Academic journal article Generations

Research on Frontline Workers in Long-Term Care

Academic journal article Generations

Research on Frontline Workers in Long-Term Care

Article excerpt

For providing essential care to some of society's most vulnerable, these workers receive less pay and less respect than their peers 'flipping burgers.'

The paraprofessional long-term-care workforce-nursing assistants (NAs) and homecare aides, personal care workers and personal care attendants-forms the centerpiece of the formal longterm-care system. These so-called frontline workers provide hands-on care to millions of elderly and younger people with chronic illness and disabilities in settings ranging from the nursing home to assisted living and other residential care options to private homes. The care is intimate, personal, and both physically and emotionally challenging. Because of their ongoing, daily contact with the care recipient and the relationships that often develop between the worker and the client, these frontline workers are frequently the "eyes and ears" of the care system. In addition to helping with activities of daily living such as bathing, dressing, using the toilet, and eating, these workers provide the "high touch" that is essential to quality of life as well as quality of care for chronically disabled individuals.

The typical paraprofessional worker is a middie-aged, single mother with a low level of educational attainment, living below or just above the poverty line. While the majority of workers are white, a large proportion of NAs, homecare aides, and personal care workers are African American, Hispanic, or Asian, particularly those in large urban centers. They are among the lowest wage earners in the United States, and many have little access to benefits such as health insurance coverage, pensions, and paid sick leave or vacation time. Ironically, while these workers are delivering essential care to some of the most vulnerable segments of our population, their peers "flipping burgers at McDonalds" make more, have much more financial security, and are treated with much more respect.

Given the inadequate financial incentives, stressful working conditions, and lack of career opportunities, it is not surprising that the longterm-care industry has encountered significant difficulties in recruiting and retaining paraprofessional workers. While concerns about recruitment and turnover have ebbed and flowed over the past two decades, this issue has recently achieved crisis status. The economic boom in many communities across the country has contributed to a paraprofessional labor shortage of unparalleled proportions. Finding a qualified, committed NA or homecare aide has become a second-order priority; recruiting unskilled "warm bodies" to provide the frontline care has become the primary goal for many nursing homes, residential-care providers, homecare agencies, and home and community-based-care organizations.

Issues related to the frontline long-term-care worker have never been sexy and have historically received relatively little attention from policy makers, researchers, and the general public. The media have begun to document the crisis status of this labor shortage, underscoring the potentially negative consequences for quality of care and quality of life. Policy makers at the federal, state, and local level are also beginning to acknowledge this problem. But viable solutions have not yet been identified. This crisis in long-term care provides a window of opportunity for collaboration among policy makers, providers, consumers, researchers, and grant makers to foster the development of a quality system of care for people with chronic illness and disabilities. Public-private collaborative efforts have the potential to contribute to a better understanding of the factors that are influencing this staffing crisis, the extent to which it is "just the economy, stupid," or whether it reflects more systemic issues that will not be resolved when local economies take a downturn. Such initiatives can also help to identify, test, and replicate interventions designed to ameliorate the problems related to the frontline labor shortage and, more fundamentally, to transform the long-term-care workplace and culture into one that respects and empowers the frontline worker. …

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