From VOA Learning English, this is the Health & Lifestyle report.
The hardest part of Culix Wibonele’s first job in long-term care was not getting hurt.
Wibonele is from Kenya. In 2014, she worked as a certified nursing assistant (or, CNA) in Atlanta, Georgia. She went to the homes of mostly older clients and helped them with everything from bathing to cooking. Wibonele worked alone. Sometimes she had to lift clients who were much bigger than she was. It was hard work. She earned only $9 an hour and received no benefits.
If not for her second job as a babysitter and her husband’s wages, her family would not have made enough money to support their four children.
“My paycheck was almost nothing. I was shocked by the amount of work we did and the pay we got,” Wibonele said.
Wibonele’s experience shows a bigger problem in the long-term care workforce. Those who care for older adults in private homes and assisted living places face low wages and the risk of injury. The industry also has trouble finding enough staff. Those findings are part of an investigative report by The Associated Press and CNHI News.
The need for these workers is rising as more people get older. By 2030, about 20 percent of the U.S. population will be 65 or older, the U.S. Census Bureau says.
“It’s a national problem, and it’s everywhere,” said Dr. Stephen Crystal. He is director of the Rutgers Center for Health Services Research.
Shortages and turnovers
The industry has dealt with worker shortages and high turnover for years. These problems got worse during the COVID-19 pandemic.
Nursing care places lost many workers during the pandemic. The workforce has still not fully recovered. in March A study of nursing home providers by the American Health Care Association found almost all have open jobs and difficulty recruiting.
Turnover is so bad at nursing homes that some lose all their employees within a year, said Alice Bonner. She is director at the Center for Innovative Care in Aging at Brown University in Rhode Island.
“The people who are left are working much harder, double shifts, overtime and with temporary workers,” Bonner said.
Noelle Kovaleski is an administrator of the Carbondale Nursing and Rehabilitation Center in Pennsylvania. She said the biggest difficulty is the lack of candidates. One nurse supervisor job at her place went unfilled for two years.
“There is no workforce coming in,” Kovaleski said. “They’re just not out there.”
Workers pass on these jobs for many reasons, including low pay and a competitive labor market. Nurses, for example, can earn more money working at hospitals than nursing homes, Bonner noted.
Experts expect more worker shortages as the industry grows. The need for full-time workers in long-term care is expected to increase by 42 percent between 2021 and 2036, says the federal Health Resources and Services Administration. The need for direct care workers, who make up most of the workforce, is expected to grow 41 percent.
Direct care workers are important in the lives of their patients. They help with bathing, medication and meals. These workers are mostly women and people of color. Many are immigrants.
Victoria Gardner is unable to use her arms and legs. She considers her at-home caregiver to be a lifeline. Her caregiver helps her 16 hours each day. Without this care, Gardner could not bathe, prepare meals, do laundry or clean her home.
“My situation is fragile because I have one caregiver,” Gardner said. “I’m not alone in that.”
The industry added about 1.5 million new direct care workers between 2012 and 2022. It is expected to add close to 800,000 new direct care jobs through 2032, which experts say will be hard to fill.
Low pay is a big reason for the worker shortages. The average yearly wage for home health and personal care aides was $33,380 in May 2023. These earnings were similar to cafeteria attendants and retail sales workers.
Experts say funding is a reason wages are low. Medicaid is the main payer of long-term care services. But many experts say Medicaid reimbursement rates are too low to properly pay workers.
Some states have tried to improve the workforce by requiring a percentage of providers’ Medicaid reimbursements to go to direct care worker wages. Others have used money from the 2021 American Rescue Plan Act to increase wages and recruiting efforts. Meanwhile, the Biden administration made a rule in April requiring 80 percent of Medicaid payments for homecare services go to pay workers.
Another reason long-term care workers are leaving the field, researchers say, is a lack of respect inside and outside the industry.
Barbara Bowers is founding director of the Center for Aging Research and Education at the University of Wisconsin-Madison. She said of long-term care workers, “I don’t think they get anywhere near the respect they deserve for the very hard work they do.”
Zulma Torres is a long-time home health aide in New York City. She said she used to cry after work because of how people treated her.
For years, she earned $6.25 an hour. Sometimes, clients treated her like a maid, expecting her to cook for the entire family. In some cases, when she took her client to the hospital, she felt judged by the nurses and doctors.
“Many times, Torres said, “you feel like just walking out.”
Culix Wibonele, the certified nursing assistant in Atlanta, now earns $18 per hour at an assisted living facility. But she has had to put up with years of low wages, layoffs, and severe headaches from being injured by a client. She still feels she is not paid enough. “I can go to Walmart and make more money than being a CNA,” Wibonele said.
Still, even with the low pay, she plans to stay in the industry. In addition to working as a CNA, Wibonele is studying at Georgia State University to become a registered nurse in long-term care.
She said, “I love the older generation, their wisdom, their stories. I love knowing that I am doing something while they are still here on the earth.”
And that’s the Health & Lifestyle report. I’m Anna Matteo. And I’m Dan Friedell.
Josh Kelety reported this story for the Associated Press and Eric Scicchitano reported it for CNHI News. Anna Matteo adapted it for VOA Learning English.
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Words in This Story
certified – adj. having met special qualifications within a field
nursing – n. the profession of caring for the sick or infirm
client – n. a person who engages the professional advice or services of another
benefit – n. something that produces good or helpful results or effects or that promotes well-being
turnover – n. the number of persons hired to replace those leaving
recruit – v. to fill up the number of with new members
shift – n. a scheduled period of work or duty
fragile – adj. easily broken or destroyed
deserve – v. to be worthy, fit, or suitable for some reward
layoff – n. losing employment often temporarily