Home Health Aides: The Unheard Crisis

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By Ryan McEniff

The demand in healthcare for registered nurses has been well documented by the Institute of Medicine (IOM) as well as the American Nurses Association among others. Less commonly thought of is the current and likely chronic shortage of home health aides. It is estimated that the demand for home health aides will grow 38% between 2014-2024 (significantly faster than average).

As the Baby Boomer population grows old, more home health aides will be needed; an estimated 630,000 more aides by 2024. Rising costs and demands for nursing homes and hospitals makes home health care even more appealing to the average older adult. Many organizations question whether there will be enough workforce to care for the elderly population as one in four home care providers has a job vacancy rate above 20%.

Many factors contribute to the shortage of home health aides in the United States. According to Bruce Darling, executive director at the Center for Disability Rights, home health aides should not be low-paying jobs. The person who makes your burger shouldn’t make the same amount of money as the person who operates a ventilator or feeding tube, Darling adds. The median pay for a home health aide is around $10 an hour, or $22,600 annually. Other employers outside of healthcare can offer higher paying jobs without the physical and emotional demands required of a home health aide. An average day for a home health aide could include:

  • Assisting clients with activities of daily living (bathing or dressing)
  • Giving medications or checking vital signs
  • Helping around the house (laundry or meal prep)
  • Arrange and plan for life events like doctors’ appointments
  • Help the clients partake in community and social events
  • Shop for groceries and prepare meals for patients

Being a home health aide can be a demanding job. Many clients have severe disabilities that limit their independence and make them reliant on others for routine activities. This can mean working with patients who are physically difficult to move, help, or care for. Patients could have mental disorders such as dementia or Alzheimer’s, making it difficult and emotionally taxing for staff to care for them.

Contrasting Darling’s argument is the fact that no formal education is required for home health aides. Most home health aides have a high school diploma. To be hired as an aide you need to complete a formal training process and pass a standardized test. Due to the relatively minimal educational standards, it can be difficult to demand more compensation for services. Despite the lack of educational requirements, other factors could reinforce the need for greater pay for home health aides.

Further complicating the situation at large is the longevity of the average lifespan. Many people are living longer with multiple chronic conditions, thus increasing not only the need for home health aides but also increasing the amount of work for the average client. Many employers are running short-staffed while simultaneously are having a difficult time filling vacant positions. This can increase the workload for current employees which can lead to burnout and inevitably employees seeking employment elsewhere. Over half of personal caregivers leave for jobs outside of healthcare.

For patients who live in more rural areas, finding caregivers can be even more difficult. North Country Home Services, a company that hires and trains home health aides in a mountainous region of Connecticut, reports that it leaves about 400 hours of government authorized care unfilled due to staffing shortages, leaving many residents of rural areas concerned.

There isn’t a clear solution in sight. Many home care agencies are implementing a wide variety of strategies to help minimize the gap. One strategy for long-term and residential service providers have utilized is to limit admissions within their facilities. Others have cut health insurance coverage for part-time staff. 84% of providers of homecare services are using current staff to meet the demands left unfulfilled. They do this by offering overtime, double shifts, and other incentives which are expensive for the organization and can lead to staff burnout. Some groups are advocating for a pay raise for home health employees to a $12 or $15 minimum.

The gap in health care services surrounding home health aides is expected to continue to widen. This gap needs to be acknowledged in the same way the nursing workforce gap was and continues to be. The home health industry needs to employ strategic changes, practical incentives, and speak up about the home care gap to create a sustainable workforce for the future to meet society’s needs.

Ryan McEniff is a senior care expert and is the owner of Minute Women Home Care, a private home health care company located in Lexington, MA.