Critical homecare workforce deserves recognition

Tuesday, February 16, 2021

HHA montageHome health aide. Direct care workers. Paid caregiver. There are many names and classifications to describe someone who provides care for another, but it comes down to one thing: caring for people, real people.

Home health aides provide critical and often life-saving care for older adults who want to remain in their homes as they age. They provide very personal care – help with bathing, dressing and eating – as well as important everyday tasks like cleaning, cooking and running errands. Home health aides are in a position to get to know their care recipients intimately and can be the first to notice critical changes in physical and behavioral health.

Yet nationwide, home health aides earn less than $12 per hour on average, with nearly one-quarter living below the federal poverty line. Wages are typically based on Medicaid reimbursement rates in each state (Medicaid is the largest payer of home health and long-term care services).  While many states, including Ohio, do increase reimbursement rates from time to time, those increases do not keep pace with inflation or wages in other sectors of the economy.

A lifeline to independence for older adults

Most older adults – nine out of 10 – want to stay in their homes as they age. But, most will also need some form of long-term care during their lives (seven out of 10). This means many will need the help of a caregiver. As families work to find balance in their daily lives – raising children and managing a career while caring for an older loved one (often long-distance) – they increasingly turn to home health aides to fill gaps in care and ensure a good quality of life for their loved one.

There’s no question that home health aides provide care that is essential to the lives of their clients. Without this care, there would be monumental gaps in our healthcare system and many older adults and families would have no other option but to choose more expensive and less personal care options, such as a long-term care facility.

A critical workforce in jeopardy

But the stability home health aides provide is in jeopardy. Home health workers’ low wages, thin benefits, unpredictable schedules and other job challenges and stresses mean there is a shortage of qualified home health aides. As the economy has improved in recent years, many have left the industry for higher paying, more stable employment opportunities.

The impact of this shortage can be felt nationwide, and our region is not immune – especially in rural areas. Home health care providers, who hire aides to provide care for their clients, are struggling to recruit and retain staff. As a result, older adults who rely on this critical care – including those enrolled in programs managed by Council on Aging (COA) – experience delays in starting their services, irregularities in their service schedule and inconsistencies in the aide who provides their care.

“Because of the shortage, clients that need help aren’t getting it,” said Samantha Williams, clinical director with Home Care by Blackstone, a COA contracted service provider. “We just don’t have the aides to work.”

“This workforce is absolutely critical to helping us fulfill our mission,” said Ken Wilson, vice president of Program Operations at COA. “Right now, the demand for qualified home health aides far exceeds the available supply. This impacts our ability to provide consistent, high-quality care to our clients.  If this trend continues, older adults and families will be faced with difficult decision about how and where to get care.”

Tackling the issue at the local level

In recent years, COA has done a number of things in an attempt to combat the worker shortage.

In 2018, COA conducted focus groups with area home health aides to learn more about their career choices. The results showed home health aides in COA’s region take great pride in the care they provide to vulnerable adults. “It’s a good day for me when I’m able to make someone’s day a little brighter,” an aide said.

Aides also reported satisfaction with their jobs, especially in knowing their work improved lives and helped people maintain independence in their own homes. “It isn’t really like a job, it’s like taking care of family,” an aide said. The aides also stated they had their clients’ trust and viewed themselves as advocates for their clients’ needs and well-being.

Based on feedback from these focus groups and other research, COA expanded options that offered families more choice in selecting a care provider and identified other ways to minimize the impact of the aide shortage on area older adults.

COA also expanded Consumer Directed Care (CDC), a program in which older adults and their families can hire someone they know to be their caregiver. Instead of using a home health care agency, clients become “employers” and hire their own “employees” to provide certain services offered through COA programs. In many cases, the employee is someone the client already knows – a relative or friend. The CDC employee is paid for the care they provide through one of COA’s programs.

Additionally, in programs where the aide shortage was having a significant impact on quality and service delivery, COA brought new providers into the market and piloted a rate increase for home care aides, the results of which showed an increase in client satisfaction but little evidence that it kept aides from leaving their jobs. COA also worked with providers to adjust training requirements for aides who provide only housekeeping services and to create efficiencies to improve scheduling and travel time for aides.

Recognizing a critical workforce

Beyond programmatic changes, COA wanted to recognize local home health aides for their critical role in helping COA fulfill its mission. COA’s Service Excellence Award was created to recognize home health aides by showing appreciation for the important work they do.

“These awards are a reminder to this critical workforce that their efforts really do make a difference in the day-to-day lives of their clients,” said Council on Aging CEO Suzanne Burke.

Since 2019, COA has recognized 112 home health aides who provide care through a COA contracted service provider. The award recipients are nominated by their clients, clients’ family members, care management staff and their employers. The recognition includes messages of appreciation, devotion, attention to detail, compassion, service above and beyond the call of duty, even life-saving events.

The Service Excellence Awards boost the morale of home health aides and reinforce the importance of the care they provide. “Winning the award was very meaningful to me,” said one aide. “It showed me that all the hard work I’m putting into this passion is being recognized by my clients.”


PHI: U.S. Home Care Workers Key Facts

U.S. Bureau of Labor Statistics