The Care Gap: Why We Need More Home Health Aides

Senior with HHA

It does not matter what you call them: home caregivers, personal care assistants, home care workers, or anything else. Home health aides (HHAs) are the most in-demand workers in the country.

According to analysis of the latest data from the Bureau of Labor Statistics, there will be 1.3 million more direct care jobs by 2028. That makes home-based direct care the fastest growing sector of the U.S. economy by far. In fact, home care should see more job growth than the next two fastest growing jobs, food service and registered nursing, combined.

This is all good news for anyone who wants to become a home health aide. But it also brings up a question: why do we need so many more home health aides?

A Changing Population

First, the senior population in America is exploding, especially the oldest old, or people over 85 years old. In 2019, a little over 6.3 million Americans were 85 or older. That number is expected to more than triple to 19 million by 2050. Each of these seniors represents a potential client for a caregiver, since most seniors will need some sort of help as they age.

Not only is the population aging, but seniors generally want to live in their homes for as long as possible. According to a survey by the AARP, 90 percent of seniors want to age in place, and 80 percent believe their current home is the only place they will ever live.

The problem is, these seniors cannot say in their homes without help. People are living much longer now, and health problems and disability become more common as people age: the oldest old are far more likely to have one or more chronic health problems. Approximately 80 percent of people over 65 have one chronic condition, and almost 70 percent have two or more.

As a result, these seniors need help with daily living tasks and managing their health care. When multi-generational households were more common, family members provided that care. However, children are now moving away and families are more spread out. Trained caregivers pick up the slack so older adults can stay out of nursing homes.

Nursing homes are now an even less attractive option for seniors who need care because of the pandemic. COVID-19 has devastated nursing homes and other institutions. At the beginning of the outbreak, nursing home residents made up only 1 percent of the population, but they made up 43 percent of all COVID-19 related deaths. The virus could spread quickly within the close quarters and in a vulnerable population.

It’s not just seniors who want to stay in their homes. The government wants to keep them there too. All seniors are covered by Medicare, and many are covered by Medicaid as well. That means the state has to pay for most of their care, and it’s far cheaper for the state to keep seniors in their homes than to move them to an institution. For that reason, the government has been diverting more funding to pay for home care.

All this demand has led to massive growth in the home health industry. As of 2020, there were more than 12,000 home health agencies registered in the United States, a sharp increase from a little as 5 years ago.

High Turnover in Home Care

The other reason for all these job openings is the high turnover in home care: caregivers are leaving their jobs too frequently. Estimates vary significantly but most sources calculate turnover somewhere between 40 and 60 percent each year, with some suggesting it could be as high as 100 percent.

This turnover is a problem for both clients and home care agencies.

Clients receive better care from experienced caregivers. The more time an HHA spends with a client, the more familiar that HHA will be with a client’s unique needs and health history. Furthermore, like any worker, HHAs get better at their jobs with experience.

That is one reason home care agencies want to reduce turnover: in order to provide better care for clients. The other is to reduce their own costs. When a caregiver leaves, the agency has to spend time and money recruiting, hiring, and training their replacement. All these costs can be eliminated if that original caregiver stays with the agency.

Like demand for more workers, the need to reduce turnover drives up wages for caregivers. Research has consistently shown that the best way for an agency to keep their HHAs is to pay better wages and provide health benefits. That is one reason PASSi offers the wages and benefits that we do.

The “Care Gap” and Pay Increases

Together, the growth of the senior population and the high turnover among HHAs has created a “Care Gap”: we have more people who need care than we have caregivers to help them. An estimate from the asset management firm Mercer calculates there will be a workforce gap of 446,300 home health aides by 2025.

In other words, almost a half-million jobs will go unfilled unless something changes.

Realistically, there is only one thing that can change: higher wages. Companies will need to raise wages across the board (and states will need to increase Medicaid reimbursements) to attract more workers. Seniors will keep living longer, and they will not suddenly give up on staying at home. Likewise, institutions will not suddenly get cheaper, so the government will still have an incentive to keep seniors in the community.

Overall then, wages and benefits must rise, and continue to do so, in order to attract workers away from retail, food service, and other industries. That is the only feasible way to deal with this looming care gap.

A Perfect Storm for Home Caregivers

Better healthcare has left us with a strange problem as a country: people are living longer, but there are not enough people to help take care of them. Combined with shifting attitudes toward aging in place, this made home caregivers more important, and valuable, than ever.

For an individual worker, home health aide training is the best way to capitalize on the growing care gap. You can be part of the fastest-growing industry of the next decade, and provide care for vulnerable people who need it.

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Penn Asian Senior Services

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