‘The conversation is way overdue’: Why the home care staffing system is broken


Families trust home health aides with the lives of their loved ones during some of the most vulnerable times in their lives. But as home care becomes more popular in the United States, supporting the people who make up the workforce will need to be a priority.

Without the workforce of home health aides, companions and other carers, the expansion of Home and Community Services (HCBS) and the creation of a more cost effective holistic approach to aging people will not serve to nothing.

In general, home health aides earn around $20,000 a year on average, often with no benefits and sometimes with inadequate training. There is a high turnover rate — especially in private home care — and vacancy rates are high.

Those vacancies will only increase as the demand for home care grows unless something changes, according to U.S. Representative Debbie Dingell, a Democrat from Michigan.

“I don’t think people think much about long-term care,” Dingell said during a recent webinar hosted by Altarum. “They don’t think about how broken or fractured the system is until they’re there. And I think the pandemic and COVID-19 have brought to light how fractured the health care system is and how fractured the long-term care system is.

Altarum, based in Ypsilanti, Michigan, is a nonprofit research and consulting organization that serves government health insurers, health foundations, and other nonprofit clients who focus on health and Healthcare.

Dingell has been an equity advocate for the direct care workforce for years. This passion grew after her husband was cared for at home by caregivers – which she acknowledged as a privilege.

“I really learned in those four years what the challenges were for caregivers,” Dingell said. “And for those in long-term care, I was lucky enough to be able to keep my husband at home. And I think more people should be able to do that. We must fight for more home and community care, so people can stay at home where they are happiest.

The Biden administration’s U.S. bailout was a start, Dingell said. It allowed for a 10% FMAP increase in Medicaid funding for HCBS over the next year.

This has thrown legislative tailwinds for home care, with President Joe Biden’s proposed US jobs plan now to set aside $400 billion to better support the US home care system.

“It’s a conversational way, way overdue,” Dingell said. “The 10% increase in funding for Home and Community Services was a much-needed investment for our frontline workers and those they serve. This was the first dedicated HCBS provision included in one of the COVID relief bills, and it provides significant relief to address immediate and specific COVID long-term care needs that have gone unaddressed for too long. long time.

Dingell is also one of many lawmakers pushing for the additional long-term care support that would materialize if the U.S. jobs plan comes to fruition.

Greater attention to the issue in Washington DC will help workers, patients and the system over time, she says.

“This sets the stage for further action … to finally reform our country’s badly broken long-term care system,” Dingell said.

Equity in home care

The direct care workforce is largely made up of women, people of color and immigrants. Raising wages would not only help workers and patients down the line, but it would also help advance a fairer system.

With low pay, no benefits, few days off, long hours and multiple clients, caregivers are likely to burn out even outside of the pandemic, Henrietta Ivey, a caregiver and founder of Black Women in Home Care, also said on the webinar.

When it comes to salaries and benefits, things haven’t changed much during the pandemic either. A recent study by real-time staffing platform MedFlyt found that 83% of caregivers did not receive more pay or benefits during the public health emergency.

“I hear home care workers talk about how they are suffering because of the [conditions] they have,” Ivey said. “They’re depressed, because they’re working to try to make a living in a job that they love to do, but really can’t afford to do because they don’t even get paid enough to furnish their own life.”

Ivey coined the acronym “RPP,” which stands for “Respect Us, Protect Us, and Pay Us.”

It is his hope, along with thousands of others in the industry, that a legislative push will make this a reality.

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