A metaphorical barn-raising started in Washington, DC, on May 26. Hosted by Jobs for the Future and John A. Hartford Foundation grantee PHI, the “Building Ladders and Raising the Floor” conference convened 75 leaders from across the workforce development and long-term services and supports sectors to discuss how the country can collectively roll up its sleeves to build the direct-care workforce we desperately need to care for our elderly and disabled loved ones.
The nation’s more than 3.2 million direct-care workers serve on the front line of our health care system and provide a lifeline of support for many of our parents, neighbors, and someday for most of us. These certified nursing assistants, home health aides, and personal care attendants deliver 70 to 80 percent of the paid hands-on care in nursing homes and home health care every day. (Our executive director, Cory Rieder, has written about two such workers, Hugo and Iman, and their impact on her life and the care of her aging parents).
Direct-care workers also constitute one of the largest and fastest-growing workforces in the country, playing a critical role in job creation and economic growth in low-income communities. With an exploding older adult population, we will need almost a million more of these workers by 2018. However, low pay and benefits make it terribly difficult for direct-care workers to make ends meet. Many live in poverty and go without basic health insurance. Even as the newly passed Affordable Care Act promises to greatly expand health insurance coverage, the long-term care sector has lobbied strongly for exemptions for these employees (see a March 2011 New York Times article on the topic). Low wages, poor benefits, as well as a lack of training and empowerment, contribute to recruitment challenges, high turnover rates, workforce instability, and potentially to compromises in the quality of patient care.
These issues and others held center stage at the “Building Ladders and Raising the Floor” conference, attended by a cross-section of direct-care providers and their associations, federal policy makers and administrators, consumer advocates, and workforce development experts. The day’s conversation was framed by the interlocking strategies of “building ladders”--developing career advancement opportunities and pathways out of poverty for direct-care workers--and simultaneously “raising the floor,” creating better jobs with better wages, benefits, and training for those like Hugo and Iman who enjoy and remain committed to their roles as caregivers.
The John A. Hartford Foundation has been a champion of the latter “raising the floors” strategy, supporting PHI with grants to improve the training of direct-care worker supervisors, create better direct-care jobs, and ultimately improve care delivered to older adults. The Foundation has also addressed direct-care policies by commissioning the 2008 Institute of Medicine report, Retooling for an Aging America: Building the Health Care Workforce and funding the Eldercare Workforce Alliance, a coalition of 28 multi-professional organizations to advocate for moving the IOM Retooling recommendations into policy. The Alliance is making headway in raising awareness of these issues with policymakers and the public. We invite everyone to help support their important work.
In addition to promising best practice models like the Jobs to Career initiative, supported by the Robert Wood Johnson and Hitachi foundations; the Green House Project; and PHI’s affiliated Cooperative Home Care Associates, the day-long conference also included sobering conversations about the challenges that lay ahead. Gerri Fiala, Deputy Assistant Secretary, Employment and Training Administration, U.S. Department of Labor, gave the keynote speech. She repeatedly emphasized that from the federal government’s perspective, “doing more with less” is the theme, given the national conversations about deficits and shrinking government budgets, both at the national and state level. She cited the need to align and leverage resources.
While challenges, particularly fiscal ones, weighed heavily on the minds of participants, opportunities also came to light. Elements within the Affordable Care Act, such as the CLASS Act, a voluntary long-term care insurance program; consumer-directed care; and new health care delivery and payment systems like Accountable Care Organizations, all present opportunities to work together across sectors to raise direct-care workforce issues and advocate for more support. A more efficiently deployed workforce will be critical to reining in rising health care costs and providing safer, higher quality care.
The John A. Hartford Foundation applauds PHI and Jobs for the Future for bringing together stakeholders from across the public and private workforce development, health care, elder care, and disabilities sectors. The nation needs all available 
hands and tools to construct a future in which we value direct-care workers as critical members of the health care team and of society. By both “building the ladders” and “raising the floors” we can build a better world for direct-care workers as well as the older adults and disabled individuals who rely on their compassionate, competent care.
For more information and recommendations on many of the central direct-care workforce issues, see “Building a Workforce to Care for an Aging Society: Challenges and Opportunities,” the special Winter edition of Generations, the journal of the American Society of Aging. The issue was sponsored by the Eldercare Workforce Alliance.