‘The Conversation Is Way Overdue’: Why the Home Care Staffing System Is Broken

Families trust home-based care workers with the lives of their loved ones during some of the most vulnerable stretches of their lives. But as at-home care becomes more popular in the U.S., supporting the individuals that make up the workforce will have to be a priority.

Without the workforce of home health aides, companions and other caregivers, expanding home- and community-based services (HCBS) and creating a more cost-effective, holistic approach for aging individuals will be all for naught.

Generally, in-home care workers make around $20,000 per year on average, often with no benefits and sometimes inadequate training. There is a high turnover rate — especially in private-duty home care — and the job vacancy rates are high.

Those unfilled job slots will only increase as home-based care demand goes up, unless something is changed, according to U.S. Rep. 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 in it. And I think the pandemic and COVID-19 has shined a light on how fractured the health care system is and how fractured the long-term care system is.”

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

Dingell has been an advocate for equity for the direct-care workforce for years. That passion developed after her husband was cared for at home by caregivers — something she recognized as a privilege.

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

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

That kicked off some legislative tailwinds for home-based care, with President Joe Biden’s proposed American Jobs Plan now planning to set aside $400 billion to better support the home-based care system in the U.S.

“It’s a conversation way, way overdue,” Dingell said. “The 10% increase in funding for home- and community-based services was a much needed investment in our front-line direct-care workers and those that they serve. That was the first dedicated HCBS provision included in any of the COVID relief bills, and it provides significant relief to meet immediate, COVID-specific long-term care needs that have gone unaddressed for far too long.”

Dingell is also one of the many lawmakers pushing hard for the additional long-term care support that would materialize if the American Jobs Plan came to fruition.

More attention being paid to the issue in Washington D.C., will help the workers, patients and the system over time, she believes.

“It sets the stage for further action … to finally reform our nation’s very 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. Increasing wages would not just help workers and patients down the line, but it would also help drive a more equitable system moving forward.

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

In regards to pay and benefits, things haven’t changed much during the pandemic, either. A recent study from the real-time staffing platform MedFlyt found that 83% of caregivers had not received 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 doing, but really can’t afford to do because they’re not even being paid enough to furnish their own lives.”

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

It’s her hope, as well as thousands of others in the industry, that a legislative push will allow that to become a reality.

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