COMMENTARY: Crisis in caregiver workforce creates gaps in care

It was not so long ago, as a hot-tar roofer, that I was throwing gravel on roofs for 10 hours a day under the 100-degree sun in California. It was hard work, but at the end of the day, I went home with no mental anguish. That is not the case for the vast majority of minimum-wage caregivers.  When they go home, they take with them the emotional pain of not being able to help an old frail woman desperately beseeching them for their companionship because they had to leave and help the woman down the hall who has been sitting in a soiled diaper for two hours. When they go home, after cleaning and dressing the lonely and desperate, their nights are filled with remorse.

The eighth-lowest paying job in America is personal and homecare aides with institutional positions for senior care not far behind with an average annual income in 2017 of $26,269 a year. It is no surprise that retaining caregiver positions is a difficult task and that there is a widening gap in delivery of service to seniors. The current unemployment rate for those between 25 and 55, the demographics of senior care workers, is currently 3.2 percent.  Historically, this is extremely low and represents great opportunity for those emotionally and physically stressed to find alternative work.

There are ways to make employment more attractive and retain employees. Communities can compete at the wage level offering more than minimum wage with benefits. A large number of caregivers are part-time workers with transportation challenges. Facilitating their arrival at work by using existing facility transportation resources to pick up and drop off employees can ensure on-time delivery of personnel. Retaining happy employees is critical when resources are thin. Improved processes and involving caregivers as owners responsible for process improvement goes a long way in delivering worker satisfaction.

Wages are not the only issue in hiring and maintaining a senior care workforce. Some other contributing factors to retaining workers are high injury rates, a high level of difficulty, and manager relations. Nursing assistants and assisted-living personnel have the third-highest injury rate of American jobs at 348.5 injuries per 10,000 workers. According to an assisted-living employee survey, the number one retention issue in assisted-living communities is manager-employee relations.

Training managers is an absolute must and should include acceptance of measurement of performance and ownership of improvement. Measurement needs to be done without putting an extra burden on management, as they are likely taking on staff responsibilities in order to meet service requirements.

Organizing buildings and residents to optimize the flow of care can lower the inefficiencies of care by reducing the number of steps between service. Involving residents in each other’s care builds community, the most important social construct for long life and good health.

Technology can help assisted-living facilities maximize the effectiveness of their personnel and keep personnel happier. Technology optimizes scheduled behavior with assessment and just-in-time delivery of service. Improve performance by employing staff as firefighters who answer technology notifications for help calls, bed exits, and falls allows scheduled walks, showers, and bathroom assistance to proceed unencumbered. Artificial intelligence is being used to identify the frail who need extra assistance, improve scheduling, and analyze real time data notifying caregivers of emergencies. Integrating it into existing systems is as easy as installing TV players in rooms with some sensors. The technology does the rest with dashboards and reports of staff effectiveness and resident needs.

I am no longer shoveling gravel to keep tar paper on the roofs of homes, protecting them from the rain. Please help me encourage government agencies to zone services closer to high-density senior hotspots, give tax breaks on the implementation of technology that services our aging population, and vote for an increase in Medicare to plug the gap that is currently being funded by families. 

Philip Regenie is the founder and chief executive officer of Zanthion, a San Francisco, Calif. company that produces artificial intelligence technology that helps patients in assisted-living facilities.