Robert Espinoza, a recently elected Member of the Academy’s Board of Directors, works as vice president of policy at PHI. He focuses on issues affecting the 4.5 million direct care workers in this country, those working in nursing homes, as home care aides, and in residential settings. The COVID-19 pandemic has cast a glaring spotlight on the critical role such workers play in our health care system. Espinoza addressed some of the issues in the Academy’s virtual roundtable on COVID-19 and the disability population. In this interview, he shares some of the ways PHI is responding to current challenges and paving the way for future changes.

Q: What do you see as the most critical issues for the direct care work force?

A: This moment has further emphasized how critical direct care workers are to older people and people with disabilities, and the significant barriers they face in employment and society at large. These workers have long been very valuable for older people and those with disabilities, but they haven’t received the same level of recognition as their peers in the health care sector. They still struggle with low wages, with minimal training opportunities, and with limited career advancement.

At PHI, we are tracking the moment and trying to understand the various policy issues that have surfaced and find opportunities to ensure direct care workers and their employers receive the funding, supplies, and personal protective equipment they need. Because the situation shifts every day and there are new measures being introduced at the federal level and in different states, it requires being nimble in order to understand the dimensions of all those proposals and where we can argue for direct care workforce supports.

We have produced original reports to help people understand the complexity of the long-term care system. In April, we released a report titled We Can Do Better, a detailed overview of our broken and scattered long-term care system. This report informs the ways that system prevents a quick response to coronavirus, or any health care crisis.

This week we launched a National Direct Care Workforce Resource Center, which serves as the country’s largest online library of resources on direct care workers. It’s intended for leaders in different disciplines who need help understanding this critical workforce, and to bring attention to various knowledge gaps, such as which issues could benefit from more research and analysis.

Q: Is the direct care workforce receiving more support now?

A: I think we’re seeing a handful of temporary measures to boost funding in the long-term care sector, with some of that funding going to nursing homes, home care agencies, and hopefully the workforce as well. Arkansas and Michigan recently increased pay for direct care workers to help with retention for the moment. But I think the big question is whether these temporary measures will be part of the long-term solution for this workforce. We have argued for years that direct care workers deserve increased compensation, better training, higher-level roles that allow for true career advancement, and of course, more recognition in both the health care system and our broader economy.

When we don’t recruit these jobs, we hurt the quality of care that older people and those with disabilities receive. We also make it difficult to fill these jobs as demand grows and employers need more candidates. We work with employers — nursing homes, health care agencies, and long-term care systems — to support them in optimizing their workforce by developing training programs, creating advanced roles, and helping them strengthen recruitment and retention efforts. I think the future of this sector is dependent on implementing a wide array of supports for direct care workers at a policy level, as well as at the industry and provider level.

Q: Have you partnered with other organizations that advocate for caregivers?

A: Yes. PHI partnered with Caring Across Generations last summer to release a joint report called Workforce Matters. The report outlined a variety of direct care job measures for states to consider within social insurance programs covering long-term care. Items such as compensation, training, advanced roles, better data collection, and support for supervisors. It offered specific guidance for states, and, in fact, we’re seeing more states thinking about social insurance and all the ways those programs could fund and support workers.

Q: What success have you had in reaching policy makers?

A: Most of the progress we’ve seen on direct care workforce policy issues has been at the state level. Especially in the last few years, we’ve seen states adopt measures that increase wages for direct care workers, strengthen training requirements for personal care aides, improve their data collection systems on this workforce, and fund innovations that make the workforce stronger or measures that help connect consumers with workers, as two examples. We’re seeing a lot of exciting energy at the state level for strengthening this work force and improving long-term care in general. We’re also seeing some proposals at the federal level that, unfortunately, have not gained traction—but it’s a promising start.


More About Robert Espinoza

As vice president of policy at PHI, Robert Espinoza oversees its national policy advocacy, research, and public education division. In 2017, he designed PHI’s #60CaregiverIssues campaign, which identified 60 solutions to the growing workforce shortage in home care and received a 2018 Communicator Award from the Academy of Interactive Visual Arts.

For more than 20 years, Espinoza has spearheaded high-profile advocacy campaigns and written seminal reports on aging and long-term care, LGBT rights, racial justice, and immigration, among other topics. He has appeared in multiple media outlets, including The New York Times, the Wall Street Journal, CNN, and the Washington Post.

Espinoza received his MPA, with honors, from New York University. He was elected to membership in the National Academy of Social Insurance after serving on the Academy’s caregiving study panel, which produced the 2019 report, Designing Universal Family Care: State-Based Social Insurance Programs for Early Child Care and Education, Paid Family and Medical Leave, and Long-Term Services and Supports.

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