IMPH Releases Recommendations for S.C.’s Direct Care Workforce in Long-Term Care Settings

COLUMBIA, S.C. — The South Carolina Institute of Medicine and Public Health (IMPH) has released a new report that surveys the challenges associated with direct care worker recruitment and retention throughout South Carolina. The report includes best practices and recommendations for expanding recruitment and retention efforts across the state. To read the full report, visit https://bit.ly/IMPHDirectCareWorkforce.

Throughout the United States, the direct care workforce provides critical services for older adults and people with disabilities while often working under demanding conditions. The coronavirus pandemic intensified work-related stress, which has led to burnout, high turnover and difficulties recruiting new staff. According to the Bureau of Labor Statistics, nursing homes across the country lost 380,000 workers between February 2020 and July 2021.

Across the country, one in six home health aides lives in poverty, more than half receive some form of public assistance and 17% lack health insurance. The Bureau of Labor Statistics estimates that the median annual wage for home health and personal care aides nationally was $27,080 in 2020 — and South Carolina wages are even lower.

“Maintaining and supporting the direct care workforce is a necessary component of providing quality care to those that need it most in our state,” says Maya Pack, executive director, IMPH. “Without a robust direct care workforce, people living in residential care facilities and people receiving in-home support services are at an increased risk of receiving sub-optimal support.”

In the decade between 2010 and 2020, direct care workers’ median annual salaries have only increased twenty cents across South Carolina, averaging $11.73 an hour as of 2020. For context, economists at MIT have determined that a living wage for a single adult without dependents in South Carolina is $14.58 hourly or $23,974.00 per year.

Improving retention and recruitment efforts can help prevent burnout, improve continuity of care and improve health outcomes among residents in long-term care facilities and individuals receiving home- and community-based services. IMPH's best practices and recommendations include the following:

Reimbursement and incentives:
Increase and effectively utilize Medicaid and Medicare reimbursement rates.
Increase direct care worker compensation to offer competitive wages.
Offer subsidies to direct care workers.
Provide health insurance.

Workforce development:
Increase the availability of workforce pathways.

Training and scope:
Standardize roles and regulatory requirements for direct care workers.
Refine direct care worker training to reflect the full set of skills required.
Strengthen training infrastructure to support adult learners.

Support and acknowledgment of the direct care workforce:
Develop peer-to-peer support groups for direct care workers.
Acknowledge and assess the direct care workforce through improved data collection.

With the expected increase in demand for direct care workers in the coming years, these recommendations are meant to focus on recruitment and retention of direct care workers and emphasize the need to proactively implement policies to improve and maintain standards of health care in South Carolina. For more information on IMPH’s Long-Term Care Taskforce and reports, visit imph.org/taskforces/long-term-care-taskforce.

The South Carolina Institute of Medicine & Public Health (IMPH) is a nonpartisan, nonprofit organization working to collectively inform policy to improve health and health care in South Carolina. In conducting its work, IMPH takes a comprehensive approach to advancing health issues through data analysis and translation and collaborative engagement. IMPH seeks to achieve its mission by convening a diverse group of stakeholders around health issues important to South Carolina. Learn more at imph.org.

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