Supporting in-home caregivers as the need for their services continues to grow

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By Mia Haney

The past two years have been extraordinarily difficult for people around the world. The pandemic has taught us many things, not the least of which is the daily necessity for high-quality healthcare. We often think of healthcare in an ambulatory or acute setting; however, at-home care continues to grow in importance as the population ages and desires to live independently.

Caregivers are called on daily to provide care to older adults, people with disabilities and those with chronic or acute conditions to assist with activities of daily living (ADL).

Setting the daily and long-term impact of the pandemic aside, a home care job was difficult before COVID-19, as caregivers regularly face many obstacles making it difficult to provide basic care and support, such as:

  • Personal care (bathing, grooming, dressing and hygiene)
  • Meal preparation
  • Light housekeeping
  • Errands
  • Transportation
  • Companionship

“Staffing in home care agencies was already problematic before the pandemic, and most respondents noted that staffing shortages have worsened,” according to research from the Office of the Assistant Secretary for Planning and Evaluation. “Many respondents reported that staff left their jobs due to fear of exposure to the virus. Some older workers and people with underlying conditions that made them more susceptible to hospitalization if exposed to COVID-19 chose to leave the field or retire.”

In addition to these stressors, the closing of schools and childcare made it even more difficult for in-home caregivers to remain on the job.

If this wasn’t bad enough, the pandemic took a severe emotional toll on caregivers and their clients. Neither were immune to the feelings of social isolation, the myriad changes caused by the pandemic in general and the new ways each had to interact with the other.

“Fear of infection and transmission among HC clients and aides were strong themes,” according to BMC Health Services Research. “Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC (home care) aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch – resulting from physical distancing practices – altered the expression of compassion in the HC aide-client care relationship.”

While this research focuses on the happenings during the pandemic, which appears to be winding down to some degree, the director of the Centers for Disease Control and Prevention recently said we should expect COVID-19 and its variants to recur seasonally like the flu, potentially making the drain—both in the number of caregivers able to work and the psychological toll—a continuing challenge.

It's clear caregivers are integral to the success of the healthcare system, yet the system often doesn’t do enough to ensure the industry can supply an adequate workforce to our aging population. By properly funding home and community-based services, home care agencies can support this workforce to provide better pay, benefits and careers.

Lessening turnover

The need for caregivers will continue to grow as the number of older adults, including those with chronic illnesses or ambulatory issues, increases.

The caregiver challenge nationwide is magnified by the growing numbers of those who need assistance. While there are approximately 2.4 million in-home caregivers today, the number of older adults continues to grow—projected to be nearly 96 million by 2060—which will drive the demand for caregivers and, potentially, cause the number of people who need help compared to the number offering help to become more unbalanced than it already is.

While the need grows, caregiver compensation and benefits continue to be limited by Medicaid reimbursement, which lags behind competitive private market rates. Today, nearly half of caregivers live in low-income households and rely on public assistance to help make ends meet.

“Caring for and supporting other human beings is a wonderful calling but should not require people to take a vow of poverty to do so,” writes Maribel Slinde of Iowa CareGivers, a non-profit that advocates for direct care workers.

In fact, 18% of home care workers live below the federal poverty level, making an average of $13 an hour as of February 2022. In 2020, turnover at home care agencies paying above the 75th percentile was more than 49%; for those companies paying below the 25th percentile, it was slightly more than 75%, according to the 2021 Home Care Benchmarking Study.

“Low wages combined with a high rate of part-time work make it challenging for direct care workers to financially support themselves and their families. Median annual earnings are just $20,200,” according to PHI’s Direct Care Workers in the United States report for 2021.

While compensation, including pay and benefits, is extremely important to caregivers, the job is more than that.

Caregivers are thoughtful, compassionate people dedicated to improving the lives of their clients. We need to cultivate company cultures that support caregivers to advance their careers and education, support emotional and mental health and empower them by providing competitive wages and benefits that can support their families.

We need to make home care agencies “employers of choice,” places where people want to work. It is imperative that state-managed Medicaid programs embrace caregivers as an integral player in the health care continuum–a means for rebalancing Medicaid spend from facility to home-based care and a cost-efficient solution for preventing unnecessary medical interventions. Investing in this workforce is imperative to the sustainability of our health system.

Mia Haney is Chief Operating Officer – Personal Care at Modivcare.


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