'The home health sector is one of the canaries in the coal mine of the effects of an aging population.' When it comes eldercare, help is wanted but workers are scarce.
By Jessica Hall
The U.S. will need about 7.9 million direct care workers by 2030, according to PHI National.
Home care provider Home Instead Inc. has a goal to hire 25,000 new care professionals this year, or about 25% to 30% more than last year. While that number sounds bold, it won't even make a dent in the millions of workers the home healthcare industry needs to add over the next several years.
With a current workforce of 65,000 home healthcare workers in the U.S. and Canada, Home Instead faces an industry churn rate of about 65% and a tight labor market where there's only 5.7 million unemployed Americans to fill about 10 million open jobs nationally.
"It's an ambitious push because there's an ambitious need," said Jisella Dolan, chief advocacy officer for Home Instead, an Honor company. "The desire to age in place, to age at home is real. The demand is there and is growing. Healthcare is moving to the home. We saw it come to life in the pandemic -- home care is a crucial part of healthcare."
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According to AARP, nearly 90% of adults over 65 would prefer to age-in-place as they grow older. In-home care professionals for older adults provide support for daily activities such as bathing, meal preparation, mobility, medication management, and other aspects of safety in the home.
Dolan acknowledges that the home care industry as a whole needs to tackle the public perception about home care offering difficult work for low pay, no benefits and limited career paths.
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Home Instead works to provide training and certifications for employees and offers "top of market" compensation among hourly wage jobs compared with hourly jobs at Target, Starbucks or Whole Foods, as well as benefits, Dolan said.
"We recognize that we need to pay what the Targets of the world are paying and top that," Dolan said. "The way first responders were celebrated and respected during the pandemic -- we need to elevate the sentiment and respect for the calling of care."
The industry has about 3.4 million home health and personal care aides, and workers in this field had a median pay of $29,430 in 2021, according to the Bureau of Labor Statistics.
The U.S. Department of Health and Human Services' Health Resources and Services Administration projects the U.S. will need about 1.85 million "full-time equivalent" direct care positions by 2025, increasing to 2.4 million by 2030. Since most direct care workers are employed on a part-time basis, the actual number of people to fill full-time equivalent positions will likely be twice that many.
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By other measures, the need is even more dire.
PHI National, which tracks direct care jobs, demand, supply and working conditions, estimated in 2022 that there are about 4.7 million direct care workers (including full-time and part time workers) in the U.S. and we'll need 7.9 million workers by 2030.
"The home health sector is one of the canaries in the coal mine of the effects of an aging population," said Tara Watson, director of the Center on Children and Families and David M. Rubenstein Fellow in Economic Studies at the Brookings Institution.
"We have a large number of baby boomers who will need support and fewer workers per older person to do this work. Improving wages and working conditions is part of the solution, but ultimately it will also be critical to expand the ranks of workers through immigration," Watson said.
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Low wages are a reality of the job.
"Wages are the biggest obstacle to hiring," said Carrie Blakeway Amero, director of long term services and supports at the AARP Public Policy Institute. "Once they're hired, there's a really high turnover rate. Retention is key."
"I think we don't tend to value caregiving. Sexism and racism affect these workers. All these factors compound and make it harder for these workers," Amero said.
"The people who take these jobs are often middle-aged women. Half are immigrants. Because of population demographics, we don't have as many middle-aged women right now as we do older and younger people. There's just not enough to fill the need," Amero said. "People have so many more options and better options than going into this field right now."
Options for helping find caregivers is offering college credit to college students for caregiving or better support and pay systems for family caregivers.
Watson of the Brookings Institution said there are limits to wages due to how home health is financed.
"Medicaid supports some home health and has reimbursement rates that constrain wages. And most people paying out of pocket will have a hard time affording help as wages rise. In practice, many families cobble together informal or unpaid care, often by mothers, along with some professional support," Watson said.
By 2034, the U.S. Census Bureau projects that people aged 65 years and older will outnumber those aged 18 years and younger for the first time in U.S. history. Demand for home care will only surge and there's already a scarcity of workers.
"The crisis is already here. We can't find workers to do this job. The pandemic created such a shortage. There are no workers anywhere. Something has to be done because it's such a crisis right now," Amero said, adding that it will likely take both public policy and industry initiatives to tackle the hiring problem.
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