In our 2015 report, The Aging Tidal Wave, we dealt with the healthcare crisis that was about to overwhelm the long-term care industry. The aging baby-boomer population was growing rapidly while the number of caregivers was actually declining.

People are having fewer children; families are more transient and many of the elderly are living with no one nearby to assist them. Therefore, they depend on homecare agencies that are having difficulty themselves attracting and retaining people in entry-level healthcare positions.

In our previous report, we concluded that something needed to be done to increase the supply of entry-level healthcare workers and neither the government nor the private healthcare sector had any idea how to avoid the impending eldercare worker crisis.

Nonprofit Steps Up

Catholic Health, the Michigan division of Ascension and the Cleveland Clinic in Ohio are participating in a pilot program funded by the Ralph C. Wilson Foundation that aims to increase retention of certified nursing assistants (CNAs) and home healthcare workers. The program, called THRIVE (Transformational Healthcare Readiness through Innovative Vocational Education), began June 1, 2019 and will continue for three years training about 440 care workers per year.

Ralph C. Wilson

“Support for care work was a passion of the late Ralph C. Wilson himself; indeed, he and his wife donated a million dollars to support homecare in 2010, four years before Wilson died at the age of 95 in 2014.” Joyce Markiewicz, executive vice president of the health system explains, “Mr. Wilson, as he started to age, needed more and more assistance. During that time, he built relationships with the folks that were caring for him and learned a lot about the struggles they faced. He was very specific for his foundation. He wanted work to be done in the area—to raise the individuals up and have them be appreciated in the community.”

Turnover

Turnover in the field of elderly healthcare is roughly 40% for homecare workers and 30% for in-hospital certified nursing assistants. If you have to replace 30 to 40% of your workforce every year, it is almost impossible to stay even, not to mention keeping up with rapidly growing demand as the massive, chronically ill baby boomer generation retires and ages.

Addressing the Critical Shortage of Healthcare Workers

The funds that the Ralph C. Wilson foundation provided to launch THRIVE are directed at the two main causes of healthcare worker turnover, wages and training.

Wages

• Many entry level healthcare workers start at the minimum wage which, in New York is slated to rise to 12.50/hour in 2021 while fast-food workers will receive $15.00/hour. Markiewicz says, “If we are too close on wages to grocery store checkers or Pizza Hut or coffee shops, we will lose our pool of people.”
• A large portion of the funding available for aged home healthcare is linked to Medicaid. “Agencies that provide these services were given a rate,” Markiewicz says. “They have to run their business, pay their employees, and squeeze out a bottom line.” This has served as pressure to keep wages down.
• Another challenge, “is the way the care is delivered. It is usually short and intermittent. You travel from one location to the next…people don’t have transportation and the wages are low.”
• Many agencies only hire these workers as per diems and don’t provide benefits. The current shortfall in workers, she notes, is forcing people to reevaluate that. “How do they provide this workforce with the ability to have health insurance so they can come up off Medicaid?”

Training

Another core idea behind THRIVE is to provide life skills training along with skills-based training. What does life skills training include? The range of issues is vast. Workers in the THRIVE program learn how to open a conversation, how to deal with difficult family members who are not following the care instructions and how to interact with a multi-disciplinary team and be a continuing member of that team.

Coaching

One last major component, notes Markiewicz, is hiring work-life coaches. “Every individual who comes through training will have a coach,” she explains. “We believe if we can get employees through the first year, we have a much better chance of keeping them employed.”

The vision is to provide coaching for individuals, much more substantial training for workers and the ability to tap into extra resources to keep workers from losing their jobs when life events arise. Retention rates will go up because [workers] are more confident in their ability to do their job. They feel supported and more valued than the institutions value them now. And if retention rates rise enough, then retaining costs will fall.

Hats Off

…to the Ralph C. Wilson Foundation for tackling what has looked like an intractable problem to the social work community as it pondered the Tidal Wave of retiring baby boomers and who would care for them.