Institute Director Len Fishman: Ease Direct-Care Health Workforce Shortage by Improving Jobs

Len Fishman testifies before Legislative committee

Gerontology Institute Director Len Fishman testifies Feb. 5 before the Legislature’s Joint Committee on Elder Affairs

Gerontology Institute Director Len Fishman offered a simple suggestion to state legislators wrestling with the critical shortage of low-paid direct-care health workers: Make the jobs more attractive.

Fishman told the Legislature’s Joint Committee on Elder Services that two things – more money and a legitimate career path to better jobs – were overwhelmingly the most important factors that would attract more workers to the field.

“How can we convince more people to accept and remain in jobs that are physically and emotionally demanding, provide poor benefits, low wages and offer virtually no opportunity for career advancement? When you ask the question honestly, it answers itself,” he told the legislators at a Feb. 5 hearing.

Fishman noted that he had spent decades dealing with the direct-care workforce challenge from many perspectives. He served as commissioner of New Jersey’s Department of Health and Senior Services before becoming chief executive of LeadingAge, the national organization of non-profit senior service providers, and later leading Hebrew SeniorLife. He remains engaged in the issue as director of the Gerontology Institute.

One clear lesson over those four decades: The severity of shortages rises and falls with economic cycles.

“The crisis has been on simmer most of the time, then it reaches a boiling point whenever employment is high” said Fishman. “It goes back and forth, depending on the economy, but the overall trajectory is clear. As the older population increases, there will be less simmering and more boiling.”

While he led Hebrew SeniorLife, the organization started a career ladder program for certified nurse aides who trained to become licensed practical nurses over an 18-month period. HSL paid for tuition and books, gave those employees a paid day off to study and provided other support.

“Of course the program was good for participants who got more responsibility and much higher pay the day they graduated,” said Fishman. “But it was also good for the other CNAs, whether they hoped to enter the program or not. They rooted for colleagues trying to move up the career ladder but also saw the program as a sign of respect for them and their work.”

Others who testified at the statehouse hearing described how challenging it is to attract paid caregivers and retain them for very long as employees. A representative of Local 1199 of the Service Employees International Union said there were about 5,600 vacancies just at nursing homes across Massachusetts.

The state’s very strong labor market certainly contributes to that problem. But, Fishman said, the real solutions remain readily apparent.

“We can do things around the margins to improve the situation, but unless we increase wages and create career paths to upward mobility, this perfectly foreseeable crisis will continue to worsen,” he said. “It’s a matter of economics and, I believe, social justice.”

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