Academic journal article Generations

Policy Perspectives on Workforce Issues and Care of Older People

Academic journal article Generations

Policy Perspectives on Workforce Issues and Care of Older People

Article excerpt

Some suggestions for solving problems that persist.

Workforce issues in the human-service sector are not new. In 1967, the Bureau of Business and Economic Research at Northeastern University conducted a detailed study of institutional employment and shortages of paramedical personnel in Boston hospitals, nursing homes, and other institutions, considering the rising demand for paramedical personnel, the nature of shortages, and economic issues. Some twenty years later, Pearlman, Mahoney, and Callahan (1991) examined the effects of a shortage of long-term-care workers on clients with dementia, identifying problems of financing, work-life quality, job design, and industry structure. MacAdam, in a 1990 paper directed at state units on aging, cited the following as major workforce issues: instability of the workforce, industry characteristics, reimbursement and rate-setting procedures, low salaries, lack of fringe benefits, less than fulltime employment opportunities, inadequate supervision and training, and few opportunities for advancement. In 1994, the American Society on Aging devoted a special issue of Generations, edited by Penny Feldman (1994), to frontline workers in long-term care.

Recently, an issue brief of the Massachusetts Health Policy Forum (Frank and Dawson, 2000) on the healthcare workforce reported the following contributions to workforce problems: slow growth of the workforce, insufficient and declining wages, lack of health insurance, insufficient training and career advancement, dangerous workloads, and poor management and supervision practices. That same brief also reported that a 1999 survey of the North Carolina Division of Facilities found that forty-two of the forty-eight continental states reported recruitment and retention problems among their paraprofessional healthcare workforce (Frank and Dawson, 2000). And last year, President Clinton proposed legislation to increase staffing levels in nursing homes, in response to reports of lower quality of life in the institutions due to nursing and paraprofessional shortages (Washington Post, 2000).

I have seen numerous other studies over the years that in part report the same factors affecting workforce policy. Yet, the problems with the human-service workforce continue to exist, either because policy makers do not know how to solve them or because they cannot be solved given the constraints of American society. In the hope of clarifying the nature of actions required to resolve some of these problems this article will apply four perspectives: economics, politics, sociology, and psychology.


The high-tech industry is facing a labor shortage and is relying on a number of strategies to solve it, including improving economic incentives (wages, benefits, opportunities), substituting capital for labor, utilizing foreign workers in their home countries, and importing foreign workers. Each of these strategies has some potential for expanding the human-- service workforce.

Wages and benefits need to be improved because average wages in the human-service and long-term-care fields are below or near the poverty level. "A profile of the Los Angeles home-care workers shows them to be mostly African American and Latino women, at an average age of 43, earning the minimum wage of $5.75 an hour," (according to the Washington Post, 1999). Across California, the average annual salary for a worker providing direct care in the community is $18,500, with salaries as low as $16,500 and $15,800 in some parts of the state (Sanchez, 2000). In Massachusetts "fill time paraprofessional workers earned $16,000 to $18,000 in 1999, which is a little more than half of the state's per capita income of $31,200" (Frank and Dawson, 2000). The Massachusetts self-sufficiency standard for Boston workers is $1,324 monthly, or $15,888 per year, with health and retirement benefits often lacking.

There are, however, barriers to raising wages and benefits. …

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