Shortage of Home Care Aides

In the United States, there is a severe shortage of home care aides, who are essential lifelines for many elderly and disabled Americans struggling to maintain independent lives in their homes. Aides provide personal care such as bathing, feeding, and dressing, as well as, home making activities, such as doing light housework, preparing meals, and shopping. Recipients of these services are more impaired and frail than most of the over 60 population (Ref: Highlights from the Pilot Study: Second National Survey of Older Americans Act Title III Service Recipients). Without these aides’ vital assistance, many elderly and disabled Americans would be unable to remain in their homes. They would be forced into institutional living situations at great expense to the public care system and at the loss of their personal choice and dignity.

Personal care aides are critical components in the home care industry performing physically, mentally, and emotionally demanding jobs with the most vulnerable members of our population. They often are poorly screened, minimally trained or supervised and rarely provided fringe benefits. These critical workers receive some of the lowest wages in the workforce often making less than hotel maids and fast- food workers. Turnover due to difficult working conditions and low wages drives up the cost of elder care while disrupting continuity and eroding the overall quality of care received by older citizens.

What Do They Do and Who Are They?

Direct care workers, usually referred to as personal and home care aides provide the bulk of paid home care. Personal care aides are unlicensed individuals who provide direct care services in the home as an employee of the client or an agency. They assist with personal care activities such as, bathing, dressing, toileting, transferring, and eating, and home-making activities such as preparing meals, doing light housecleaning, and shopping. These aides are truly essential to the ability of many older and disabled individuals to live as independently and productively as possible.

The need for personal care aides will grow faster than the average of all occupations through 2014. The number of personal care aides will grow 47 percent between 2000 and 2010 (Ref: Health Care Employment Projections: An Analysis of Bureau of Labor Statistics Occupational Projections, 2000-2010). But this is as would be expected based simply on the demographic trends previously discussed. Personal and home care aide is expected to be one of the fastest growing occupations, as a result of both growing demand for home services from an aging population and efforts to contain costs by moving patients out of hospitals and nursing care facilities as quickly as possible.

Agencies report vacancy rates as high as 35 percent and difficulties finding qualified personal care providers. Few agencies are accepting new clients for personal care services. This means that thousands of elders and people with disabilities are languishing in costly government funded institutions. In Texas, for example, the average cost of community care is $15,529 per year compared to an average cost for nursing home care of $30,882 per year. This is a shocking waste of both human capital and public dollars.

Who is taking these jobs?

Nine out of ten personal care aides are women approximately 40 years old. These women often are the sole providers for their own households. Many personal care aides earn incomes below the federal poverty level with many workers or their children qualifying for public assistance programs. Individuals work as aides for a variety of reasons but characteristically because they care and know they are making a difference for the clients they serve.

Why Is There a Shortage of Direct Care Workers?

Despite the current need and growing demand for personal care aides, high turnover rates plague the industry, ranging from 25 to 50 percent in home health care. The majority of that turnover occurs in the first three months of employment. High turnover rates lead to poor quality of care, disruption of continuity of care and reduced access to service for these services. High turnover rates also increase the costs for providers. High turnover and vacancies mean that providers must spend relatively large amounts on recruitment and training costs, an estimate of at least $2,500 per lost employee. This reduces funds available for aide compensation, thereby creating a cycle of further high turnover and vacancies.

What Needs to Be Done?

Efforts must be concentrated in areas that will enhance screening, promote retention and reverse high turnover rates for direct care workers. First, enhanced screening methods that provide comprehensive criminal record and applicable registries checks must be employed. Adequate and ongoing training of personal care aides must be provided by care institutions. The content needs to provide practical up-front training with peers and orientation for new hires to prepare individuals to work with increasingly frail, possibly cognitively altered elders. Finally, and most importantly, wages must be raised to a competitive level for these positions. A Wisconsin study found that facilities that paid direct care workers higher wages had lower turnover rates (Ref. Hattan, E. & Dresser, L. (2003).

What’s the big deal? It all comes down to paying a reasonable wage, providing adequate training, treating people with respect and expecting them to be respectful.