By Thomas Goldsmith

Elaine Atkins was recently taking care of a 90-year-old woman who started crying, believing she had forgotten her pencil on the way to school and that her mother would be angry at her.

Instead of reminding the client that her mother had died many years ago, Atkins, an Orange County direct care worker, found a pencil for her. She knew from long experience in the field that showing empathy would be better for her client than “reorienting” her to a confusing present.

“Once I gave her that pencil, everything was fine,” Atkins, a medical technician at Carol Woods Retirement Community in Chapel Hill, said Tuesday.

NewsMatch announcement: Your gift supports quality stories on aging and older adults in NC. Your gift doubled for twice the impact thanks to NewsMatch. Give at spoke between sessions at a Direct Care Workforce Summit at Durham Tech that brought together direct care workers, business owners, social work leaders, academics and employee groups.

Presentations at the event showed that both residential- and home-care companies need workers to provide hands-on care to people who are among society’s most vulnerable, because of age or disability. There’s a growing need for well-trained, caring people in these jobs, but current statistics show that pay in the field has declined even in a prosperous economy.

Pay heads south

Between 2006 and 2016, average hourly pay for all North Carolina direct care workers slipped from $10.90 to $10.32, said Kezia Scales, Durham-based director of policy research for PHI, a national advocacy organization for direct care workers.

For home health aides, the fastest-growing segment of direct care workers, the decline was more dramatic, from $10.59 to $9.30 an hour from 2006 to 2016.

Pam Palmer, regional ombudsman for long-term care at Triangle J Area Agency on Aging, left, talks over issues at a Direct Care Workforce Summit Nov. 27, 2018, at Durham Tech, with Sue Roth, a member of the Durham County Adult Care Advisory Committee and Elaine Atkins, an Orange County direct care worker. Photo credit: Thomas Goldsmith

“Legislators, congressmen, they really need to look at caregiving in the home,” said Charles Thurston, chief operating officer of Wisdom Senior Care in Durham, an employer of home health aides.

Agencies at which clients’ care is reimbursed by Medicaid have to base their rates on what federal and state authorities vote to spend, while private-pay services are more market-driven.

People at the meeting heard that North Carolina employs more than 123,000 direct care workers, but will need 34,000 more by 2024, or a little more than five years away.

“We’re not anywhere near keeping pace,” said Sue Roth, a member of the Durham County Adult Care Advisory Committee.

“Love this work”

Presenters focused on how to attract and keep new hires In a workforce that’s demanding, notoriously underpaid and often undertrained.

“Across the country, we’ll need a million more home care workers by 2026,” Scales said. “In some senses, we are all in the right job … We just have to figure out how to meet the demand.”

Presenter Candace Rashada, director of career readiness at Durham Tech, mentioned a key point that employees find in the career’s favor.

“They love this work,” Rashada said.

In addition, in counties outside North Carolina’s urban regions, direct care jobs are often among a small number of positions open to people with high school degrees or less.

Scales listed challenges that many direct care workers face: part-time status, low annual wages, lack of health insurance, and life below the poverty line. About 40 percent of direct care workers need public assistance to meet individual and family needs, she said.

And the jobs, although vital to clients and families, typically don’t bring high esteem from society, Roth said.

Be prepared

“This may be a little politically incorrect, but the level of respect for direct care workers isn’t as high,” she said.

Public and nonprofit organizations help potential employees prepare for jobs that are often rigorous and complex. Applicants also have to be able to explain why they want jobs in the field.

“Why? Because my mama was a CNA and my grandmama was a CNA?” said Kelli McLean, career center manager at NC Works, Durham County, referring to the job of certified nursing assistant.


Applicants who know what the job entails are better candidates and workers, McLean said. Training in direct-care careers at Durham County Career Works, as at NCWorks agencies across North Carolina, is designed to produce clients that are “looked at, recognized and hired at the end of the day,” she said.

At Durham Tech, organizer Chanelle Croxton talked about efforts to represent interests of direct care workers through the local chapter of the National Domestic Workers Alliance. North Carolina is starting down a trail seen in other states, where labor groups such as the Service Employees International Union represent some direct care workers, said Thomas Konrad, a long-time researcher into issues touching this workforce.

According to SEIU, its affiliated nursing home employees — now more than 10,000 — in Illinois and Indiana have won improved contracts and helped pass legislation that made long-term care jobs safer.

A proposed Obama-era change in U.S. Labor Department rules would have opened up overtime pay for millions of additional workers, including home-care and other direct-care employees. But after the Obama administration delayed implementation, the rule was then overturned by a federal judge in late 2017.

Konrad said he and others will continue to approach state officials and legislators about innovative programs and other means to improve the daily situations of direct care workers, including increasing their pay under Medicaid.

“We have to think about 10 years; we have to think long-term,” Konrad said. “We have to make a commitment to this workforce that goes beyond today and tomorrow.”

Correction: In our original story, we mis-identified Elaine Atkins as Elaine Watkins. The error has been corrected. 

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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...

One reply on “Demand for NC Direct Care Workers Mounts, but Wages Decline”

  1. The rate of pay and lack of benefits for direct care workers should be a national disgrace! Seniors and persons with disabilities are being put at risk because of lack of qualified staffing. And in the meantime, state legislatures, including NC, continue to pursue more and more privatizing of Medicaid, which can only reduce services and quality of care for those who need it most (all the while health care executives and those at the top of the health care food chain pad their pockets with taxpayer dollars!). Our current health care models are foolish and devastating; more money should be invested in the people providing direct care services who continue to be squeezed out by the greed at the top.

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