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Converting Leavers to Stayers
March 28, 2006
As the care gap grows, one possible new source of qualified and motivated direct-care workers is in the pool of caregivers recruited by Medicaid-funded programs that pay for consumer-directed care, such as California's In-Home Supportive Services (IHSS) program. IHSS supports home care clients who recruit, hire, and supervise their own personal assistance workers. Most of the people they hire are friends or relatives who might not have considered direct-care work if a loved one had not needed them.
Two new studies from the Better Jobs Better Care research program look at what makes some of those caregivers stay and others leave once their loved one no longer needs their assistance. They also recommend things states and employers can do do -- including offering health insurance and wages of at least $10 an hour -- to encourage more of these caregivers to remain in the direct-care workforce.
In Labor Force Expansion through Retention of Related Caregivers, Ted Benjamin and colleagues from the University of California, Los Angeles, surveyed a random selection of IHSS workers who at one time were paid to care for a family member or friend. They compared those who were still involved in some form of caregiving, who they called the stayers, with those who were either working in another occupation or unemployed (the leavers). Most said they would be willing to provide care again, with 67 percent of the stayers and 43 percent of the leavers saying they would be willing to care for a stranger. More than half (82 percent of the stayers and 59 percent of the leavers) said they would care again for a friend or relative.
Leavers listed salary, benefits, and the desire for more independence or new challenges as their primary reasons for pursuing other occupations. More than a third (38 percent) said they earned ''quite a bit more'' now than during their initial work experiences.
The researchers conclude that paying family members can expand the workforce, and public payment draws more permanent workers into the caregiving workforce. They recommend that states ''provide timely outreach information about other home care work opportunities'' when IHSS workers leave paid caregiving work, and that worker registries, which typically exclude family caregivers, include IHSS workers.
They also recommend that those recruiting home care workers stress ''the altruistic elements of caregiving.''
In Wages, Benefits, and Flexibility Matter: Building a High Quality Home Care Workforce, Candace Howes and colleagues from Connecticut College surveyed 2,200 IHSS workers randomly drawn from eight California counties, including both high and low wage-earners in rural and urban areas. In San Francisco, they found, the turnover rate fell from 61 percent to 26 percent when the wage increased from $5 to over $10 per hour and health and dental insurance was offered. As of 2004, 43 percent of San Francisco's IHSS workers listed health insurance among the most important reasons they took the job. More than a quarter (28 percent) listed dental insurance, and even higher percentages report both health and dental insurance as a primary reason why they stayed in the job.
Most of the IHSS workers are low-income (half earn less than $1,000 a month) and over a third work at another job, so ''flexibility and wages matter,'' the researchers note. ''Research clearly shows that giving workers $10/hr plus access to decent benefits significantly increases the supply and retention rate of home care workers, making it possible for consumers to find good caregivers and for California to sustain its unique and cost efficient long-term care system.''
Elise Nakhnikian
Communications Specialist
Paraprofessional Healthcare Institute
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