A new report identifies opportunities to strengthen the home care workforce and improve quality and access.
With 15 million home-dwelling adults in the U.S. requiring some degree of personal assistance, there are significant opportunities for home care services and policies moving forward. These assistance needs are impacted by factors such as gender, race, ethnicity, nativity, geographic location, and health and economic status, as well as pending shifts in the population. A new report, Envisioning the Future of Home Care: Trends and Opportunities in Workforce Policy and Practice, offers insights into how to strengthen the lagging home care workforce and enhance quality as demands for services and support in this sector grow.
While unpaid caregivers (usually family members) provide much of the personal assistance for older adults, personal care aides, home health aides, and nursing assistants provide the paid home care support. The home care workforce has more than doubled in size from 2008 to 2018 and now stands at nearly 2.3 million workers. Personal care aides made up 81% of that employment growth. These workers are mostly female (87%) and people of color (62%). Nearly one-third (31%) were born outside of the U.S. Just over half (54%) have a high school education or less.
The home care industry is currently dominated by several trends including increasing for-profit ownership, the expansion of acute care providers into this sector, home care franchising, and the entry and exit of tech-driven companies. Elsewhere, publicly-funded consumer-directed programs, which enable patients/families to hire their own workers, have grown in popularity. These trends present some challenges. First, there is uncertainty about whether all home care providers are equally prepared to provide quality care and meet job/workforce standards. At the same time, the significant variation in certification and licensure rules complicates efforts to ensure consistency and effective communication across settings and providers.
The median wage for home care workers is $11.52 per hour, with annual earnings of about $16,200. These numbers are only slightly higher than they were a decade ago. Earning is limited by part-time scheduling, with nearly two in five aides working fewer than 35 hours per week. Many workers, it should be noted, would like to work more hours.
The PHI report authors suggest, “Along with better wages, hours, and benefits, the evidence shows that job quality in home care can be improved through high-quality supervision, which is often lacking in home care, and other employer-driven employment supports.” The authors further suggest, “At the systems level, strategies to improve job quality for home care workers include increasing the minimum wage and implementing supportive employment policies for all workers, along with raising reimbursement rates to fully cover home care labor costs and directly increase home care wages.” Monitoring and evaluation, they say, are essential to ensure these strategies are successful.
Watch InFront next week for more from this report regarding reimbursement/payments and home care technology.
