MDS Alert

Look to your workforce to see what your facility can do to champion your community.

It may not surprise you: People of color —  especially women — have a huge role in providing direct care to residents in long-term care and skilled nursing facilities, as well as in other direct care situations, like within private homes. Your facility is already providing a crucial service to society by providing care to vulnerable, ill, or elderly residents. Investing in your community by implementing specific strategies could provide a huge impact on the stability and quality of the care you deliver — and better your team members’ lives as well.

Employee demographics changing with care needs

The staffing demographics for long-term care industry employees — especially for those who provide direct care to residents — is changing to meet the increasing demand for providing more care to more people. As the U.S. population ages, the long-term care industry can expect to hire more staff for most roles within skilled nursing facilities. Providing high-quality, consistent care will always require competent, dedicated staff. Better understanding different population makeups can go a long way in strengthening your direct care staffing.

“Women of color make up the largest and fastest-growing segment of the direct care workforce — from 2005 to 2015, the number of women of color in direct care grew from 1.2 million to 1.7 million,” says Stephen Campbell, a data and policy analyst at PHI in New York, in an Issue Brief published by PHI.

PHI defines the direct care workforce as personal care aides, home health aides, and nursing aides, so its numbers include those who work in facilities, as well as those who work in other situations.

However, it’s not just women of color who are entering direct care employment at a rapid clip.

“While the number of men who are nursing assistants remained constant in that period, the number of male home care workers tripled, growing from 60,000 in 2005 to 182,000 in 2015,” Campbell says.

Know how education levels vary

Interestingly, and perhaps not surprisingly, the level of formal education varies considerably within a facility. Obviously, registered nurses have been through more schooling and have more credentials than aides, but there’s a considerable discrepancy in the education levels of many aides and assistants as well.

“Women in direct care generally have lower levels of formal education than men, and white direct care workers generally have higher levels of formal education than direct care workers of color,” Campbell says.

“Women of color in direct care are twice as likely as their white counterparts to have less than a high school education. Nineteen percent of women of color in direct care have less than a high school education, compared to nine percent of white women in direct care,” he adds.

This lack of formal education, along with inherent differences in treatment by society, means that many aides who are people of color, especially, may be struggling in their home lives. The high turnover rate for many jobs in the long-term care industry is one reflection of the tumult many people experience. Investing in your facility’s direct care workforce can be a boon to your team, with the positive impact rippling out to your community at large.

“Unfortunately, direct care jobs do not provide economic stability to women of color and their families—they are generally more likely to live in poverty and rely on public benefits than their counterparts, and they have smaller family incomes to rely on for support. In this context, improving the economic well-being of women of color in direct care would improve their quality of life, and it would help attract workers to this important occupation, as well as help retain them,” Campbell says.

Discrimination is real — and potent

Better understanding how discrimination works on a large scale and its effects on individuals, including your employees, is crucial to understanding how to acknowledge the many issues it raises and finding resolutions. The reality of discrimination and its negative impacts on individuals, families, and neighborhoods is one contributing reason to the immense employee turnover in the long-term care industry.

“Discrimination has eroded the economic stability of these workers and limited their options in employment and education. They struggle with low family incomes and high poverty rates, and many rely on public assistance to survive. Black immigrants are slightly better off economically, but they may lack access to culturally and linguistically competent training opportunities and employment supports. Addressing racial disparities and improving the lives of Black/African American workers and their families will lead to stable, high-quality care for the nation’s older adults and people with disabilities,” Campbell says in a research brief, Racial Disparities in the Direct Care Workforce: Spotlight on Black/African American Workers, also published by PHI.

Facilities can help and enjoy benefits, as well

Campbell and PHI offer succinct ideas for facilities to address these issues, positively impacting your employees’ lives, while also stabilizing your facility’s own workforce and increasing the quality and cohesion of your team.

“All workers need jobs with livable wages, good benefits, appropriate training, and advancement opportunities. People of color working in direct care struggle with additional obstacles rooted in a lifetime of racial discrimination and other forms of discrimination,” Campbell says.

Establish a dedicated “flow” for opportunities for your workforce — regardless of their level.

“Expand opportunities for advancement in direct care. People of color face significant barriers to accessing educational opportunities that can lead to higher earnings. Building training and advancement opportunities into direct care jobs can help workers obtain the skills and roles to improve their economic stability,” Campbell says.

Take part in the collection of data, to see both how you’re doing as an individual facility and how you’re doing as a larger company, especially if your facility is part of a larger business. This data collection and analysis is crucial to implementing fairer and more just policies — and reducing turnover, as well as boosting your facility’s reputation as a great place to work.

“Collect race-related outcomes data. Long-term care leaders need better data on the direct care workforce to measure its size and distribution, stability (including turnover, retention, and vacancy rates), and compensation rates and trends, among other variables. Monitoring these outcomes by race and ethnicity is particularly important for identifying where disparities exist and how they specifically impact people of color in the direct care workforce,” Campbell says.

Make specific goals a priority, both in hiring and in the retention of workers. Promote employees from within where possible, so you can have a handle on employees’ character and abilities, and not evaluate them just for their attributes on paper (depending on the role for a particular position, of course).

“Set hiring and retention goals to diversify the long-term care field. While people of color are a large and growing segment of the direct care workforce, diversity is needed at every level in long-term care organizations. Trainers, supervisors, managers, and executive leaders in diversified organizations will be better prepared to address the challenges that people of color face in their direct care roles—and help meet diverse consumers’ needs,” Campbell says.