Getting out of bed in the morning, getting into bed at night, going to the bathroom, taking a shower, dressing, preparing and eating meals: These are known as activities of daily living. When people need some help with these tasks because of illness, disability, or frailty, they usually rely on family or friends. But when people live alone and when family and friends need assistance, professional help is the answer. Direct care workers help people in their homes and through other community-based programs – like residential care homes, home health agencies, and adult day centers. The problem is that the direct care workforce is in crisis. The number of people needing help is outpacing the growth of the workforce.

Direct care work is physically and emotionally demanding, and working conditions are often unfavorable. Workers leave the field because of low wages, lack of benefits, limited opportunity for advancement, lack of appropriate training, poor public image, lack of respect, and exclusion from patient-care planning. According to a study by the American Health Care Association, turn-over rates nationally approach 70 per cent. This means that more than two out of three direct care workers leave their jobs in the course of a year.

Detailed descriptions of this crisis and recommendations to alleviate it are being presented this spring in a "Legislative Study of the Direct Care Workforce in Vermont" (see below for links to the Study) and in a day-long conference on April 30 in Burlington hosted by the Champlain Long Term Care Coalition (CLTCC) and the Community of Vermont Elders (COVE). The problem is simply stated: How do we attract and keep a high quality and stable direct care workforce? The answers are complicated.

Janice Clements, CLTCC's facilitator, has experienced the problem at all levels – as a family caregiver herself, as the facilitator of a family caregiver support group, and as a board member of the Visiting Nurses Association and PACE Vermont. "Families suffer when direct care givers turn over and care becomes inconsistent and unreliable. It's difficult for long term care agencies to find and keep workers. Besides low wages and lack of benefits, workers suffer from a lack of transportation options."

"The nursing shortage is only giving us a taste of what is coming with the direct care worker shortage," says Jeanne Hutchins, CLTCC's chair and director of Elder Care Services at Fletcher Allen Health Care. "As we move long term care out of institutions into the community, the availability of direct care workers is critical," she says.

Both the legislative study and the caregivers' conference reflect the work done in Vermont since 2001, when the state first identified the needs of direct care workers in its "Paraprofessional Staffing Study." Since then, COVE has spearheaded several projects geared to recruit and retain direct care workers. "COVE'S mission is to promote the security, well-being, and dignity of seniors," says president Dolly Fleming. "Valuing caregivers cannot be divorced from our mission."  

With a four-year grant from the Robert Wood Johnson Foundation, called "Better Jobs, Better Care," COVE, one of five recipients in the nation, worked with fourteen Vermont long term care provider organizations to help them evaluate their working environments  and increase worker satisfaction. Through BJBC, COVE has collaborated with the Visiting Nurse Association to develop training packages, like the 40-hour class "Care Well," offered through Community College of Vermont and the state's technical centers.

COVE has helped to develop the Vermont Association of Professional Care Providers, a non-profit membership organization dedicated to professional growth, employment opportunities, and quality of life for direct care workers. COVE has also advocated successfully for the establishment of a direct care worker registry to help find and market workers. Planned to be up and ready in September, the registry will provide a place for workers to describe their experience and help consumers find good matches. Right now, says Fleming, "people mostly find workers by hook or by crook."

"Much of our work comes down to encouraging cultural changes," says Dolly Fleming. "Ironically, direct care workers are those who are closest to the client, but they are the workers least valued."

The 2008 legislative study of direct care workers describes the problems and offers detailed recommendations, including: raising wages, providing health insurance, improving training, and recruiting workers from new sources. "This is an important report, deserving serious consideration," Fleming says. "I hope that it doesn't wind up on a shelf." 

Geared to policy makers, legislators, and long term care employers, the all-day conference on direct care workers will focus on best practices in recruitment, support, and retention. Along with a national perspective, the findings and recommendations of the Vermont legislative study will be presented.

"The conference will bring the study recommendations off the page," says Fleming. "We all need to work together in addressing this problem and begin as a state to truly respect and honor direct care workers."

Direct Care Workers Conference, Wednesday, April 30, registration at 8:30 am, Hilton, 60 Battery Street, Burlington. Information: Contact Sheila Burnham, COVE, 802-229-4731; sheila@vermontelders.org

Related information - Legislative Study of the Direct Care Workforce in Vermont from Vermont Department of Disabilities, Aging and Independent Living

• Page with links to report
• Executive Summary - 21 page PDF document

Barbara Leitenberg writes on senior issues for the Champlain Valley Agency on Aging. This article originally appeared in the Burlington Free Press.