Direct Care Workers and Quality Jobs/Quality Care: Marla Lahat

October 4, 2016
By DC Coalition on Long-Term Care

This month, the Consumer Health Foundation (CHF) will post a series of blogs on the direct care workforce in partnership with the DC Coalition on Long-term Care, a nonprofit organization which was formed to improve the quality of long term care programs and ensure that low-income District residents with disabilities or chronic care needs can continue to live in their communities safely and with dignity. We would like to thank the Coalition for interviewing stakeholders from the nonprofit, business, and local government sectors on their views about this important workforce. We would also like to thank the Coalition for facilitating CHF’s interview with a direct care worker from the Washington, DC region.


The Paraprofessional Healthcare Institute (PHI) described the direct care workforce as composed of home health aides, nursing assistants, psychiatric aides, and personal care aides. The direct care workers provide 70-80% of caregiving for older adults and people with disabilities. It is projected that by 2020, there will be more than 5 million direct care workers, which will make it one of the largest employment sectors in the country. Nationally, direct care workers are 88% female; 20% are foreign born; the average age is 42 and growing older; and 55% have a high school diploma or less.

Direct care workers have the lowest wages in the health care sector. In the Washington, DC region, direct care workers’ yearly wages range from $19,000 to $22,500. However, an individual with no children needs to earn at least $31,656 and higher to meet basic needs. Approximately 30% are uninsured and 47% are enrolled in public benefit programs. Other challenges include the lack of training and high worker turnover. The Affordable Care Act also requires expansion of roles, higher skills and performance from the health workforce, including direct care workers, to deliver care. At the same time, it is an opportunity to improve both patient care and provide career pathways and better employment for direct care workers.

CHF views the direct care workforce as an example of the intersection between the health reform and economic justice fields. According to PolicyLink, increasing wages for direct care workers has a significant impact. For example, California saved more than $5 billion each year after the hourly wage was increased to $14 for direct care workers because they did not need to avail of public benefits. In San Francisco, workers’ turnover fell by 57 percent.

The following interviews reflect many of the above issues nationally and within our region.



Marla Lahat, Home Care Partners

Can you tell me about the work of Home Care Partners (HCP)?

We are a nonprofit home care agency; we have been here for 60 years; and we have always provided non-medical home care. We are focused on home health aides who provide long term care for older people and people with disabilities who do not need a nurse but need an aide to provide help with their daily needs. These are chronic needs that last for years and years. We also emphasize training for our staff and support for family caregivers.

What are some of the biggest challenges of direct care workers?

The workers face many challenges. They have difficult jobs, they do not have guaranteed hours typically, their wages are low, and their benefits are few. It is a type of a job where you go out and you do not know what you are going to find. I think for agencies that employ direct care workers the challenge is to offer good pay and benefits and some kind of assurance in terms of hours within a very restrictive reimbursement system. Agencies that get reimbursements through Medicaid and Medicare are only reimbursed at a certain rate so they do not have the ability to provide everything they would like.

I think many people are unaware of how extensive the home care industry is. Can you give me an idea of the scope of the direct care workforce?

The biggest employer would be agencies that are Medicaid providers. Under Medicaid a person might be eligible to get a personal care aide. As an agency, we get our funding from local government contracts and grants. We employ about 200 aides but there are many more agencies like us. Some clients actually find their own workers. I think there is a huge need and it is a fast growing industry.

Are there any policies or programs that have been in enacted in the DC metropolitan area that support better home care services? What changes, if any, do you recommend?

I think DC is progressive in terms of its workforce policies. I think there are some federal policies that are making things better. What I think is difficult is that reimbursements have not kept up. It would be great for all workers to earn overtime, minimum wage, and get paid for their travel time, but there are not always reimbursements for these. Paid family leave will be very beneficial for this group of workers.

What motivates you personally to seek high quality home care for your clients?

If workers are treated well, and they should be treated well, then they perform well and they are the service we are providing. Our clients want good workers so they can remain in their homes, so they feel they have a trusted person, and have someone they look forward to seeing. Quality home care is essential.

Why do you think direct care workers in general receive less attention and support than providers despite their significant presence in the health care workforce?

Unfortunately, in our society the lower-paid workers do not get the same support. I think it is going to take a while before we really value the work that direct care workers are doing. They are the lifeline (but) we do not respect them in that way.

What are some of your short-term and long-term goals for the direct-care workers?

I do want to be able to continue providing the best benefits we possibly can within our budget. The travel time pay between their clients is something HCP is doing. It is a huge expense for us. I want to be able to continue providing these benefits. I would love to see our workers eligible for paid family leave but I do have to consider the cost. I would love to provide the best education including on innovative and unusual topics. The more education, the more tools they would have in their tool box for handling situations.

What do you want funders to know about programs that improve the quality of direct care jobs?

Quality direct care jobs will lead to a more satisfied and stable workforce, a workforce that is less dependent on public programs, and which, in turn, will be able to support our older residents and residents with disabilities.



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