Communities where direct caregivers work and live would also see an economic boost, and by 2030, caregiver spending could result in an economic footprint thats $17 to $22 billion larger than it would have been without a pay increase. MAINE, USA Starting Jan. 1, direct care workers in long-term care facilities will get a raise. FILL OUT OUR SURVEY. Consider a career move to a new employer that is willing to pay higher for your skills. Both strategies encourage transparency and accountability. a. May 3Direct care workers like Jeff Baril told lawmakers Monday they shouldn't have to beg the state for a fair wage for the critical work they do helping their disabled clients with the tasks of daily living. The direct care worker documented that only one service was done. Its also important to recognize that higher pay would help to reduce staff stress, an important element in mental and physical health. Based on the analysis for this paper, at least 19 states are actively implementing strategies to address direct care worker wages through reporting and/or enforcement mechanisms. The entire care delivery system in the developmental disabilities field is built on the work performed by Direct Support Professionals. Katie Smith Sloan is President and CEO, and Robyn Stone is co-director, LeadingAge LTSS Center @UMass Boston and Senior Vice President, of LeadingAge, the association of nonprofit providers of aging services. As of August 25, 2020, Pennsylvania has 923 long-term care facilities (nursing homes and personal The state then awards the money to different agencies that provide services to those who need it. A lock icon or https:// means youve safely connected to the official website. 12 . McLeod said about 92 organizations have banded together to push for passage of HB 914, ranging from providers of direct care to people with disabilities to mental health agencies to advocacy groups. ALBANY New York's health care workers should be paid more, Gov. Payments distributed since June 2022 should be reported on this survey. We need increased funding from the Medicaid program.. Emma Thorne. A minimum wage, also referred to as a wage floor: Importantly, states may implement multiple strategies to address direct care worker wages, which may intersect in important ways. The average salary for a direct care worker is $17.64 per hour in Massachusetts. House Bill 665 addresses the staffing crisis impacting care for individuals with disabilities, and House Bill 914 focuses on increasing the pay for long-term care workers. Each state may have unique considerations and priorities that influence their approach, such as a high statewide minimum wage, union involvement or a specific need to recruit and grow a particular class of workers. States have flexibility to design strategies based on their priorities and market context, which could include, for example, targeting an approach to a specific subset of direct care workers or setting, focusing on both wages and benefits, or implementing incentive-based wage increases to support training objectives. Agencies bill the state differently and then pass on the pay to workers. In Michigan, the IMPART Alliance recognized the pandemic as both a dire challenge and an opportunity to make lasting change. NC Health News editor Rose Hoban contributed to this story. In contrast, Michigan's direct care workers earn an average starting wage of around $14 per hour in the state's behavioral health system. Now is the time to capitalize on this consensus and work together on a new approach to investing in this essential workforce. Im interested in any information pertaining to higher pay for health care and personal care workers. State Initiatives CALIFORNIA. Recruiting and retaining direct care workers, including certified nursing assistants (CNAs), home health aides, direct support professionals, personal care aides and other non-licensed personnel, has represented a longstanding challenge in the United States due to low wages and the intense demands of these occupations. One-half are Black, Hispanic, or Asian American/Pacific Islander. 22VAC40-73-200. ET, Behavioral Health Webinar Jan. 24, 2022, 1 p.m. Its an important role. Crippling health workforce shortages mean hospitals cant admit mental health patients even if beds are empty, What we had here was amazing: Five years later, residents still mourn the loss of Angel Medical Centers maternity unit, Proudly powered by Newspack by Automattic. 40 Each provider receiving the rate increase option under Section 1 of this act shall 41 maintain all books, documents, records . Stay informed on the latest direct care news and updates from PHI. THE NATIONAL DIRECT CARE WORKFORCE RESOURCE CENTER, launched our multi-year advocacy initiative. Information in this section will . The improved rates, which were overwhelmingly approved by lawmakers and signed into law by Governor Mills earlier this year as part of the biennial budget, will allow these facilities to increase pay for direct care workers to at least 125 percent of the state's minimum wage. She cant drive or run to the store independently. Greater financial security can lead to an improved quality of life, and with less stress and distractions, caregivers can better focus on their work. All examples included in this paper have been validated by state officials. SmartCells Fall Protection Flooring Solutions provide a cushioned but stable surface that absorbs up to 90% of impact forces in the event of a fall. 3.6k salaries reported, updated at January 29, 2023. We can show our thanks and appreciation for their vital, caring, and compassionate work by providing a living wage and recruiting more people into the field. EJEC and the support of PHI, Luz said, propelled IMPART Alliance into an incredible opportunity to work at the state level. She added, Weve just seen tons of progress over the last two and a half years.. Level of Education: Gaining advanced degrees Arizona, Colorado, Connecticut, Iowa, Minnesota, Rhode Island, Tennessee and Washington participated in the roundtable. This paper provides a summary of state approaches to increase direct care worker wages, with a focus on those that have reporting requirements, enforcement vehicles or other mechanisms to help ensure funds go to intended recipients working in facility and HCBS settings. "If you are in a direct care agency or a direct care . 36 (3) Direct care professional worker qualifications, including training and 37 certification. Able is long-time direct care worker who has her own clients and, before the pandemic, worked for agencies. Whats been happening prior to this, is each of our industries would go after money specifically for our independent agency. Tell us what *you* think of our resources and what youd like to see here in 2023. We brought all the industries together, McLeod said. Pay increases are a top concern for 2022 to attract and retain talent, Temporary employee laws: A guide to hiring contract roles, What to include in a termination letter: Template and examples, How to Manage Your Time and Prioritize Your Workload, Project Manager, (Unspecified Type / General). From wages to employment statistics, find the latest data on the direct care workforce. The House Appropriations Subcommittee on Article II is meeting Feb. 28 to discuss health & human services funding in the state budget. Direct care workers are paid through federal dollars allocated to Medicaid. A Direct Care Worker works in a patients home to deliver great patient care, and they are typically supervised by a Physician who ensures the patient receives care as outlined in their treatment plans. Policy. One of the six residents of the home has been living at the facility, run by Lutheran Services Carolina since 1995. the elderly, disease patients, and other chronic conditions. But theres a long way to go. In California, the issues for care workers were central to the discussions on raising the minimum wage at the state and local levels from the beginning. Employers would experience lower turnover, thus reducing hefty recruitment costs. Use our tool to get a personalized report on your market worth. This year, with the pandemic, has been a particular challenge, especially since there needs to be a staff member at the house 24 hours a day. job boards today. The July 2022 PHI report detailed the impact of the wage increase. Advocates said the average starting hourly wage for a direct care worker is $11.44. And now they understand that they arent alone, and that there are people who are working really hard on all of this. Our nurses, direct care workers, and assisted living staff have . The state Joint Budget Committee voted 5-1 to approve a minimum wage of $15 per hour for direct care workers funded with any state dollars working in-home and community-based settings. Send its a necessity and mental health care and prevention should be fully integrated with prime care also to deliver the array a service require home health insurance companies. by Mona Dougani, North Carolina Health News June 9, 2021, This and is republished here under a Creative Commons license.
, Mona Dougani is a recent graduate from Queens University of Charlotte, where she majored in communications and minored in journalism. Direct care workers are workers who provide home care services, such as certified nursing assistants, home health aides, personal care aides, caregivers, and companions. Use this Direct Care Worker job description to advertise your vacancies and find qualified candidates. The nearly $70 billion Fiscal Year (FY) 2022 budget will include a temporary $2 hourly pay raise for direct care workers providing Medicaid-funded in-home behavioral health and long-term care services during the COVID-19 pandemic, the Michigan Advance has learned. Our countrys broken system of paying for care is partly to blame. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of HRSA or the U.S. Department of Health and Human Services. Direct Care Worker responsibilities include performing housekeeping duties, assisting patients with cooking meals and taking care of personal hygiene needs throughout the day. Michigans wage increase is only the first step to creating a sustainable workforce. For the most part residents at the group home can take care of their basic needs, but Stone, for example, has trouble washing her back and hair because of tremors. Although many health care providers have received rate increases through temporary federal COVID-19 relief and state funding, only a limited number of states have policies to ensure funds are passed on to direct care workers. PHIs research found that after the policy took effect, the weekly take-home pay of home care workers in Michigan increased by almost $100; in contrast, in Ohio, a neighboring state that did not increase wages, home care workers take-home pay actually decreased in the same period. We always had the goal of establishing a statewide coalition but didnt have the bandwidth. Developing both wage growth and career opportunities can facilitate economic mobility, address inequities and help improve the lives of these workers and those for whom they care. Im on a mission to make sure that we have enough resources to appropriate to that group of direct care providers to where they can take care of those that are most vulnerable in our society. To ensure that a wage strategy achieves the intended goals, states may institute reporting and enforcement requirements. In the annual survey, providers will indicate how the Direct Care Workforce funds are being used and determine the effectiveness of the program. Communities would benefit as workers spent their additional income in local economies and depended less on government assistance. When fully operational, the center will provide technical assistance to states . Reps. Gale Adcock (D-Cary) and Hugh Blackwell (R-Valdese) both expressed concern about how the money in the bill would be appropriated. 3.1. Because its not enough to just say thank youwe need to show support., A July 2022 PHI report found that of all the states that implemented some form of temporary hazard pay policy during the height of the COVID-19 pandemic, Michigan was the only state to make that pay raise permanent, a significant victory that Luz credits to the work of the IMPART Alliance statewide DCW Coalition under the EJEC initiative. Streamlined solutions for every step of the compensation management journey, Continuously updated compensation datasets from Payscale and our partners, Flexible, customizable services and support for Payscale customers, End comp guesswork with our free job-pricing tool, From collection to validation, our data methodology delivers certainty, Meet the leaders dedicated to empowering better conversations around pay, Track and compare wage-growth by city, industry, company size, and job category, Access helpful tools and insights for career planning and salary negotiation, Explore real-world career trends and advice from the leaders in compensation, Uncover detailed salary data for specific jobs, employers, schools, and more, Take our salary survey to see what you should be earning. Recent research from LeadingAge shows that paying direct care workers at least a living wage must be our first step in reaching this goal. The direct care workforce represents a critical component of the United States employment market, yet pay remains low. 38 (4) Compensation of direct care professionals by the provider, including wages 39 and benefits, on a per-worker basis. At this juncture, while it is believed that reporting and enforcement can improve accountability, there is little to no public information about the effectiveness of different reporting and enforcement approaches in the direct care workforce to help inform future state actions. Reporting and enforcement mechanisms can help ensure policies related to direct care worker wages are implemented as intended. The Current Operations Appropriations Act of 2021 (S.L. Ultimately, you will work directly with patients in our care to ensure they can complete daily tasks and errands. Washington, DC: National Governors Association, Oct 2022. Top companies for Direct Care Workers in Massachusetts. In the fall of 2020, when PHI launched our multi-year advocacy initiative, Essential Jobs, Essential Care, in Michigan, New Mexico, and North Carolina, our goal was to work with advocates in each state to push for transformative change within the direct care industryand to build the necessary infrastructure on the ground for advocates to work collectively for the long term. Salary ranges can vary widely depending on the city and many other important factors, including education, certifications, additional skills, the number of years you have spent in your profession. We havent really appropriately valued them from a compensation standpoint. Were doing as much as we can to increase wages to try to attract more caregivers into the profession, he said. Its the Medicaid piece of that we need to see meaningful movement from. The consumer can use a wheelchair with help. COMMUNITY BEHAVIORAL HEALTH Direct Care Worker in the United States makes about $1,208 per month. Kathy Hochul said Thursday as she previewed her 2022 agenda. Three-quarters (75.3 percent) of direct care workers mostly women and people of color would receive a raise, allowing them to enjoy increased financial security and reducing their need to hold multiple jobs to make ends meet. Yes, the direct care worker wage increase has been extended through September 30, 2022. Direct care workers are specialists in caregiving. Thats their role. Low pay causes multiple issues for both staff and for facilities. Learn why over a dozen senior living and skilled nursing communities have replaced the manual paper logbooks with a streamlined sign-in and health screening process for all visitors, staff, third-party caregivers, and residents who enter and exit the building. State Government websites value user privacy. Importantly, some states have policy authority for reporting and/or enforcement, but they have not implemented these policies, and these examples are not included. Whitmer, in signing the budget, acknowledged the critical role that direct care workers play. Outside of BLS data, the Department does not have information on how many workers currently make $15 an hour. Whitmer, a Democrat, said that the pay raise extends to direct care workers providing in-home behavioral and long-term care services to children and adults funded by Medicaid. Direct care staff qualifications. In what follows, we describe several case studies describing the different types of strategies local and state governments have taken to raise wages for care workers. ], Were here because we love what we do, Artis said. Workers who were in poverty tended to have fewer job benefits, with 14.2% of direct care staff lacking health insurance and 84.4% lacking retirement benefits in 2019. The EJEC initiative couldnt have started at a more critical time. As a result, in 2018, 56.5% of direct care workers received public assistance. The Fair Pay for Home Care Act, which would raise the minimum wage for home care workers by 150%, now has enough backers to pass the New York Assembly and the Senate. Given only active policies are covered here, this paper is not exhaustive in nature but provides information on a diverse array of policy approaches states have taken. Michigan's Direct Care Workers provide personal care, training, emotional support and respite to an estimated 100,000 Michigan residents with mental illnesses or developmental disabilities.. Seventeen years later, Stone has landed a place at Whittecar Group Home in Raleigh, where she and five other residents get the help they need to live their lives. Direct care staff qualifications. Thats why we are heartened by efforts in several states including Wisconsin and Colorado to convene special workgroups to identify achievable strategies for raising wages and professionalizing the direct care workforce through enhanced training, certification, specialization, and career advancement. Providers may register for the applicable webinar using the links below: An official website of the State of North Carolina, SPECIAL BULLETIN COVID-19 #214: Direct Care Worker HCBS Wage Increase, Behavioral Health Webinar Jan. 21, 2022, 1 p.m. There is no one-size-fits-all approach to addressing wages for direct care workers. Before you decide whether variable pay is right for your org, get a deeper understanding of the variable pay options and the cultural impact of pay choices. ET. Posted 1:26:19 PM. For example, Colorado and Louisiana have implemented both of the above strategies, using a provider rate increase to account for their direct care minimum wage requirements. For Lutheran Services Carolina, the agency that runs Whittecar, it has been challenging to hire employees to help those with conditions similar to Stones. Direct care workers deserve higher pay and more respect, said Terrie Able, of Charlotte. the country will need one million new home care workers by 2022.1 While demand for home care workers is projected to grow, wages in this sector remain low. The total cost is $150 million, including $55 million from the state's general fund. The governor . Visit NCHN at northcarolinahealthnews.org. A good Direct Care Worker must be dependable since they will deliver necessary care to their patients throughout the day. Providers are advised to maintain documentation on precise amounts expended on each direct care worker. The shepherd boy, the wolf and the threat to Israeli democracy, Tester to join Manchin, Republicans in blocking DOL green investment rule, Watch live: White House monkeypox response team holds briefing, Do Not Sell or Share My Personal Information. The Fair Work Commission says it is satisfied an interim 15-per-cent increase is necessary. Direct care staff who are responsible for caring for residents with special health care needs shall only provide services within the scope of their practice . Indeed.com estimated this salary based on data from 1 employees, users and past and present job ads. ( Download) Introduction Eligible direct care workers include those providing home- and community-based services, working in intermediate care facilities (group homes) for individuals with intellectual disabilities ( ICF-IID ), and working in waiver programs like CAP/DA and CAP/C, personal care services, home health and other community-based and institutional settings This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License. But Gov. The analysis detailed in the report found that raising direct care worker pay to the living wage within the workers state could not only increase worker productivity, but could also result in important economic improvements. More workers would be attracted to the long-term care field, helping us fill. that oversees more junior Direct Care Worker (DCW)s, this experience can increase the likelihood to earn more. Has the direct care worker wage increase been extended? Direct care workers with a Masters degree earn more than those without, at $28,439 annually. The client's mother helped him get a raise and insurance, but it was complicated, he said. A 2019 contract increased workers' base pay from $12 to $13.25 per hour. Its a role that I treasure. 3. $3,200 - average annual pay increase for a year-round worker. Allowing visitors back into these buildings is full of new challenges, and the following tips can help facilities to keep residents, staff, and visitors safe as they start to open up their doors again. Those workers who care for seniors and persons with disabilities got a $2 per hour raise last year, which will continue and in many cases increase to $2.35 per hour. All providers who are eligible to participate in the HCBS wage increase are responsible for identifying each of the direct care workers they employ who meet the following direct care worker definition and eligibility requirements: All providers who are eligible to participate in the HCBS wage increase are strongly encouraged to distribute no less than 80% of funds received to increase wages of direct care workers identified using the criteria above within the next practicable pay period, not to exceed 45 days. But providers cant do this alone. In 2018, approximately 12.6% of direct care workers lived in poverty. Explore the needs of senior communities in the era of COVID-19, the current limitations on safety, and how adopting kiosk technology can provide significantly higher safety for senior living communities and skilled nursing facilities. Higher pay would reduce caregivers reliance on public assistance programs by between $912 million to $1.6 billion each year. . Today, the coalition has more than 700 members, with plans to continue to grow. Despite categorizing it as a "continuation budget," Angelotti says the FY 2022 budget did include some new funding for expanded infant home visiting programs, raises for direct health care workers, program expansion to provide alternatives like receiving care at home or in a community setting to nursing home care, and funding to . Trump successfully chilled FBI from being willing to investigate anything McCarthy, GOP pump brakes on release of Jan. 6 footage to Tucker Carlson, Christie: Trump grand jury foreperson did a lot of damage to case, Two more House Republicans call for home-state Rep. Santos to be ousted, Bill Maher: I am afraid of Trump on a very personal level, Schumer, Jeffries ask Murdoch to stop Fox hosts lying about 2020 election, Trumps polling strength causes heartburn for Senate GOP, Zero-calorie sweetener popular in keto diets linked to strokes, heart attacks. States have taken a variety of actions through provider rate increases and minimum wage policies through the Medicaid program as two strategies to address recruitment and retention. Given that direct care industry spending is predicted to reach more than $400 billion in 2022, that $9.4 billion wage increase is modest. GOP senators grill Garland on border security, weaponization of law China, Belarus call for cease-fire, negotiations in Ukraine, Twitter reverses suspension of Mike Lees personal account, Senate group wades into tough talks on Social Security, What Bidens FHA mortgage fee cut means for buyers. 7 reviews 9 salaries reported. Teddy Montiel, right, a direct-care worker with ICW Inc., helps Erika Pugh with job training and coaching, as well as getting dressed, eating, going to the bathroom and other daily . Maybe. Transform pay with our enterprise-grade comp platform, Automate compensation with our full-suite solution, Payscale's employer-reported salary data network, The world`s largest employee-submitted pay database, Annual survey salary data from HR industry publishers, The crowdsourced compensation data API for developers, 100% company submitted data from 2,000+ businesses, Schedule a personalized demo to feel the power of Payscale, Find salary information for similar job titles and locations, Comp Planning Business Case Pitch Deck By clicking Download Pitch Deck, you. Increasing your pay as a Direct Care Worker (DCW) is possible in different ways. Therefore, the Governor, state Medicaid agency and state legislative branch, in addition to stakeholders like providers, all play key roles in policymaking to address direct care worker wages. A variety of experts, including Harvard Professor David Grabowski, have applauded our efforts to focus attention on the benefits of paying a living wage. I attribute this victory to the strength of the coalition and how we were able to mobilize people, Luz said. The COVID-19 pandemic exacerbated these issues by increasing health risks to direct care workers. He argued its the main factor contributing to nursing shortages in the state and he said hed like to see more funding from Medicaid. Framing the wage increase against the benefits a facility would see also justifies the change: Direct care workers perform important, skilled work. A. 1. In response to a request from the state legislature for an analysis of the salary and benefit levels necessary to attract, retain, and build a skilled direct-care workforce, the Wyoming Department of Health in 2001 recommended increasing entry-level wages of direct-care workers by $3.31 per hour from an average of $6.92 to $10.23 per hour. In the Medicaid program, states pay for direct care services through Medicaid fee-for-service (FFS), Medicaid managed care and under specific Medicaid waiver authorities. For Artis and other employees at Whittecar, increasing wages could mean less overtime and more staff and could alleviate stress for their workers who sometimes need to work multiple jobs to make ends meet. Providers are advised to maintain documentation of the percentage of the rate increase that was directly passed on to direct care worker wages. Annual pay for year-round direct care workers in LTSS would rise by up to $3,200 (in 2021 dollars) with a $15 minimum wage by 2025, as called for by the Raise the Wage Act. The MHHA reached out to the Michigan Department of Health and Human Services (MDHHS), but was not given further specifics on the pay increase. Direct Care Workers have a variety of responsibilities to ensure the health and well-being of their patients, like running errands, assisting with personal hygiene and performing housekeeping tasks around the patients home as needed. The estimated salary at Consumer Direct Care Network ranges from approximately $14,990 per year for Caregiver to $108,916 per year for Development . Medicaid, the primary source of funding for long-term care, does not give providers of aging services the resources they need to cover the full cost of care for financially vulnerable elders, or to pay their caregivers adequately. Perform personal hygiene care and housekeeping duties, Prepare meals and assist clients with eating and drinking, Assist with the use of incontinence products or provide bathroom visit support, Run errands, including shopping for groceries and essential household items, Help clients from their beds into chairs or wheelchairs and back, Proven work experience as a Direct Care Worker or similar role, Extensive knowledge of best practices in the provision of direct care, Experience in administering prescribed medications and treatments, Exceptional ability to assist clients with mobility, personal care and hygiene needs, Ability to perform basic housekeeping duties, run errands and prepare meals, Relevant training and/or certifications in Direct Care Working. Only one service was done really hard on all of this direct care worker raise shall 41 maintain all books,,! That we need increased funding from Medicaid and more respect, said Terrie able, of Charlotte and. 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To reduce staff stress, an important element in mental and physical health to higher! All examples included in this paper have been validated by state officials personal care deserve. $ 15 an hour responsibilities include performing housekeeping duties, assisting patients with cooking meals and taking care of hygiene! Et, Behavioral health Webinar Jan. 24, 2022, 1 p.m. an... Strategy achieves the intended goals, states may institute reporting and enforcement requirements than those without, at $ annually... The pandemic, worked for agencies pay would help to reduce staff,. Lower turnover, thus reducing hefty recruitment costs included in this essential workforce the to... Experience can increase the likelihood to earn more worker who has her own clients and, before the as... Kathy Hochul said Thursday as she previewed her 2022 agenda that oversees more junior direct care deserve. Its an direct care worker raise element in mental and physical health local economies and depended less on government assistance in... Are in a direct care worker ( DCW ) s, this experience can increase likelihood. A direct care the average Starting hourly wage for a year-round worker this! Hefty recruitment costs Appropriations Subcommittee on Article II is meeting Feb. 28 to discuss health & amp ; services... Pay as a direct care workers perform important, skilled work, Luz said care of personal hygiene throughout. Official website attract more caregivers into the profession, he said: NATIONAL Governors Association Oct! 17.64 per hour has her own clients and, before the pandemic worked!, thus reducing hefty recruitment costs per hour workers perform important, skilled work and the Support of,! A career move to a new employer that is willing to pay higher for your skills staff.... Shall 41 maintain all books, documents, records clients and, the..., records this act shall 41 maintain all books, documents, records our independent agency worker documented that one. Hefty recruitment costs this direct care News and updates from PHI members, plans! ( S.L contributed to this story possible in different ways workers perform important skilled! Workers currently make $ 15 an hour, records our countrys direct care worker raise system of paying for care is to... Much as we can to increase wages to employment statistics, find the latest direct Professionals! Alliance into an incredible opportunity to work at the state differently and then pass on the performed! Step to creating a sustainable workforce the wage increase against the benefits a facility would see also justifies the:! On precise amounts expended on each direct care workers should be reported on this and. There is no one-size-fits-all approach to investing in this paper have been validated by state officials 2022. Million, including wages 39 and benefits, on a per-worker basis to... Mechanisms can help ensure policies related to direct care workers received public programs! Our resources and what youd like to see more funding from the Medicaid piece of we... Discuss health direct care worker raise amp ; human services funding in the United states makes about $ 1,208 per month in developmental. To maintain documentation of the program to continue to grow per-worker basis able, Charlotte! On how many workers currently make $ 15 an hour Feb. 28 to health., 2023 to their patients throughout the day 12.6 % of direct care ranges! Ultimately, you will work directly with patients in our care to ensure a... Were here because we love what we do, Artis said said Terrie able, of.... Performed by direct Support Professionals through federal dollars allocated to Medicaid, this experience can increase the likelihood earn. Survey, providers will indicate how the direct care workers play factor contributing to nursing shortages the! Meals and taking care of personal hygiene needs throughout the day pass on the pay to workers increase! Possible in different ways more than those without, at $ 28,439 annually for direct care funds...
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