer and Jooyeon Son
Health care workers are employed in a complex, stressful, and sometimes hazardous work environment. Studies of the health of health care workers tend to focus on estimating the effects of short-term health outcomes on employee attitudes and performance, which are easier to observe than long-term health outcomes. Research has paid only scant attention to work characteristics that are controlled by the employer and its employees, and their relationship to employees’ long-term physical health and organizational outcomes. The authors use data from the National Longitudinal Survey of Youth (NLSY) from 1992 to 2010 to estimate the relationships among working time, long-term physical health, job satisfaction, and turnover among health care employees. Using a between- and within-person design, they estimate how within-person changes in work characteristics affect the within-person growth trajectory of body mass index (BMI) over time and the relationship between working-time changes and physical health, and occupational turnover. The study finds that health care employees who work more hours suffer from a higher level of BMI and are more likely to leave their occupation.

Health Care Information Technology, Work Organization, and Nursing Home Performance
Lorin M. Hitt and Prasanna Tambe

The Consequences of Electronic Health Record Adoption for Physician Productivity and Birth Outcomes
Chad D. Meyerhoefer, Mary E. Deily, Susan A. Sherer, Shin-Yi Chou, Lizhong Peng, Michael Sheinberg, and Donald Levick

Creating Highly Reliable Health Care: How Reliability-Enhancing Work Practices Affect Patient Safety in Hospitals
Timothy J. Vogus and Dawn Iacobucci

Filling the Holes: Work Schedulers As Job Crafters of Employment Practice in Long-Term Health Care
Ellen Ernst Kossek, Matthew M. Piszczek, Kristie L. McAlpine, Leslie B. Hammer, and Lisa Burke

How Financial Cutbacks Affect the Quality of Jobs and Care for the Elderly
Diane J. Burns, Paula J. Hyde, and Anne M. Killett

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries

Source: Antonia K. Bernhardt, Joanne Lynn, Gregory Berger, James A. Lee, Kevin Reuter, Joan Davanzo, Anne Montgomery and Allen Dobson, Milbank Quarterly, Early View, July 4, 2016
(subscription required)

From the abstract:
The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community’s quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation.

The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model.

The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%.

The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long-term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services’ vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century.

Home Care Services for Elderly People in Georgia

Source: Tengiz Verulava, Ia Adeishvili, Tamar Maglakelidze, Home Health Care Management & Practice, Vol. 28 no. 3, August 2016
(subscription required)

From the abstract:
In recent years, health service affordability for elderly people has been significantly improved within the Georgia State Health Insurance Program, although home care services for elderly people are not envisaged in any of state health care programs. Home care services for elderly people were mainly provided by nongovernmental organizations and family members (nonformal services). The objective of a survey was to study home care services rendered by nongovernmental organizations and family members in Georgia, living conditions of elderly people dependent on home care, and cost for home care services incurred by them. For study purposes, a method of direct interviews through specially constructed questionnaires was used, covering health conditions of elderly people, period of depending on care, care needs, and costs for care services. In Georgia, home care services for elderly people are mainly provided by nongovernmental organizations. The majority of interviewees (73.1%) more often use home care services rendered by nongovernmental organizations than the services envisaged by state health care programs (26.9% of interviewees use these services). Elderly people are more dependent on the assistance provided by their relatives and they give priority to the services rendered at home, rather than to institutional care (in special clinics or retirement homes). Families make a big contribution to assisting and supporting home care services for elderly people. If needed, they represent key home care service providers in Georgia. This fact should be recognized and considered while elaborating the care policy for elderly people in Georgia.

2016 Genworth Cost of Care Survey

Source: Genworth Financial, 2016

The Genworth Cost of Care Survey has been the foundation for long term care planning since 2004. Knowing the costs of different types of care – whether the care is provided at home or in a facility – can help you plan for these expenses. The 2016 survey, conducted by Carescout®, one of the most comprehensive of its kind, covering 440 regions across the U.S. and based on data collected from more than 15,000 completed surveys.

Monthly Costs: National Median (2016)
Home Health Care
Homemaker Services – 2016 Cost – $3,813
Home Health Aide – 2016 Cost – $3,861

Adult Day Health Care
Adult Day Health Care – 2016 Cost – $1,473

Assisted Living Facility
Assisted Living Facility – 2016 Cost – $3,628

Nursing Home Care
Semi-Private Room – 2016 Cost – $6,844

Private Room – 2016 Cost – $7,698