Mobilizing For Equity


At the 4th Annual Patient Navigation Town Hall "Empowering and Mobilizing Our Patient Navigation Workforce", experts discuss how navigators can mobilize for equity in their field.


Stewart McKeough: This is going to be a great session. It's called Mobilize. We're pulling this from Empowering and Mobilizing our Patient Navigation Workforce. And you and I talked briefly about this on Friday, really having a better understanding of pay equity of certification training, how public policy can inform strengthening this workforce moving forward. So, we're going to hear from public policy experts, a great interview coming right up in a (second) with the New York Times, we will hear what Texas is doing. Texas has been at the forefront of community health worker certification for the past 20 years, we'll hear from a University of Texas health expert to talk about what they've learned and what they could do a better job at and how we in New York State and other states can replicate some of this good work. So, we're in for a good hour I think it is, hour and 15 minutes. But I first want to start by introducing our audience to Katie Engelhart and Kim Rockwood, I watched an interview that Katie had done with Kim on the New York Times in May. And immediately watched it because the headline was so grabbing these, essentially it was these people look after our most vulnerable populations, and yet their average pay is $16,200 a year. Are we okay with that? And of course, I thought, No, I'm not. And yet we hear these stories across the United States. And we hear them a lot with our community health workers. So, I wanted to introduce you to Katie and to Kim. We will replay the Times video that I saw and then I'll turn it over to you both so that Katie, you can update us with Kim on what's happened since that video ran on the Times and then Dr. Klemp and I will have some questions. Let me just formally introduce you though first. Katie Engelhart is a reporter and documentary film producer, who has worked as a correspondent for NBC News, and whose writing has appeared in The New York Times, The Guardian, the Atlantic and California Sunday. Her first book, The Inevitable Dispatches on the Right to Die will be published in 2021. And I'll just add in that Katie's a Canadian like I am, so I was immediately drawn to her and she's speaking with us today from her cottage in Northern Ontario, and I think we're all very jealous. And Kim Rockwood, oh my gosh, you've been working in health care since 1984. And you became a certified nursing assistant in 1987. And since that time, you've been Become a MAP Certified restorative aide certified assistant. And you've been trained in nonviolent crisis intervention and in supportive care for Alzheimer's. You're a remarkable individual Kim and I can't wait for our audience to get to know you a little bit more. Right after we play this video.

Kim Rockwood in video: I mostly care for people in their homes. People like parents, grandparents, the most vulnerable population of our society, people who need help going to the bathroom, eating, taking their medications. This is for your bones. This is for your pain. We do everything for him, 'We're going to lift you up, alright.' I work seven days a week, but I love my job. I wouldn't do anything else. I've worked for over 30 years doing this, and I make just over $15 an hour. I live in Massachusetts and my salary is actually one of the highest in the country. 18% of us live below the poverty line. Nationally, we make just over $16,200 a year. And even though I work in health care, I cannot afford health insurance. I avoid going to the doctors. I have medical bills I haven't paid. My tattoo is: "We're all in this together. "And it is "the world has a heart." Since COVID, the federal government was giving out more than $100 billion emergency money to hospitals, nursing homes, long-term care facilities. That's great, but most of the money isn't going to people like me. I'm not a materialistic person and I'm not asking to make a million dollars, I don't mind doing hard work, but I need to make a living. I need to be able to pay my bills, especially now with Coronavirus. Most home givers aren't receiving hazard pay. I've had to pay for a lot of their PPE out of my own pocket. If we are essential workers, we need to be treated like essential workers. If I were to go on unemployment and stop working, I would make about the same amount of money if not more, and then there's not going to be anybody to take care of these people. And that's just crazy. It's a very broken system. These patients are sick, and they need to be cared for. Last Tuesday, Nancy fell, she basically sat on the floor until she was found. I would hate to have her end up in a nursing home or a long-term care facility. But that's what's gonna happen if she doesn't receive the care.

Kim Rockwood: [crying] I give her a quality of life that she deserves, and I don't want her to lose that. That's why I do what I do. If she falls, she loses all of that. I'm sorry. It doesn't have to be like this. The federal government, Department of Health and Human Services must require some of the money that is going out for relief to go to the frontline caregivers. States could also use the Medicaid to increase our pay, some states increased wages for all health workers, including home caregivers, Arkansas is doing it now. Even a few dollars more an hour would change our lives and make the health care system more sustainable and safer for our patients. But when this is all over and in a post COVID world and money shouldn't get taken away, caregivers will still be needed. We should be paid a living wage, we need help.

[Video ends]

Katie Engelhart: I still find that piece very moving and I'd like to talk a little bit about how things are going for you (Kim). Now that were a few months on, but first, I thought it would be useful to just explain sort of how we got to know each other. So, I was working on a piece for the New York Times. And our idea was to find frontline workers, find essential workers and give them the ability and technical tools to author their own op ed to make their own case for what needed to be done in response to Coronavirus. And I guess I started thinking about how we defined frontline workers. And Kim and I, we've talked about this, but it became pretty clear that you know, while a lot of attention was rightly on the acute needs of COVID patients, there wasn't a whole lot of thought going to post-acute care to considering where these patients would go and how they'd be cared for after they got better. And this is even in, April and May as we were hearing warnings from Italy that homecare is going to be the next frontier of all of this. And as I did more research, it became very clear that you know, the homecare industry was already in crisis, there was an enormous shortage of homecare workers. A lot of workers didn't have the training and support they needed, underpaid, not protected, uninsured without paid sick leave all these things we now realize are really detrimental to the health of patients. And I think you know, the fact that this is work that's done largely by women, often women of color, immigrant workers hasn't escaped anyone who's been paying attention. What Coronavirus really showed us is that the health of caregiver population is closely tied to the health of the patient population. And I think that Kim, when we connected really saw that and really had ideas for how the situation could be improved. So, Kim, it would be useful to know I guess, to start how things have been going for you since we last spoke since this video was made.

Kim Rockwood: I'm still working seven days a week. I did move out of COVID-19 facility, and I'm working in a long-term care facility on top of working with Nancy and Brendan (from the video). I have a hospice couple that are living at home. And I lost two people who work for me with Nancy. And her needs are more than they could handle. So, I picked up more hours with her. Pretty much the same thing. nothing's really changed.

Kim Engelhart: Yeah, so it sounds like I mean, even before Coronavirus, we knew that turnover was a huge problem. A lot of healthcare agencies even in Massachusetts, which has either some of the highest rates in the country, if not the highest, you know some homecare agencies, we're finding a turnover rate of nearly 100% every year, and when I spoke with someone from the homecare industry, he said to me, you know, unfortunately our main competitors here are Burger King or McDonald's. Because those jobs sometimes pay better. They sometimes offer you know more in the way of benefits or support, there's room to advance, there's room to, you know, graduate to higher pay scales, and you're far more likely to get injured. Homecare workers are something like three or four times as likely to be injured on the job as other workers. And so Kim, I'm curious how you've seen that quick turnover and how you're finding it's affecting the care of your patients and I know you've also have a specific tide of fast food and have been able to see that comparison.

Kim Rockwood: I've worked with Nancy since last January, and in that time, I have been consistently working with her pretty much seven days a week. In the fall, when I went to school, I had people working with me, including my daughter, my daughter and I are the only one that are still with her. We've gone through five different PCAs. To be a PCA, you don't need to be certified, you honestly don't need to be trained. And once people come in and see the actual tasks that are involved in taking care of somebody who has been hospitalized, is trying to avoid going to any sort of long-term care facility or a hospital setting. It's work. And it's complicated. It's a lot more than making breakfast or putting out medicine. And, you know, they come in with the idea, well, I'm going to make this kind of money, but it'll be easy work. And it's not easy work. And Dunkin Donuts, took my daughter and she's now making $19 an hour as an assistant manager and I'm making $15.94 taking care of Nancy and Brendan, and my hospice couple who are dying.

Katie Engelhart: Well, I think a lot of people don't realize that, you know, Kim is, you know, as you've said, a certified nursing assistant, so able to work in long-term care settings, like nursing homes, and also a PCA, so personal care assistant working with people in their homes. The facilities require a certain level of training, it's not always very much sometimes, you know, 70 hours of training, depending on the state, but often to be a homecare worker, you know, for some reason, there's not that same criteria or same requirement of any sort of, you know, formal training and Kim, how do you find that that's affected the care of your patients because obviously, you know, you're very trained. I know, Kim's also, you know, paid to do a lot of additional certification, but you're sometimes trading off with people who are new on the job and aren't as experienced.

Kim Rockwood: I've had patients call me in the middle of the night because their catheter was clamped off and never released and the caregivers have left. I've had patients, clients get hurt while being transferred via a mechanical device such as wires. I've had patients not given the medication that they needed on time and ended up diabetic reactions. By going into somebody's home and caring for them in a health aspect, by not being trained, you're jeopardizing their safety. You're jeopardizing your health. You're jeopardizing your wellbeing. And you're jeopardizing the whole community of individuals living at home because it gets to that point where they can't be taken care of, it won't be an option to live at home, they will be mandated to go into long-term care or assisted living or whatever. Because, you know, I mean, how many lawsuits can there be or how many injuries because of PCA's not being trained before somebody says enough is enough.

Katie Engelhart: For someone who does want training for someone who joins the field, and you know, they're working at home care, and they want to get better and they want to improve their skills. What kind of options are available to them? Are there options to get new certifications with, you know, some government assistance to increase that pay scale.

Kim Rockwood: If you go into like a department of transitional Assistance Program, you can go into a certified nursing assistant program through community colleges. I know that Red Cross offers programs. However, unless you're going through a transitional program, because you are getting state funding for whatever to sustain your own life, you have to pay out of pocket. I have been certified basically through any job that I've ever been, I grabbed the opportunity and I take it where I go, or I pay for it. I'm $24,000 in student loan right now, finishing up my associate as an RN.

Katie Engelhart: It seems like culturally, we've, you know, we've moved away from an institutional model. People don't want to be in the hospital longer than they need to be. It's expensive. They don't want to be in nursing homes or other kind of rehab facilities and yet, the infrastructure is still back in the old days, right. Yeah, it sounds like you're still operating pretty much in the same setting that you did in the '80s.

Kim Rockwood: Right now, in Massachusetts more than 36,000 people are living at home independently receiving home services. And they're not getting paid, you know?

Stewart McKeough: Dr. Klemp and I just popped up the minute we heard you talking about certification training and we're about to move into our next segment of this session to hear from our UT Health advocate and subject matter experts. So wanted to wrap some things up with you but Dr. Klemp, I think what we're hearing from Katie and Kim is how important it is to find the best way to sync up our training and certification and accreditation wherever you fall in the continuum. What do you think?

Dr. Jennifer Klemp: Right, and I also heard from Kim kind of (that) there's not a lot of standardization or sort of, you know, it works a lot better to demonstrate your value which you have listed off. I mean, I the empathy I have for the role that you're filling, but also, the complicated nature of your patients, right? So, we're talking about a lot of skills that people have, how do we demonstrate that competency? How do we make sure that there's some standards around that, and there's that need to have it be a little more universal, versus all these one offs or a lack of sort of certification? So the way that we move towards that and move towards increasing value is to put that into a story, right. And the story usually includes outcomes and metrics that can then be taken to payers where payers say, okay, yes, this is part of a bundle, this has to happen. So, this is a very complicated picture that you've described through your experience. And it really goes to kind of the bigger society challenges we have, and dealing with, with policy, the accreditation, the billing, like this is a really big and complicated issue. And that human experience, I think just highlights the need to push this forward so we can start putting more value on a very necessary service and, you know, tool for our patients and providers and organizations.

Stewart McKeough: Katie and Kim, thank you both very, very much. Any more thoughts? Any before we move on to the next segment?

Katie Engelhart: I think just as I said before, you know, I think we're really seeing in nursing homes what happens when the lowest level of caregivers not offered, you know, support such as a paid sick day, the ability to stay home and to not spread infection to residents and, you know, all signs point to homecare being the next place where we're going to see these outcomes if nothing's done.

Dr. Jennifer Klemp: Yeah, the compassion, fatigue and burnout is there, and I commend you and thank you for what you do, Kim because you are amazing and your resilience is amazing.

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