What older Americans really need

Older Americans Month is traditionally a time to recognize older adults’ contributions to the United States. But if we genuinely want to use this May to give back to the parents, grandparents and other elders who have done so much for us, we must turn our attention to the direct care workers (nursing assistants, home care and home health aides, personal care assistants, direct support professionals and other frontline care workers) who help millions of older adults live as healthily and independently as possible.

A recent survey of home care consumers illustrated the close relationships and mutual concern that flourish between so many direct care workers and the people they assist: “Consumers talked about how a worker would pop over to the house over the weekend on her own time, just to check in and make sure they were doing well. Or a worker would bring some sort of food item to the house that the person really loves. You hear this a lot in nursing homes too. And it was a two-way thing: The consumers were also really invested in their workers. They asked about their families. They were worried that they don’t earn much or don’t have benefits like health insurance and they have a family to provide for.”

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Those consumers are right to be worried—both about the workers themselves and about the impact their situation can have on continuity and quality of care and services. Direct care workers average only $10.63 an hour, largely because their work has long been dismissed as “women’s work,” the kind of care work traditionally done inside the home and for no pay. Due to their low wages, nearly half of all direct care workers live in households that rely on public benefits like Medicaid or food stamps.

Direct care workers are also far less likely than the average American worker to have benefits like paid sick days. It’s a shame that the people who help older adults stay healthy and safe—which happens to be the theme of this year’s Older Americans Month—have to choose between losing pay they can’t afford to do without or going to work sick or injured, perhaps even putting their clients at risk. And despite high rates of on-the-job injuries and higher than average rates of chronic conditions that become more serious when untreated, nearly a third of direct care workers didn’t have health insurance in 2011. Of course, many of them have since found coverage under the Affordable Care Act, but many are still forced to go without insurance because they can’t afford the monthly premiums. Still others, in states that refuse to expand their Medicaid programs, find themselves trapped in a health care coverage gap.

Add to all that limited opportunities for training and career advancement, and it’s no surprise that the direct care profession has high turnover rates and trouble attracting new workers—and that’s not good for anyone. Turnover disrupts the continuity that’s critical to quality care and support. It also costs consumers, families and other employers both time and money, forcing them to keep hiring, training and building trusting relationships with new workers.

The issues facing direct care workers—and everyone who counts on them—are even more significant given our population trends. Our aging population is growing so fast that we can expect 72 million Americans—almost 20 percent of the U.S. population—to be 65 years and older by 2030, the year when the 85 and older cohort will start to grow rapidly. Folks in this second age group are among those most likely to need the kind of care, services and support that direct care workers provide, so today’s workforce challenges are not going to fade away. In other words, this is not a problem individuals and families should have to grapple with alone. It’s a challenge we face as a society, one that needs public attention so we can come up with policy solutions that give consumers and workers the support they need.

The good news is that there’s good news. From improved access to quality health care under the Affordable Care Act, to new minimum wage and overtime protections for home care workers that will go into effect next January, to the paid family and medical leave that would be available to nearly all U.S. workers if the Family and Medical Insurance Leave (FAMILY) Act becomes law, numerous policies and practices promise—and, in some cases, already deliver—important changes for direct care workers and their families. But we need to make sure these policies are passed and implemented properly, and even that is just a starting point. We need true and significant improvements to direct care workers’ pay, benefits, advancement opportunities and working conditions if we’re going to make direct care work a middle class job that people can commit to as a career without condemning themselves and their families to a life of near-poverty.

Let’s not just pay lip service to honoring America’s older adults this month. Let’s be smart and strategic, loving and honest. Let’s stop shortchanging elders by turning our backs on the direct care workers they depend on. Improving wages, benefits and career advancement opportunities for direct care workers is one of the best investments we can make as a nation. It promises a huge return—not only for our growing population of older adults, for direct care workers and for all of our families but for our economy as a whole. What’s more, it’s an excellent way to show our gratitude and respect for the older adults who have done so much to help build our future.

Ortiz is the national advocacy director of Direct Care Alliance, a non-profit organization that is the national advocacy voice of direct care workers.