Beyond EAP: Reducing Turnover & Poverty in a Low-Wage Workforce

By Michelle Zadrozny, LMSW

As a social worker experienced in EAP, I was always interested in having the EAP serve as a bridge between community supports and low-wage workers – the ones who are often left behind when it comes to employee benefits, health, and well-being.
I finally had an opportunity to do just that when I was recruited to develop an internal EAP for a large home care agency in Austin, Texas, called Helping Area Neighbors Daily (HAND). The vision was to create a hybrid model that provided internal counseling and case management, but also leveraged extensive nonprofit community supports to serve the unique and challenging needs of personal care attendants (PCAs). These are part time, minimally paid caregivers who are becoming a big part of the American workforce as the U.S. population ages.
This article describes how this model was formed and ways in which the EA field can help address the needs of this growing population.

Defining the Problem
Recent estimates suggest there are approximately 800,000 PCAs in the U.S., and in two short years there will more than 1 million. Attendants are predominantly low income, primarily female (90%), and ethnically diverse (60% Black, 30% Hispanic). They help seniors and people with disabilities with the tasks of daily life that most of us take for granted, such as bathing, dressing, grooming, toileting, and housekeeping. Personal care attendants are the most rapidly rising profession in the U.S. and work in home care, assisted living facilities, and nursing homes.
The combination of challenging, poorly compensated work and a stressed, uneducated workforce (which often lacks access to basic health services) creates a situation where the elderly, sick, and poor are being cared for by personal care attendants who themselves need care, support, and assistance.

Forming the Aspire Model
In 2013, under my leadership, HAND formally committed to develop Aspire: A Workforce Development/EAP Model. The intent was to facilitate the support and growth of PCAs in order to address issues of poverty and lack of resources, improve the quality of life and wellness (including EAP supports), and offer opportunities for professional development. The goal was to expand the program so that it could be replicated for PCAs nationwide and with other low-income workforces. HAND currently employs over 500 attendants.

Program Description
The Aspire program is an innovative, first-of-its-kind workplace training and support program for PCAs to:
* Enhance their quality of life;
* Increase engagement in wellness activities; and
* Enhance the quality of care provided to local seniors and individuals with disabilities who need day-to-day home care.

The program was built on existing integrated behavioral health models, behavioral economics theory, and clinically tested best practice EAPs. Aspire includes the following components:

* Professional job training and education in caregiving, fall prevention, effective communication, and other job skills essential for those who work with individuals with chronic illnesses, disabilities, or personal care needs.

* An EAP that supports PCAs through counseling services and networking connections that leverage community supports and utilize counseling and social work interns.

* Holistic health and wellness education that includes job-specific courses along with life skills classes, including English as a Second Language (ESL), financial literacy, healthy relationships, and diabetes risk-management.

In-person training occurred monthly. It included one hour of skill building and one hour of wellness training, community resources, and a psycho-educational group model with a peer support component.

Program Expansion
Aspire, the EAP/Workforce Development program I created for HAND, was awarded the “Innovative Program of the Year” by Leading Age Texas in 2015. As a result, our efforts drew the attention of other private and nonprofit home care providers. We then began leveraging resources to build the capacity to expand Aspire to other employers facing similar industry challenges.
The Aspire program continued beyond HAND and is now part of the Central Texas Home Care Coalition, an employer-driven collective of key stakeholders committed to the ongoing support and well-being of paid caregivers. The collective priorities of the coalition for this group are:
1) Training needs,
2) Retention and work supports (including EAP), and
3) Wages and advocacy.

We support our workforce by improving access to health care, offering career supports, and in developing additional skills for PCAs. Our coalition believes that taking care of employees is essential in order for them to take care of their clients (senior citizens and those with disabilities).

As businesses continue to do more with fewer employees, we need to be creative in how we create career opportunities for the working poor. Businesses that understand the need to support low-wage workers help strengthen families and communities alike.
As EAP strives to forge its place among wellness and other employee engagement initiatives, focusing on a low-wage workforce brings a social justice component of EAP back to our profession. In other words by advocating for medical access and mental health parity for ALL workers, we are creating a niche for uniquely qualified EAP social work and counseling professionals.
It is my intent to create a replicable model that other forward-thinking companies and agencies can adopt to promote the economic stability and professional development of their workforces. Not only is up to 100% annual employee turnover (such is the case in the caregiving field) outrageously costly for businesses, it is completely preventable. Additionally, a workforce development initiative tailored to lift low-wage workers out of poverty is an essential function of being a socially responsible corporate citizen.

Editor’s note: This article is based on Michelle’s 2015 World EAP presentation, “Sustaining and Retaining the Home Care Workforce: An Innovative EAP Model.” Michelle is the owner and principal of Creating Transformational Workplaces (, which helps implement initiatives to enhance organizational development and workplace-based wellness.

Key Outcomes of the Aspire Program

Outcomes of the Aspire program in 2013-15 included the following:

* Provided monthly training events that reached two thirds of the workforce;
* Assisted 12% of the workforce through the Employee Assistance Program, with issues related to family stress, transportation issues, housing instability, and lack of food;
* Offered EAP and job-performance coaching sessions for issues affecting the Personal Care Attendant’s ability to remain focused on the job;
* Increased awareness of diabetes risk and prevention resources;
* Developed ESL (English as a Second Language) curriculum specifically for the Home Care/Personal Care Attendant workforce, in partnership with Literacy Coalition/English at Work, expanding both work opportunities and income potential upon program completion.

- Michelle Zadrozny