An Iowa Ideas column in June discussed shortages in the direct care workforce, and called for action to address them.
Recently, conversations have been occurring about a possible solution — the expanded hiring of immigrants.
Hiring more immigrants can help meet the demand for direct care workers, but it may only mask — and further delay dealing with — the real problem: that the people who do this work are neither respected nor rewarded.
The long-term-care industry (nursing homes, assisted living centers, home care agencies, organizations supporting people with disabilities, etc.) — uses a business model built on a foundation of inadequate pay, benefits, and training for front-line workers.
This business model has worked for the owners and operators — they’ve made money — but it hasn’t worked for the people providing the services or those receiving them.
Direct care workers have been, in too many instances, exploited. They’ve been seen by too many as expendable commodities. I’ve witnessed this “expendable” mind-set at the Iowa Capitol over the years — with a facility owner referring to their workers as “a dime a dozen” and with a former Republican legislator equating the value of direct care workers to migrant “melon pickers.”
Similarly, direct care jobs have been consistently referred to by workforce and economic development officials as “low skill” and “entry-level” — damaging words that send the message that these are unimportant jobs that anyone can do, jobs not valuable enough to consider for a career.
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These are the attitudes that have prevented direct care workers from being in jobs that Iowans should aspire to be in, and stay in.
Iowans receiving services have been shortchanged. Poor jobs create a revolving door of direct care workers (turnover is estimated at 50 percent annually); high turnover results in lower quality of care provided by workers with less knowledge and experience. Lower quality care has led to more service complaints, and greater frustration among consumers and their families.
Iowans — the workers and those they serve, support and protect — deserve better.
So, what will the impact be if the industry chooses to address their workforce challenges by recruiting and hiring more immigrants?
If immigrant hiring is used to transform the business model — to raise wages, improve benefits, expand training, give necessary attention to the challenges of different languages and cultures, etc. then workers and those they serve will benefit.
However, if expanded immigrant hiring is used to maintain the status quo — keeping wages and benefits low with inadequate training — then the effect will simply be to make a bad situation worse. The all-too-common lack of respect for and the exploitation of direct care workers will continue, while language and cultural differences will add additional barriers to the provision of high quality care.
The solution to the problem of direct care worker shortages has been known — and ignored — for a long, long time. It’s pretty simple — if you create better jobs, you’ll get better care.
The crisis in the direct care workforce and the growing conversation about the use of immigrant labor creates a need for leadership.
My request to whomever delivers the governor’s Condition of the State address in January: Tell legislators and the public that your administration cares about direct care workers and those they serve, and that you will work with the industry, workers, consumers and advocates to make poor jobs much better jobs — jobs that will be attractive to existing Iowans and future immigrants.
That commitment will make Iowa a much better place to live and work.
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• John Hale is co-owner of The Hale Group, an Ankeny-based consulting, advocacy and communication firm. Comments: firstname.lastname@example.org