Dr. Jennifer Craft Morgan of the Georgia State University Gerontology Institute gave a talk at UNO on Direct Care Worker Retention in the health care field with a trauma-informed approach. Dr. Morgan covered multiple different topics that will help improve practices and increase support for those working in the direct care industry.

When talking about Direct Care Workers, a study in 2022 showed that 58% work in home care, 15% as residential care aides, 9% in nursing homes, and 18% in other industries.

Dr. Morgan discussed the effects that the COVID-19 Pandemic had on these workers, and the traumas they dealt with, such as job uncertainty, political turmoil, financial insecurity, and even systemic racism. Statistics show that care workers are often women of color and are also often immigrants. Their median annual income is $23,000, leading to roughly 40% of care workers living in low-income households and needing to rely on government assistance. There are also a good portion of workers who are unpaid family caregivers, providing the same level of care without any compensation. Many healthcare workers in general, roughly 25%, are ineligible for emergency paid leave, and roughly 30% of registered CNAs are part-time and therefore cannot receive employment benefits.

The pandemic also highlighted the issue of staffing, as only 2% of nursing homes nationwide report full staffing.

Direct Care Worker Ashtin Schlisner in Lincoln explained that “retention is a constant problem” in this line of work. “I have noticed more recently that [hospitals] will hire traveling care providers over local ones because they are more likely to stay longer,” she said. Traveling Direct Care Workers have higher salaries because of the contracted work, creating more expenses for healthcare facilities and less retention from local workers. In a 2022 study from the American Health Association, hospitals spent a median of 38.6% of their nurse labor expenses for contracting workers in January of that year. In contrast, they spent a median of 4.7% in 2019.

Dr. Morgan used these facts to underline the need to increase recruitment and career growth for care workers, as well as improve the quality of the jobs available to lower the risk of burnout for nurses. She highlighted five trauma-informed principles: Safety, Choice, Collaboration, Trustworthiness, and Empowerment.

Safety

Focusing on protecting nurses physically and mentally.

Giving workers access to their own healthcare, the ability to take paid leave when they are sick and/or injured, and giving access to benefits for part-time workers is the first step to improving the safety for nurses.

Choice

Creating multiple options that can facilitate the best choices for individuals and groups.

Increasing workplace flexibility and allowing for reasonable and supported breaks to give nurses more choices when they are working.

Collaboration

Working together towards positive decisions. 

Engaging currently employed nurses in the hiring of new nursing staff, as well as using ‘walking interviews’ as a way of introducing possible new hires into the workplace. It is also important to help bring new employees into the fold and build a healthy team dynamic with other nurses in the training process.

Trustworthiness

Supporting others with consistency and follow-through.

Opening the lines of communication between workers and supervisors is the strongest ways to build trustworthiness between the different levels of organization, improving check-ins and getting to know the nurses on staff.   

Empowerment

Validation and affirmation towards the choices the individual makes.

Giving workers the ability to improve their skills and develop new ones that can help them climb the ladder in their organization and be able to reach higher levels and be able to use those abilities to help their hospitals and other nursing locations.

Schlisner believes that direct support for workers themselves “would greatly influence the attitudes and performance of healthcare workers. We see and hear everything, and it can be severely detrimental to our mental [and physical] health status.”

This topic hits at an important time as on September 1st the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would require long-term residents of nursing homes to receive a minimum number of daily hours with a nurse, as well as a registered nurse to be on call 24/7. As of August 2023, statistics have found that, at most, 3 states would have 75% or more of their nursing homes pass these regulations, 2 states and Washington DC would have 50% or more meet requirements, 16 states could guarantee at least 25% of their facilities, and 29 states could not even manage 25%. Schlisner suggested that the government, at any level, could provide more time and funding to employees and patients by improving salaries and increasing benefits for patients, allowing healthcare networks “to hire more employees or at least give current employees more incentive to stay.”

Equally, at the beginning of 2022, it was found that senior care centers were down 10% on hiring and that without raise increases across the board it would be difficult to hire new staff. Multiple proposals have been made to increase funding for nursing homes and pay rates, such as LB893 and LB1172 which were allocated for developmental disability services, and LB1089 and LB989 for Medicaid nursing facility rates. These were combined into LB1011 and LB1014, which also dealt with the federal funds the state received for the COVID-19 Pandemic relief.