“A Service to God”- Lavorn Cryor Discusses Life As A Direct Care Worker
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.
Lavorn Cryor is a Certified Nursing Assistant (CNA) with Iona Senior Services. He is originally from Hawaii and has lived in Maryland for several years. He began as an in home companion in the healthcare field and became a CNA. Lavorn has worked in several home care facilities in the DC metro region including assisted living, group home, private duty and adult day programs.
What are your responsibilities as a Certified Nursing Assistant?
My duties are a little bit varied at this facility. I multi-task as a certified nursing assistant (CNA) or home health aide (HHA). I’m providing personal care for those who have elevated dementia. So I might take them to the restroom and assist them with hygiene or things of that nature.
The Department of Labor describes a certified nurse’s jobs as “providing basic care for patients in hospitals and residents of long-term care facilities, such as nursing homes” and a home health aide’s job as “helping people with disabilities, chronic illness, or cognitive impairment with activities of daily living.”
How were you trained?
The process was more of a hands on training. I was not at this facility but my original training was at Right At Home where I was trained as a companion. It was basically being with the clients and if they had an issue, then I will help out. Then I worked with an adult day care in Bowie and my training included more elevated dementia care. We provided programming to keep them (clients) cognitively aware. Programming included field trips, current events, things that are happening in the news that every normal adult would like to know about. Of course, it also included outdoor activities like gardening, maybe walking. We also had exercise.
Can you explain the training process?
It is hands-on training. Originally I told them I didn’t have a license so that’s why I started off as a companion. The facilities offer in-house training – basically you have someone who is more senior than you and they train you on the spot. From there you’re required to take a testing program and once you pass the test you’re certified. For my home health aide work, I was at Iona and they sent me to a regular formal training program which was basically like a college or school setup. It’s about an eight-week course and once you’ve completed that course you’re required to take a test that is administered by the Board of Nursing of DC.
How does licensing work?
Once you’re licensed in the state, you can work in any of the cities. I had to get a home health aide license to work in D.C. Now D.C. has changed its law. As long as you’re working in a facility that has a registered nurse (RN) and you’re trained under that RN which means that you’re trained in house, it’s okay for you to work as long as that nurse’s available. We have a nurse on staff every day. So technically I have a license that’s not really required by our facility but you never know when you need to work elsewhere or hold down 2 – 3 jobs to make ends meet so you never know, you always have to have that license available.
What have you found are the biggest issues you’ve had as a direct care worker?
Basically the scheduling issue. If someone calls off, we can’t abandon our clients. So if you’re working in private duty and a person calls off, until they find someone else, you’re required to stay. If they do not find someone to come in, then you have to stay and end up doing a double (shift). We are required to be very flexible and that doesn’t leave you much room. I’m also in school for health care administration and going to school and having a schedule that can sometimes impact your school work in such a way that you don’t have enough time to be where you need to be; that was very difficult during those times. So I was very lucky to find Iona.
How did the schedule affect you as a single parent?
At other locations, I used to call out sick and then go to doctor’s appointments and that was very difficult because kids often have a lot of appointments. I found it easier to just schedule their appointments in groups. So like dentists, doctor, whatever else, I was on WIC program, I had them all within one week. I would call out sick 3 or 4 days and handle all of my appointments. Now that I’m at Iona, they give us time off to handle appointments, it’s worked into our schedules. We have so many days per year and we utilize them accordingly. It’s easier here. We do get paid leave.
Is it legal for direct care workers to work double shifts? Lavorn answers this question from work experience before he worked at Iona.
Legally, if you work 16 hours you’re supposed to get the next day off completely, even if you’re scheduled to work at 3pm the next day. But a lot of times the managers will say “Well you’re scheduled for 3pm and I don’t have anyone to cover you because that’ll put another person in jeopardy.” So they’ll say, “Please work a double, go home and then come back,” so that’s a little difficult. It’s often overlooked because the managers will say the only time that (working a double) will be an issue is when there is inspection and of course those things don’t happen every day. Imagine if you’re doing a 14-hour shift, you don’t get off to 11 and you’re driving home and you’re extremely sleepy, which puts a sleepy person on the road.
I read that direct care workers have some of the lowest wages in healthcare, what’s your opinion on that?
When I started out as a companion, I was making $7.00 an hour, when I moved to Bowie and was working at the Adult day program, I was making around $9.00 an hour and I gradually increased from there. Right now, I’m making $18.00 an hour but it took me a long time to move up to that status. Experience does help. Since I moved to Iona my experiences have paid off and my wages have increased but prior to this it was a struggle. A lot of time care workers are working two and three jobs. This is the profession where you’re really seeing people sweat because one job just won’t cut it.
What overall issues have you noticed with the low-income clients you serve?
Generally, just access to food. I think a lot of people not only don’t have the access but the education to proper nutrition. A lot of people get used to a certain diet and when they go to the supermarkets they are gravitating more towards the instant meals, you know, something you can pop in the microwave. People my age and younger’s ability to know how to cook is very limited, so when their parents are older (you know the population I’m serving) they’re not getting adequate nutrition because their children aren’t getting adequate nutrition. It’s hard to navigate that.
As a CNA, I can come in and shop for them. I like to encourage healthier things but a lot of times when participants or residents are stuck in their ways they want a certain item and that’s what they’re going to eat. I try to encourage at least the very basic hydration, you know drink some water, eat some vegetables you know get some greens in once in a while.
A lot of times when we are in private duty, we’re like the family members: we’re advocating for them. We’re the first people they see in the morning and we are the last person they see at night, so how we interact with them has a lot to do with their mental wellness. Our bosses see that and some of us get performance pay raises because we work better with clients.
How do you advocate for your patients?
If somebody’s family member hasn’t seen them in months. You find that a lot in assisted living – family members only come to see them once a year. A family member can say my client isn’t being bathed, they’re not coming out of their room. As a caregiver, I saw you yesterday and you were just fine, today I see you and you’re in the corner so I’m going to bring that to the attention of my supervisor. I’ll say this person is not getting adequate treatment and making sure they do get adequate treatment. My job shift may be only 8 hours a day but I expect the next 8 hours and prior that they are being treated the way I treat them.
Are there any issues that have affected your work that I haven’t mentioned?
Here at Iona we get paid everything. If I call off sick, I get paid for those days off but a lot of assisted living facilities or agencies, if you call off that’s a loss in pay. So you try your best not to call off. When you work that double with 16 hours, you could call and say I just can’t make it in but you know if you do, you’re not going to get paid for that day so that discourages you from saying, “hey I need that time to rest”. A lot of us are literally working pay check to pay check. So if you’re working pay check to pay check, you can’t afford to call off and say you need to sleep.