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Caregiver Shortage May Reach Crisis Level

Finding a proven, compassionate caregiver has always been a challenge. We can theorize they are a product of a loving family or nurtured and cultivated through example to be a respectful, caring person with good instincts in determining what one truly needs to feel safe, comfortable and happy. We can also say that in many cases compassion combined with the ability to project it in a tangible, meaningful way is an innate trait that when combined with formal training is what produces the best caregiver. How we define a good caregiver is another question entirely. Specifically, because as a professional who has spent many years in the industry and someone who has seen the best and worst side of caregiving, we know not all peoples’ needs are the same. Some would say the caregiver that cleans most thoroughly is the best. Others may say, those who are kind, soft spoken and good companions and conversationalists are the best. It really comes down to what care needs one may have and how they define “care”. One thing is for certain, there is and will be a shortage of caregivers in the United States for several decades to come due to the demographic nature of our country. And it’s not due to a lack of people with these traits. It’s due to a host of other variables affecting the market.

Helping Hands Home Care is finding that due to the nature of our volatile industry where the future of our clients is uncertain and generally short-term, we cannot guarantee our caregivers hours indefinitely. We are at the mercy of the client who may need care one day a week or regularly for weeks on end, but suddenly due to an illness, visiting family member, transition to a facility or death, not need services any longer. This leaves the agency in a paradox insofar as ensuring the caregiver can still feed their family, earn a wage and be retained by Helping Hands Home Care. The problem herein lies with the fact that the agency during this suspension of services or termination of services does not get paid during that time and therefore cannot pay the caregiver. The business model simply doesn’t allow for that to happen if the business wants to survive. We highly value our caregivers and know retention is more cost effective than acquisition, so we strive to find the caregiver replacement work immediately. However, that doesn’t always happen quickly and often times leads to the caregiver seeking work elsewhere.

With the low unemployment rate and labor shortage, it is not difficult for an experienced (or inexperienced) caregiver to find a replacement opportunity thereby transitioning themselves into another industry or segment of the healthcare industry with more stability, leaving a continued shortage of caregivers nationwide. Many (including ourselves) ask what will happen when we can’t find caregivers to care for an ailing parent or frail grandparents who cannot care for themselves? What will we do when we can’t recruit enough caregivers to fill vacancies or obtain enough state funding to keep the doors open?

People are saving less and unable to afford services and Medicaid is on the chopping block. States are facing shortages and not able to fund social services adequately so that agencies are able to pay a living wage and still meet the administrative and business expenses associated with supporting the program and staying in business. The problem will only get worse with the forthcoming “Silver Tsunami” and increasing demand while coupled with a shortage of funding on the private and public side of the equation.

These types of questions haunt individuals, families and long-term care providers such as Helping Hands Home Care. For starters, we must ensure we have enough direct care workers—home care aides, nursing assistants and personal care aides—willing to take jobs that assist frail elders and people living with disabilities with daily tasks such as bathing, dressing, and eating.

Helping Hands and our industry colleagues routinely experience that the current workforce isn’t robust enough to meet demand — and affects the entire system of caregiving. Families can’t find home care workers, so they quit their jobs and deplete their savings to care for a loved one. Workers leave emotionally fulfilling caregiving jobs because they can’t afford to live on $11 an hour or because they see few opportunities to advance in their careers in this occupation. Home care agencies like ourselves, nursing homes, and managed care plans struggle to find workers willing to take these jobs, and they feel strapped by the paucity of state Medicaid funding and it’s getting worse.

A nationwide research firm has determined there are eight signs that the shortage in direct care workers has become a crisis.

1. The population of older adults in the U.S. continues to rapidly age, igniting demand for long-term services and supports. The population of people age 65 and older will more than double between 2014 and 2060—from 46.2 million to 98 million. Over the last few decades, as the baby boom generation matured, the long-term care system also changed, moving away from nursing homes as the preferred setting and increasingly to home and community-based services, which requires more direct care workers. Today, 52 percent of people age 65 and older require some form of long-term care in their lives.

2. A sizable growth in elders and people with disabilities means a growing demand for paid caregivers: home health aides, nursing assistants, and personal care aides. Between 2012 and 2024, we’ll need roughly 1.1 million direct care workers, including 633,100 home care workers and 59,000 nursing assistants. And it’s not just frail elders who need long-term care; people with disabilities regularly rely on direct care for assistance with daily living; thirty-seven percent of people receiving long-term services and supports are under the age of 65.

3. The primary labor pool for direct care workers isn’t keeping pace with these national trends, raising concerns about the broad appeal of this occupation. Women are the primary labor pool for direct care workers, making up 89 percent of home health care workers and 91 percent of nursing assistants. Yet research shows that the pool of women ages 25 to 64 will grow by less than one percent in the same time frame, or 1.9 million workers. Unless this sector can attract a wider diversity of candidates, while vastly improving the quality of these jobs, more positions will be left vacant and more consumers will be left without care.

4. Direct care workers are leaving this occupation in droves, often within a year, fed up with low wages, marginal benefits, and limited opportunities to advance. Research shows that one in two direct care workers leaves her job within 12 months, often citing low wages as the primary reason. (More broadly, new research reveals that more long-term care workers are leaving this sector than entering it, often becoming unemployed.) Other reasons for high turnover among direct care workers? Poor supervision, thin benefits, strenuous travel schedules and workloads, and few opportunities to move up the career ladder. In some areas of the country, these workers find better paying jobs in other industries, such as retail.

5. The workforce shortage in paid caregivers is becoming severe in some regions of the country, particularly in rural areas. Research shows that rural areas might be grappling more with shortages in workers, since those areas are often characterized by a dearth in healthcare and long-term care resources. Additionally, workers in rural areas have longer travel times between clients and fewer public transportation options than what’s available in urban settings. Given the differences in Medicaid funding across states, we also assume that the stock of paid caregivers differs across states, region to region. More research is desperately needed.

6. Policymakers, long-term care providers, and the general public are hampered by the lack of available data and research on the direct care workforce. Few states and municipalities track data on the direct care workforce, including current and future occupational projections, the level of turnover in different settings, and vacancy rates in facilities, among other figures. Without this data, it’s difficult to identify where the shortages are most severe or the variety of reasons for the shortage. It’s also difficult for researchers and program evaluators to empirically study broader questions and craft interventions related to the direct care workforce and long-term care.

7. Home care providers and other long-term care entities cite the workforce shortage as a top concern for delivering quality care. According to a 2015 study of more than 700 private home care agencies, 60 percent of respondents identified caregiver shortages as one of their top three “threats to the future growth of [their] business in 2015.”

8. The shortage in workers extends beyond long-term care—and is garnering public attention. In the broader health care field, leaders and practitioners report the challenges in finding physicians, nurses, and other primary care professionals, especially in rural parts of the country. The public overall is overwhelming concerned that we will soon run out of primary and long-term care professionals who can assist our families with their basic health needs. We’re at a critical tipping point—and we must act.

Helping Hands Home Care is one of Oregon’s most trusted home care agencies. We have seen first-hand the difference a caregiver can make in a person’s life. We strive to hire the best and are witness to the trends highlighted above. Our solution is to pay more, provide benefits, show compassion and a path to success, as our caregivers are expected to do for their clients. The feeling of safety, respect and purpose is something every human desires and we have adopted a mission of providing that purpose at all levels. Our Quality Assurance Specialist is tasked with ensuring caregivers are well vetted, heard, trained and ready for the field. Likewise, our Care Coordinators are tasked with ensuring caregivers are getting the hours and shifts they need to make ends meet. And it is management’s job to continue to cultivate staff, develop efficient programs and ensure the business thrives, because without the business, you can’t employ caregivers and you cannot provide valuable services to vulnerable clientele.

Helping Hands will continue to struggle with the reality of the shortage and pitfalls of the volatile industry because we care. We care because we see the advantages and the fulfilling and safe home-life of our clients when they are provided a good caregiver. We also see the smiles and caring hearts of our caregivers when they make a difference. There is no substitute for in-home care and there are no better caregivers than those at Helping Hands.

By Toby Forsberg, President
Helping Hands Home Care
Statistics provided by Huff Post, 2017

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