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Frontline Caregiver Shortages

Crucial shortages of frontline caregivers including home care aides and nurses are looming everywhere.  Whether it is a child with complex medical needs, an individual with disabilities or an older American, the shortage of these workers impacts all Americans.

As the baby-boom generation ages and the elderly population grows, the demand for the services of home and personal care aides will continue to increase. 

There is not only a shortage of workers entering the field, but many of those in the field are leaving for higher wages in industries like retail and fast food. Nearly half of all direct-care workers abandon the field each year. Older individuals, who benefit from having familiar caregivers attend them, sometimes experience dozens of caregiver changes during one year.

• Since March of 2020, providers have seen a 23% decrease in home care aides working for them, which led to a 28% increase in open shifts since before COVID. The pandemic has only made things worse, exposing the vulnerability of not only older individuals and people with disabilities, but also those who care for them.
• Providers of in-home care report having to turn down 50% of those seeking care due to a lack of staffing.  
• Nearly half of all direct-care workers abandon the field each year.
• This hard-working, yet underpaid home care workforce disproportionately comprises women and people of color.  
• The Build Back Better Plan currently being considered by lawmakers in Washington D.C. only skims the surface of America’s home care problem. The original goal of $400 billion in funding has been cut down to $150 billion which will not adequately address the current caregiving crisis. 
• The caregiving workforce needs to increase by 8.2 million jobs to accommodate future needs.

Compensation Issues

The first step is to make home care aides and in-home nurses’ wages more in line with the value of their role. We need a workforce that is committed, trained, and reliable. Their work is physically and emotionally tolling, incredibly important and increasingly in demand, and yet their pay indicates they are not being valued as such.

This is increasingly important as the minimum wage increase to over $15 per hour in some states. Any increase in minimum wage must be matched with a proportional increase in Medicaid and Medicare funding. Home care professionals do very important work and certainly deserve to be paid above minimum wage.

In addition to home care aides, in-home nurses’ wages must also be addressed primarily through improved government funding. With more lucrative nursing positions available in doctors’ offices, hospitals and even in school settings, in-home nurses are frequently attracted to other settings out of burnout and necessity. The one-on-one nature of home nursing means that the work often done by a team in other settings, providing life-saving interventional care, is left to one person. Home care nursing reflects a “top of the profession” level of care. These highly trained and highly skilled nurses deserve wages that reflect their qualifications, hard work, and dedication to caregiving.

Training Issues

We must address growth opportunities and upgrade the roles of the nurse and aide by giving them opportunities to develop or improve their skill set and increase wages. This will attract more individuals to take on this important role. Our education systems need to embrace this as a viable career opportunity with a path that has established and realistic growth potential.

• Employment of home health and personal care aides is projected to grow 33% from 2020 to 2030, much faster than the average for all occupations.

• Each state has different levels of training, certifications, and licenses that must be maintained. 

Professional Perception

Home care aides are not recognized as respected professionals – mostly due to lower wages and misconceptions of their role in assisting people whose lives depend on their care.  While home care nurses bring medical care into people’s homes, and many times directly prevent costly hospitalizations, their workforce numbers have been stagnant for nearly a decade.

As a result of the work environment, many experienced caregivers are leaving the profession for other opportunities. Nearly half of all direct care workers abandon the field each year. Older individuals, who benefit from having familiar caregivers attend them, sometimes experience dozens of caregiver changes during a single year.

Home care workers are primarily women, people of color, and immigrants. As a result, they are at heightened risk of experiencing discrimination on the job and in their daily lives, and gender and racial equity are central concerns for this workforce.*

• Nearly 9 in 10 home care workers are women.
• While people of color make up 38 percent of the total U.S. labor force**, they comprise 62 percent of all home care workers.
  

Both nurses and aides need to be valued and supported by provider agency employers and individuals they care for, and given opportunities to develop or improve their skill set, career advancement, and wage increases.  

*Scales, 2020

**Ruggles et al., 2020.

Impact on Families

When home care shifts go unfilled, either the individual is left at home alone with no care, or a loved one must fill the void.Too often, nursing homes are the only option.

When an individual becomes a family caregiver, they often must call out of work or quit their job altogether. They also miss out on sleep, taking care of themselves and their children and other family members, and must often forgo other responsibilities. In many cases, when a family cannot access professional in-home care, they are forced to make the decision to place their loved one in a nursing home.

According to the most recent data from the AARP, an estimated 41.8 million people, or 16.8 percent of the population, currently provide care for an adult over 50. That’s up from 34.2 million (14.3 percent) in 2015. While many caregivers feel their role has given them a sense of purpose or meaning (51 percent), these positive emotions often coexist with feelings of stress or strain.

Of those caregivers:

• 23% have taken on more debt
• 22% have used up their personal short-term savings
• 11% report being unable to cover basic needs, including food.

The only solution for families is to access affordable home care to augment the family’s caregiving.