Collaborative Co-design of Portable Work Benefits Policy Model and Prototype based on Direct Care Workers' Needs, Attitudes, and Beliefs

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Direct care workers (DCWs) comprise an essential, highly-skilled, rapidly growing part of the health care workforce. DCWs assist people with disabilities and frail elders with activities of daily living. DCWs decrease health care costs by preventing the need for institutionalization, hospitalization, and other costly medical services among their clients. From 2016 to 2060, the number of adults aged 65 and over will increase from 49.2 million to 94.7 million. The number of adults 18 to 64 will remain the same, leading to a shortage of family caregivers. There were 31 working-age adults for every adult aged 85 and over in 2017, but this ratio will diminish to 12 by 2060. DCWs are expected to grow by 1.3 million from 2019 to 2029. This growth will not keep pace with the projected growth of people with disabilities and frail elders. The turnover rate among DCWs is already high due to poor work conditions and inadequate compensation, with more people leaving the workforce than entering it. It is critical to explore ways to improve DCW working conditions and compensation to prevent further shortages in the workforce. Although DCWs contribute enormously to public health, their health is put at risk due to the nature of the work, low wages, and lack of worker protections and traditional work benefits. DCWs are vulnerable to injury, abuse, infectious diseases, and other poor health outcomes due to the previously listed disadvantages. The DCW workforce in the United States is predominantly comprised of priority populations: female, racial or ethnic minorities, and one in four workers are immigrants. The risks that DCWs face exacerbates existing health disparities among these priority populations. There is compelling evidence that work benefits improve health outcomes. Work benefits also protect clients of DCWs from healthcare-associated infections as DCWs would be able to take paid sick leave when ill. Portable work benefits are work benefits that employees can take with them from job to job, prorated so that multiple employers (like clients) can contribute, and accessible to all workers. Portable work benefits are not widely available but have been proposed as an innovative way for workers who lack work benefits can receive them. We propose to 1) conduct focus group discussions to explore the needs, attitudes, and beliefs of DCWs regarding portable work benefits; 2) hold two co-design sessions and a focus group session with DCWs to develop and refine a portable work benefits policy model for DCWs in Maryland (with agency representatives invited to the second co-design and focus group sessions), and 3) hold a co-design session and a focus group session for adapting and further refining portable work benefits apps and websites for DCWs. This study will provide a first step toward obtaining DCWs work benefits that will protect their health and those around them, improve work conditions and compensation, and prevent further workforce shortages among DCWs. This research will also ensure that portable work benefits for DCWs are appropriate. The methods and results of this study can also inform research for other vulnerable worker populations that lack traditional work benefits.