Flo Nolte needs help but can’t get it. After being diagnosed with terminal cancer four years ago, everyday household chores in her rural Missouri home have become more and more exhausting. She has a long-term care policy that includes home care, so last year she decided to ask her insurance company about hiring help. After waiting several weeks, they finally sent someone.
“I was told there was only one home health company in the area that my insurance would cover, and that company only had one employee—a nurse’s aide,” said Nolte.
The woman came several times per week to administer medications, do laundry, change bedding, help prepare meals, and transport Nolte to doctor’s appointments—but one day she just didn’t show up. The home health company called and explained that their employee had been let go, and they didn’t have anyone else who could take her place. That was months ago, and Nolte has since been accepting help from friends and family because she’s too weak and overwhelmed to do it all on her own.
Unfortunately, seniors all over the country are experiencing the same thing. Whether they are seeking home health from private insurance companies or state-paid programs, the elderly are on waiting lists to receive care at home. According to a recent survey from the workforce research organization Center for State & Local Government Excellence, health care professions in the home-based care field are often most difficult to staff – with 75% of those surveyed saying that nursing positions offered challenges from a recruiting perspective.
Betsy Sawyer-Manter, CEO of home-based care program SeniorsPlus in Maine, recently told NPR that it’s very hard to keep enough employees in a state where 21% of residents are 65 and older.
“We are looking all the time for workers, because we have over 10,000 hours a week of personal care we can’t find workers to cover,” stated Sawyer-Manter.
Why the shortage of home caregivers?
According to the American Medical Student Association, the population of baby boomers – individuals over the age of 65 – will increase by 73% between 2010 and 2030. Not only does this mean a lot of current healthcare workers are retiring, but there are more people at home with common chronic illnesses such as hypertension, higher cholesterol, obesity and diabetes—conditions that don’t always require hospitalization, but make living alone more difficult as they age.
Researchers warned about the imminent need for baby boomer long-term care as far back as 2001 when the Urban Institute and Robert Wood Johnson Foundation wrote the report titled “Who Will Care For Us? Addressing the Long-Term Care Workforce Crisis.” They discussed the consequences of a shortage of nursing assistants and home aides as millions of seniors approach retirement, stating that, “Low wages and benefits, hard working conditions, heavy workloads, and a job that has been stigmatized by society (will) make worker recruitment and retention difficult.” Twenty years later, the condition of the home health industry has proven them right. Most home care jobs pay between $11 and $14 per hour, which is the same hourly rate as McDonald’s restaurants. When you factor in the drive time to a patient’s home, the grueling physical labor of housework or lifting patients, and sometimes having to deal with unsanitary conditions—many employees would rather work in fast food.
Joanne Spetz, director of the Health Workforce Research Center on Long-Term Care at the University of California-San Francisco, feels a need for more financial incentives for home care workers to stay within the industry.
“The people who are in these jobs always get the same amount of pay and the same low level of respect no matter how many years they are in the job,” Spetz said. She thinks more money needs to be put into bettering home care, which will work “only if that money is targeted for training, recruiting and retaining workers.”
The added challenge of Covid-19
As if aging baby boomers and low-paying jobs weren’t already a problem for the home health industry, the Covid-19 pandemic reduced staffing at home health agencies significantly. A study by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) found that because some states didn’t recognize them as essential workers, many home care workers could not obtain protective equipment, testing or vaccines as other health care workers could. Some workers left their jobs due to fear of contracting the virus, and some left because their hours were reduced when patients were fearful of becoming infected in their homes. All of this greatly impacted agencies’ financial sustainability, and they’ve since had to work to build new staffing while also rebuilding their businesses.
Hope for a change
As home care agencies rebound from a pandemic that reduced employee numbers to lower than ever before, our government is striving to help the elderly who need it. Thirty-four states have passed policies that pay family members for taking care of loved ones, while a nationwide policy has been passed to allow non-physician practitioners to order home health services. Maybe this will make it easier for agencies to take on new clients.
As far as payment incentives to keep home care workers in the industry, the Biden administration is working on that. In his $400 billion American Jobs Plan proposal, there are goals for an increase in funding to improve low-wage caregiving jobs while aiding providers in their recruiting and retention efforts. Some states are also taking it upon themselves to increase home care worker pay, including Illinois, which recently increased its minimum pay rate to $15 per hour. Hopefully these strides will be successful in drawing more caregivers into the industry.
For now, Flo Nolte will be anxiously waiting for the home health agency in her area to call her back.
“I’ve been paying the premium for years so that I could receive care when the time came,” she said. “Now that I actually need it, I can’t get the help that I paid for.”