Area Agency on Aging: Direct care workers, often the unsung heroes


By Kay Kaylor
PREVIEW Columnist

I advocate for residents in extended care and assisted living residences as the region’s lead long-term care ombudsman. I also am a Senior Medicare Patrol and State Health Insurance Assistance Program counselor, all as an employee of San Juan Basin Area Agency on Aging (SJBAAA). Information on the many aging and care concerns will be included here.

Direct care workers are essential, especially as frontline heroes who take risks during the pandemic and in the future as the aging population increases. 

According to Robert Espinoza, vice president of policy at Paraprofessional Healthcare Institute (PHI), 4.5 million direct care workers serve aging Americans and people with disabilities and one-fourth of them are immigrants. PHI is a nonprofit based in New York City that “offers a range of services that help providers attract quality workers, promote excellent care, reduce turnover, and achieve cost efficiencies,” as stated on its website. 

Espinoza is interviewed on a July 16 American Society on Aging recording titled “Advancing Racial and Social Justice for Direct Care Workers,” the season two opener of its Future-Proof: Equity and Justice broadcast program. For years, advocates have been seeking better wages and benefits for direct care workers who help people age in place at home and those living in group settings, such as nursing and assisted-living homes. Current proposed legislation attempts to address some caregiving issues. 

Adults age 55 and older make up one-fourth of direct care workers, Espinoza said, offering “years of work experience and family caregiving experience to these jobs.” 

He praised the “wisdom and character” of these older workers and mentioned their unique concerns.

“Quality jobs equal quality care,” Espinoza noted. 

State and federal Medicaid public health insurance funds government long-term care programs, such as Home and Community Based Services, which helps people remain in their homes, and pays for more than half the residents in nursing homes. During the pandemic, some states have cut or discussed cutting Medicaid.

One idea to deal with ongoing direct-care issues, Espinoza said, is a public social insurance program for long-term care, which some states are starting to create. Developed countries such as Germany and Japan use social insurance, and Washington state passed a variation of social insurance based on a payroll tax that begins in January 2022.

SJBAAA offers resources for people age 60 and older or on Medicare. For further information, please call or text 403-2165 or send an email to