5 min Read

Who Will Care For Us?

By Alanna Hendren

One of the biggest challenges we face at DDA is recruiting and retaining excellent staff. Since we strive to provide the best quality services in the world, we need the best staff in the world to implement our ambitious plans for the infants, children, adults and families whose lives we touch.

A recent Community Social Service Employer’s Association (CSSEA) report indicates that one-third of unionized community living agencies in B.C (usually the highest paying) had turnover rates greater than 20%, and just under 10% had turnover rates over 30%. Unfortunately, recruitment and retention of the community support labour force will not be improving in the future.
The American Network of Community Options and Resources (ANCOR) also reported recently on American Direct Support Professional (DSP) tenure – 35% last less than 6 months and 22% last less than 12 months. 57% leave within the first year and only 43% last over 12 months. Federal policy changes similar to those in Canada and Australia have increased demand for DSPs without increasing funding (state budgets are shrinking, Medicaid is threatened by the repeal of the Affordable Care Act).

Population trends are projecting an even smaller potential workforce as the need for services increases:

  • Wages are not commensurate with the responsibilities involved
  • 57% annual turnover rate – Turnover impacts quality of care and service – staff leave before they have time to develop a relationship with the person served
  • Employers can only offer insufficient professional supports
  • Lack of options for a career
  • Low wages de-value the work of DSPs
  • Wages are too low to hire people with expertise, training or a college education
  • Fewer younger people are entering the sector while aging Baby Boomers are retiring
  • An increase in demand and intensity due to a growing numbers of people with autism, dual diagnoses, complex care needs, multisensory disorders and extraordinary quasi-medical needs due to aging

Women aged 25 to 64 are the main demographic of DSP workers in the U.S. but in the next decade, demand for DSPs will far outgrow the labour force growth rate. The biggest increase of workers during this time is expected to be in the 65 to 74 age group (59.28%) and labour market participation of the 75+ age group, which will double (increase of 94.5%), primarily because they cannot afford to retire. By 2024, the Baby Boom generation will be aged 60 to 74, with many unable to continue working. The job with the greatest projected growth in the U.S. is Home Health Aide, which will result in a shortage of 348,000 workers (for jobs that pay about $21,380 per year). These women make less than hairdressers, retail sales clerks, receptionists or customer service representatives – about the same as waitresses. Employers of DSPs in the U.S. estimate that community support agencies incur costs averaging $4,200 to $5,200 (USD) in recruitment, on-boarding and orientation expenses for employees who are more likely to leave within one year than they are to stay.

Canadian statistics are equally alarming as illustrated below. By 2024, the 55 to 64 workforce will increase by 16% over the number employed today and those 65+ will increase by 24%, while population growth in the overall 15 to 64 worker demographic will increase only 0.9% annually (see figure 1.2 below).

This shortfall in potential workers will be a persistent challenge to all sectors that require caregivers or support workers. Improvements in diagnosis (e.g. autism) and provision of community-based services in other areas will create an escalating demand for support among all vulnerable populations (i.e. children, youth, mental health, addictions and particularly aging) but there is a decreasing pool of people who will do the job. There will be an increase in private (family) pay but there won’t be anyone to hire unless pay rates grow substantially. Current job entrants are not interested in high levels of responsibilities, low pay, hard work, and careers with no opportunities for advancement.

A Conference Board of Canada report (2016) recently noted that by 2026, more than 2.4 million Canadians aged 65+ will require paid and unpaid continuing care supports. This is a 71% increase over 2011. By 2046, 3.3 million people will need continuing care supports. Estimated spending growth (see figure 1.1 on page 4) for these individuals will exceed the pace of revenue growth. Families will need to contribute $590 million annually as governments only pay 2/3 of expenses (see figure 1.1). Unfortunately, demand is very surely going to outstrip supply of potential workers, including those who work with people who have developmental disabilities.

An estimated 5.3 million Canadians also provided some level of unpaid continuing care to seniors in 2015. By 2046, this number will increase to 11.6 million. These friends and family provided an average of 21.9 hours of help per week through the efforts of an average of 5 individuals. This totals 1.2 billion hours of unpaid continuing care provided to seniors annually. In addition to this, 62.5% of unpaid caregivers also pay privately for seniors care while 100% of public continuing care budgets are spent annually, creating a huge demand for caregivers. So, who will care for people with developmental disabilities, a population increasing at a rate of 6% to 8% annually?

The personal service robot project that we are currently working on at DDA with our corporate partner, JDQ and our university partners at UBC, SFU and BCIT could help people with developmental disabilities and their families through these future worker shortages. From waking a person up in the morning to managing their schedule and connecting them to the world, a personal service robot can become a repository of all information related to the individual, an organizer, a monitor, a teaching assistant, a communicator, an entertainer, an emergency-detector, and a personal problem solver.

Today the annual cost for a full time support professional (7.5 hours per day with few benefits) is in the range of $40,000 to $50,000 per year. This is an extraordinary expense for all but the most affluent parents and prohibitive for most people. With a personal service robot, the same outcomes could be achieved with a capital investment that we hope would initially cost about $10,000, one-time-only for a device that can be deployed at all times. Agencies could also use robots to augment the work of professional staff. So stay tuned for future progress reports!