As more and more older adults report a desire to spend their twilight years at home, there has been a boom in home-based care. The trouble is, the home care industry has been plagued by staffing shortages for many years. This makes it difficult for the families of older adults and the older adults themselves, to give older adults what they sorely desire. Often, family members have to become makeshift caregivers, forced to get time off from work, or sometimes even work part-time, use adult day care facilities, or retire early, just so they can give older adults the home care that they need. Getting home care is even harder today, because the risks of having hired help or volunteers in the house often outweigh the benefits. This puts additional pressure on family members to take care of older adults. It’s this crisis that is the subject of a fascinating piece in the New York Times.
As the New York Times shows, it can be hard to find help, either through word-of-mouth, local agencies or other means. Often, local agencies will charge fees only to tell you that they don’t have any home caregivers for you. Eventually, some families are forced to place their older adults in facilities, often at incredibly steep rates. The economic consequences of the staffing shortages in home care are massive.
The homecare industry is made up of a hodgepodge of nonprofit programs, publicly funded care, and for-profit businesses and chains, all of whom operate under federal and state regulations. There is also a gray market that caters to clients who want to avoid regulation and so hire privately.
Vicki Hoaqk, the Home Care Association of America’s executive director, says this is the most frustrating period in her 20-year career in the industry. It has never been so hard to find workers. The association is made up of 4,000 agencies and 500,000 people and yet, even then there is a struggle to help people get the workers they need.
According to the Bureau of Labor Statistics, the direct day care workforce shrunk by 342,000 workers in the last year. This includes nursing homes, as well as other home care and residential care staff. This reverses a long-held pattern in which employment rose in each category every year. The reason for the contraction in the labor force is that many workers were laid off, or workers resigned because of Covid-19 related fears or health problems, child care issues, and other issues.
Thankfully, employment in the home care industry rebounded toward the end of last year and is now just 3% off from its pre-pandemic levels. However, this rebound occurs at a time when there has been an explosion in demand for home care workers. Other healthcare categories, such as nursing home occupancy and assisted living, are in decline, whereas home care is on the rise. At present, there are over 800,000 older adults and disabled people, all eligible for Medicaid, and all on state waiting lists to receive home care. Those clients who are paying with private schemes or their own funds are being turned away by agencies. With the nightmare of Covid-19 receding, many people have taken the lesson that congregate care settings are less healthy and safe than home care. Resolving this crisis is one of the great challenges the country faces moving forward.