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Not Enough Home Health Workers

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It will come as no surprise to anyone seeking care for a family member that home health care workers are in short supply. Not totally unrelated given the interplay of supply and demand, the cost is high.

According to a recent industry report, home health care providers are turning away over a quarter of referred patients because they do not have sufficient staff. As the report states, “[t]he need for more home care workers is on a direct collision course with the United States population demographics.” I’ve pointed out before that we are now actually in something of a trough in the need for home health and other care. This is for two reasons. First, most people don’t need care until they are 85 or older. Second, we have a relatively small number of Americans 85 and older because relatively few people were born 85 years ago during the Great Depression and World War II.

This will change almost overnight in about 10 years when the oldest Baby Boomers begin reaching the 85-year-old threshold. If we have a shortage of paid caregivers today, we’ll have a crisis in a decade — unless we take steps to address it now.

Why Aren’t There More Home Health Workers

The report, “The Home Care Workforce Crisis: An Industry Report and Call to Action,” issued by the Home Care Association of America and the National Association for Home Care % Hospice, lists a number of factors that are exacerbating the the current shortage, including:

  • Medicaid reimbursement rates that are not keeping up with inflation.
  • A drop off in the number of immigrants as the result of Covid.
  • Public assistance rules that penalize people who work or earn too much, discourage many home health caregivers from working more than part-time.
  • A high turnover rate among home health workers.

While home health care is very expensive, $27 an hour on average nationally according to the Genworth Cost of Care Survey, or $4,500 a week for round-the-clock care, home health aides receive only about half this amount. In addition, they have few of the protections and benefits afforded other employees, whether paid sick and vacation time, contributions to 401(k) plan, or simply the camaraderie of working with colleagues. Since by definition home health aides cannot work remotely, they are at risk of contracting Covid or other illnesses. The fact that wages are going up for other low-skill jobs (and one can question whether caring for someone with dementia or physical ailments is really “low-skilll”) means that many home health aides now have alternatives that at least some will prefer.

What About the Future?

Quoted by Marketwatch, Scott Williams of Interim HealthCare, a network of franchises which reports having as many as 3,000 job openings, says “It’s kind of the perfect storm now. Our franchisees are really in a constant hiring state at this point.” Within a decade, the “perfect storm” will become a devastating hurricane. A report by PHI predicts that we will need a million more home care workers by 2029.

We will only be able to expand the home care workforce, as well as that of other direct care workers in nursing homes and assisted living facilities, by making significant changes in how we recruit, train and compensate home health aides. These changes should include:

  • Higher pay for home health aides.
  • Easing Medicaid eligibility rules so more seniors and their families can qualify for home health coverage.
  • More support for family caregivers to reduce the demand for paid home health aides.
  • Loosening of immigration rules so that we have the workers we need. (This will be a growing issue in all industries as Baby Boomers age out of the workforce.)
  • More protections for home health workers, whether employed directly by families or by agencies, that include paid vacation and sick time, health insurance and funded retirement savings.
  • Expanded childcare and English as a second language instruction would enable more parents to work outside the home.
  • More training for home health aides.

What other suggestion do you have?

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