Despite growing demand for long-term care, providers struggle to find workers

The hardest part of Culix Wibonele’s first job in long-term care was not getting hurt.

Originally from Kenya, Wibonele worked as a certified nursing assistant in Atlanta in 2014. She went to the homes of mostly older clients, helping them with everything from bathing to cooking. Wibonele worked alone and sometimes had to lift clients much bigger than her.

It was a demanding job and paid just $9 an hour with no benefits. If not for Wibonele’s second job as a nanny and her husband’s income, they would not have been able to make ends meet while supporting their four children.

“My salary, you know, was literally nothing,” Wibonele said. “I was kind of shocked by the amount of work we were expected to do and the pay you get at the end.”

Wibonele’s experience reflects broader trends in the long-term care workforce. Those who care for the elderly in settings such as private homes and assisted living facilities across the U.S. face low pay and risk of injury as the industry struggles with staffing shortages, CNHI News and the Associated Press found as part of a state examination. of America. long-term care.

However, the demand for these workers increases as the population ages. By 2030, about 20% of the U.S. population will be 65 or older, and that percentage will continue to grow, according to the U.S. Census Bureau.

“It’s a national problem and it’s everywhere,” said Dr. Stephen Crystal, director of the Rutgers Center for Health Services Research. “Almost everyone is understaffed.”

The industry has been dealing with labor shortages and high turnover for years, problems that have worsened during the COVID-19 pandemic.

Nursing care facilities laid off employees after the pandemic began, and the workforce has not fully recovered, federal data shows. A March survey of hundreds of nursing home providers by the American Health Care Association found that nearly all have open jobs and difficulty recruiting. And a recent nursing home staffing mandate from the Biden administration has panicked facility administrators, who say they are already struggling to fill vacancies.

Turnover is so low in nursing homes that some see all their staff leave within a year, said Alice Bonner, director of strategic partnerships at Brown University’s Center for Innovative Care in Aging.

“The people who are left are working a lot more, working double shifts, working overtime and working with temporary and temporary workers,” Bonner said.

Noelle Kovaleski, administrator at Carbondale Nursing and Rehabilitation Center in Pennsylvania, said the biggest hiring challenge is a lack of candidates. A nursing supervisor position at her facility went unanswered after being placed at a major job site for two years.

“There’s no labor coming in,” Kovaleski said. “They’re just not out there.”

Workers transfer these jobs for many reasons, including poor pay and a competitive job market. Nurses, for example, can earn more working in hospitals than in nursing homes, Bonner said.

Experts see a potential shortage looming as the industry grows. The global demand for full-time workers in long-term care and supportive settings is expected to increase 42% between 2021 and 2036, according to the Federal Health Resources and Services Administration. Demand for direct care workers, which make up the majority of the workforce, is expected to grow by 41%.

Direct care professionals play vital roles in their clients’ lives – a certified nursing assistant bathing an incontinent patient with dementia, a home health aide assisting an older widower with his medication, a personal care aide helping residents from a group home having lunch. These workers are mostly women and people of color, and many are immigrants.

Victoria Gardner, who is quadriplegic after a road accident left her unable to stand or use her hands, sees her home caregiver as a lifeline. The caregiver helps the 57-year-old Pennsylvania woman 16 hours a day. Without this care, Gardner would not be able to shower, prepare meals, do laundry or clean the house.

“In my situation now, I have a caregiver. That’s a very fragile position to be in. I’m not alone in this,” Gardner said.

The industry added about 1.5 million new direct care workers between 2012 and 2022, an AP-CNHI analysis of Bureau of Labor Statistics data found. About 800,000 new direct care jobs are expected to be created by 2032 — which experts say will be difficult to fill.

Payment is a big factor.

The average annual salary for home health and personal care aides was $33,380 as of May 2023, according to the agency. These incomes were similar to those of cafeteria workers and retail salespeople.

Direct care workers are typically in the lowest salary range. About half of them rely on public assistance, according to a January report from the Department of Health and Human Services.

Experts point to financing as the reason wages are low. Medicaid is the primary payer for long-term care services, but many stakeholders argue that Medicaid reimbursement rates are insufficient to adequately compensate workers.

Some states have made efforts to bolster the workforce, such as requiring that a percentage of providers’ Medicaid reimbursements go toward caregivers’ direct wages. Others used funding from the American Rescue Plan Act of 2021 to boost salaries and recruiting efforts. Meanwhile, the Biden administration finalized a rule in April that requires 80% of Medicaid payments for home care services be used to pay workers.

Zulma Torres, a longtime home health aide who works in New York City, said she used to cry after work because of the way people treated her.

For years, she earned $6.25 an hour. Sometimes customers treated her like a maid, expecting her to cook for the whole family. In some cases, when she had to take her client to the hospital, she felt like the nurses and doctors were judging her.

“A lot of times you feel like just leaving and thinking, you know, this isn’t for me,” Torres said.

Researchers say a lack of respect within and outside the industry is another factor driving away long-term care workers.

“There is a general view, I think among the public, that people who work in long-term care are inferior,” said Barbara Bowers, founding director of the Center for Aging Research and Education at the University of Wisconsin-Madison. “I don’t think they get anywhere near the respect they deserve for the hard work they do.”

Culix Wibonele, a certified nursing assistant in Atlanta, now makes $18 an hour at a nursing home. But she has had to endure years of low pay, layoffs and long-lasting migraines since she was injured by an agitated facility resident. Her salary still doesn’t seem enough.

“I can go to Walmart and make more money than being a CNA,” Wibonele said.

Still, Wibonele said he plans to stay in the industry for now. In addition to working as a CNA, she is studying at Georgia State University with the goal of becoming a registered nurse in long-term care.

“I love (the) older generation, their wisdom, their stories. I love knowing that I’m doing something while they’re still here on earth,” Wibonele said. “As much as we don’t get enough, I’m not going to change that.”

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Kelety reported from Phoenix and Scicchitano from Shamokin, Pennsylvania. AP data journalist Nicky Forster in New York contributed.

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The percentage of the US population over the age of 65 continues to rise – and will continue to rise over the coming decades. Because nearly half of Americans over age 65 will pay for some version of long-term health care, CNHI News and the Associated Press examined the state of long-term care in The High Cost of Long-Term Care series, looking at child care facilities for adults. for high-quality assisted living facilities, to understand the accessibility, staffing, and equity challenges that exist today and lie ahead.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute Science and Educational Media Group and the Robert Wood Johnson Foundation.