Senior Care

Thank you to Pioneer Network for allowing us to share these thoughts..

Houston, We Have a Problem
Ruta Kadonoff
Executive Director, Pioneer Network

Is it just me, or are there red flags everywhere lately, calling on us to take notice of the impending collision between our demographics and our workforce trends? Evidence is mounting and the chorus of voices is growing, begging us to recognize that we are on the brink of true crisis. I see many parallels between this issue and the climate change discussion. Whatever your personal convictions about possible causes and potential solutions to either, the data seem to be increasingly clear and screaming ever-louder, ‘Houston, we have a problem.’

I’d like to share a few quotes that have been rattling around in my head over recent days and weeks …

“We’re never going to attract a workforce unless they are going to get paid a livable wage, or at least a somewhat livable wage, and benefits.”
– Betsy Sawyer-Manter, Executive Director, SeniorsPlus, quoted in Sun Journal (Lewiston, ME)

“It should not be financially irresponsible to be a caregiver, but it is.”
– Corey Anne Rotella, CNA and writer ( CNA Edge blog), speaking at Pioneer Network conference plenary session

“…guaranteed economic hardship is not an effective recruitment tool. We cannot keep doing the same thing with respect to worker wages and expect a different result.”
– Stephen Campbell, Policy Research Associate, PHI, writing in AgingToday

“If you truly believe that excellent, personal care can be provided to over a dozen residents by an exhausted, stressed out and fiscally struggling caregiver…come be my resident. Come be dependent on me for everything and have to share me with over a dozen other people. Tell me then that below average pay for caregivers is an “acceptable measure.” Tell me then that my residents are not worthy of enough respect to give their caregivers a living wage and good working conditions.”
– Hannah Hedges, CNA and writer ( CNA Edge blog), speaking at Pioneer Network conference plenary session

If you are reading this newsletter and identify with the mission and values of the Pioneer Network, none of this comes as a shock to you. The quality of long-term care jobs, in both residential and home and community-based care settings, is not what most of us would agree it ought to be. And yet, I can’t help but think that while we know this intellectually, it’s time to begin facing the not-so-flattering reality that our collective acceptance of the low-wage nature of these jobs as ‘just the way things are,’ is a huge part of what allows the status quo to continue. It feels so much better to focus on things we perceive as within our control — staff engagement, empowerment, building relationship, effective leadership, and all the other hallmarks of organizational culture change. Please do not misunderstand, I’m not minimizing the importance of those factors one bit. Susan Eaton’s landmark research on this topic tells us unequivocally that management DOES make a difference. But when we stop short of also being willing to confront the economic realities of caregiving jobs as a critical part of the equation, we ignore the elephant in the room.

People within and outside the field typically equate direct care work with other low-wage jobs — the “Walmart worker” or the fast food employee. With all due respect to individuals working in those jobs, I am hopeful we all see just how big the gap between those worlds and ours is in terms of skills needed and demands placed on workers. And yet, wages are typically similar, if not actually lower for care work.

I have heard many complaints about the challenge of finding people to enter and stay in long term care jobs when they have other options — almost implying a moral failing on their part when they do not choose the more difficult path. I have also heard corporate executives voice their frustration with the fact that they cannot “find good people” for direct care positions — noting that they leave when faced with the “realities” of the job. When I probed that statement further, one corporate director of HR told me, “they can’t keep up, they get frustrated when they have to work short, they don’t have a strong work ethic or understand what the job takes.” Certainly, there are people who try caregiving only to discover they are not suited for the role — and it’s best that they move on. But as we spoke it became pretty clear that his comments reflected frustration with what I took to be people who simply came to the conclusion they were unwilling to accept poor working conditions where they were required by circumstances (such as routinely “working short”) to do a substandard job in exchange for poverty-level wages. I didn’t have the guts to ask that executive whether, if compelled to make a decision between the two in order to pay his rent, he would accept a job as a CNA in one of his homes or opt to go flip a burger. That might have been an interesting conversation…

We all know there are many, many extraordinary individuals who continue to do this work for its intrinsic rewards, regardless of what that means for them and their families from an economic perspective. Our existing system is built on a core of these people, supplemented by a revolving door of others that come and go, leaving the committed individuals to pick up the slack, which more often than not they do. Until they burn out. And the sad fact is that as long as enough of these people continue to step up, it saves us from truly confronting the thorny issue of compensation. These are the people we rely on to be there day and night to take care of those we have a professional responsibility to serve within our organizations, or a personal responsibility to care for — our mothers, fathers, grandparents. And it’s worth remembering that at some point in our lives, we will likely rely on them to care for us, too. That is, if we can still find any willing to take on this huge responsibility, this physically demanding and emotionally trying work. I suspect we may not, unless we begin to accept shared responsibility for changing the existing reality.

Like the climate change conundrum, there is little agreement about solutions. The trend lines tell us there is also precious little time to figure it out. Calling on the refrain of “there simply isn’t enough money in the system to pay more” becomes a smoke screen to hide behind. “Of course, we’d like to, but…” Again, for as long as there are people willing to take the available jobs, we can continue to tell ourselves that it’s the truth. But I believe that is changing — and the statistics are beginning to show it. Unless we can come to grips as a society, and as organizations employing direct care workers, with the fact that we must find a way to improve this situation, to adequately compensate workers on whose skill and compassion our lives and those of our loved ones depend, we are living on borrowed time.