By Steven L. Dawson
Celebrating a 60th birthday gives one pause. Even though I spend my workdays on eldercare issues, I write about “older workers” and “55+ elders” as if they were someone else. When it comes to my own aging, I confess I’m not really prepared; I haven’t really thought this through.
Sadly, I’m not alone. While Americans are well aware that the Baby Boomers are now beginning to pass into retirement, they fail to grasp the other half of the equation: The Boomers are also passing out of the workforce. Left behind is a relatively smaller cohort of workers available to provide the services and supports that I and my fellow elders will soon require.
Particularly acute for elders will be the mismatch between the supply of and demand for direct-care workers—home health aides, certified nurse aides, personal care attendants. Eight out of every 10 hours of paid direct-service care to elders is provided by a direct-care worker. Already at 3.2 million, the demand for direct-care workers is predicted to grow by an additional 1.1 million—the fastest-growing category of jobs in the country.
Therefore, we must face reality: America is not prepared to care. We are already scrambling to find and keep direct-care staff in our homes and nursing facilities, yet we are failing to provide adequate incentives to attract and retain this frontline staff. For example, home care aides, unlike nearly all other U.S. workers, are not even protected by federal overtime and minimum wage laws. And in a bitter irony, even though we ask these workers to serve our health care system, one in four does not have health insurance.
Yet simply decrying the exploitation of this workforce will never be enough to prepare America to care. Instead, we must take advantage of health care reform, insisting that the new law’s proposed “care coordination teams” include not only a doctor and a nurse, but also explicitly include the social worker, the direct-care worker, and the family caregiver. This is the true “comprehensive care team,” and only by becoming a valued member of these new care-team models will direct-care workers ever successfully argue for adequate training, livable wages, and health insurance.
Clearly, geriatric social workers, direct-care workers, and family caregivers share a common goal: ensuring that both the social service and clinical needs of elders are addressed in the implementation of health care reform. New coalitions, such as the national Eldercare Workforce Alliance—whose 28 members include the Council on Social Work Education—are promoting exactly these types of comprehensive, multi-disciplinary teams within both policy and practice arenas.
Although my fellow Baby Boomers and I may be retiring, we are not shy. As we are forced to confront the caregiving needs of our own parents, we are slowly beginning to pay attention—and we will increasingly insist on new models of care that genuinely address the whole person. Together, with family caregivers, social workers, direct-care workers, nurses, and doctors, we can prepare America to care.
Steven Dawson, president of PHI, has worked for over 18 years to secure quality care by championing quality jobs for our nation’s direct-care workforce. PHI, with a staff of 42, works with more than 30 home care and nursing home providers to improve the skills necessary to create relationship-centered organizations. In addition, Steven co-convenes, with Nancy Lundebjerg of the American Geriatrics Society, the national Eldercare Workforce Alliance.