Given the choice, would you prefer to live and be cared for in the comfort of your own home or a dedicated institution? According to John Bowblis, professor of economics at Miami University, long-term care in the U.S. “is going through a process of ‘rebalancing’ overall—shifting from institutional care to more home-based services.”
This shift is generally viewed as positive, with most older adults and people with disabilities understandably preferring living at home for as long as possible. As a result, the demand for dedicated in-home caregivers has surged. A 2023 study found that from 2008 to 2019, the number of Medicaid-covered patients seeking home care increased from 2 million to more than 3.2 million.
However, as demand soars, the whole industry is struggling with a shortage of qualified home care workers. That same study discovered that, while the home care workforce had grown during those years (from 840,000 to more than 1.4 million), the difference in growth meant an “11.6% drop in the availability of home care workers for every 100 patients seeking their help.”
Despite the indispensable role of home care workers, nonprofit organizations like our clients VNS Health and Consumer Directed Choices, responsible for sourcing, coordinating, and delivering quality home-based care, are feeling this challenge acutely. These new realities strain the existing workforce, limiting the quality and availability of care throughout the system. Consequently, the whole sector is challenged to greatly improve its efforts to attract and retain a quality workforce of caregivers.
A growing crisis: the current landscape of home care
The shortage of home care workers has made headlines nationwide from Arizona to Wisconsin to Massachusetts. About 95% of home- and community-based care providers have expressed “moderate or severe staffing shortages,” with 77% turning away new referrals as a result. To make things worse, 72% of providers also admitted that the staffing shortage has made it difficult to “adhere to quality standards.”
This crisis is only expected to deepen with time as the population ages. With the number of adults aged 60 and older in the U.S. expected to grow 30% by 2050, the demand for home care workers is predicted to also surge by “nearly 37% by 2028.” If the ongoing challenges in recruiting and retaining workers persist, a severe shortage is imminent nationwide. New York State alone is projected to be short of nearly 1.5 million home health care workers in the coming decade.
Behind the statistics are the very real stories of individuals and families struggling with the shortage. From being unable to take your child home from the hospital because of a lack of home care nurses to having to constantly find and train new aides as a result of high turnover, families are facing a landscape shaped by scarcity and uncertainty.
Consequences of the home care worker shortage
This shortage of home care workers has serious consequences for everyone involved. Caregivers are feeling the weight of burnout and fatigue as they struggle to cope with understaffing. With fewer hands on deck, they’re pushed to their limits trying to meet the needs of their clients while looking after themselves. This not only affects their own health but also impacts the quality of care they can provide.
Meanwhile, recipients of home care are experiencing delays in getting the help they need, leading to increased anxiety and uncertainty about their welfare. And, with staffing levels stretched thin, there’s the risk of rushed or incomplete care, putting the safety and comfort of patients at risk.
Caregivers are feeling fatigue as they struggle to cope with understaffing. Recipients of home care are experiencing delays in getting the help they need, leading to increased anxiety and uncertainty about their welfare.
Economically, the shortage poses significant challenges. As demand for home care services rises, the lack of workers drives up healthcare costs and strains already burdened systems. Without enough home care workers, people often resort to more expensive forms of care like hospitalizations or long-term facilities, driving up costs and overcrowding hospitals.
To top it off, the shortage also impacts family caregivers who often step in to fill the gaps. Juggling caregiving with work can lead to lost productivity and missed career opportunities, creating a cycle of financial strain.
Addressing the causes
To ensure the sustainability of this vital workforce, addressing the root causes of the shortage is essential. For many, this starts with fair pay and comprehensive benefits, including healthcare coverage, retirement plans, and paid time off.
Pay is regularly cited as “the biggest barrier” to growing this workforce, with countless stories of workers leaving the sector for “less labor-intensive jobs that pay better.” Some studies have even reported that nearly 25% of home care workers live below the federal poverty line, and more than 50% are enrolled in programs like the Supplemental Nutrition Assistance Program.
There are discussions that the makeup of the workforce contributes to this challenge. Nearly 90% of home care workers are women, with over half being people of color and more than a quarter born outside the United States. These statistics paint a picture of a workforce with “limited political influence” doing a job that is considered at “the bottom of the economic pole.”
By shifting to a “caregiver-first culture,” home care companies can address the shortage directly and ultimately ensure the well-being of the care recipients.
Working conditions are another obstacle to be improved. The job is physically demanding with unpredictable yet long schedules. Plus, workers often don’t receive enough training to handle the complex medical conditions they come in contact with. Taking measures to ensure safe working environments, provide adequate training and support, and prevent burnout and fatigue could be valuable ways to improve recruitment and retention of essential home care workers.
For companies that are already delivering on the above, it’s also equally important to clearly communicate their commitment to offering better pay and benefits in their recruitment efforts. For instance, Consumer Directed Choices’ straightforward message to those who relate to the statement, “I am a caregiver and want better pay and benefits,” leaves little room for confusion, effectively conveying the company’s mission to address and remedy the issues that caregivers struggle with the most.
Essentially, by shifting to a “caregiver-first culture,” home care companies not only address the shortage directly but can also be confident that, by treating their caregivers well, they will ultimately ensure the well-being of their customers in the future.
Campaigning for change
In diving into this home care crisis, it becomes quickly apparent that many professionals in the field believe that the solution lies not just in addressing immediate recruitment needs but also in initiating a major “cultural shift” in how “society views and values home health care work.”
Raising awareness is key, as emphasized by Bill Dombi, president of the National Association for Home Care & Hospice. Public awareness campaigns hold the potential to elevate the profile of home care workers, fostering a newfound respect and appreciation for their contributions. As Dombi explains, “It is tough to take a job that people don’t respect, and if you can bring the respect and increase the image—and we believe COVID has helped do that—we can make some headway.”
Dr. Mary Naylor of the University of Pennsylvania echoes this sentiment, advocating for comprehensive measures that extend beyond mere financial incentives. “We should, as a society, say that these people matter,” said Naylor. Her vision for creating career pathways and opportunities for upward mobility speaks to the need for structural reforms that empower home care workers to thrive in their roles.
The solution to the home care worker shortage lies not only in improving pay and working conditions but also in fostering a culture of respect and appreciation for the indispensable work they do.
Ultimately, the solution to the home care worker shortage lies not only in improving pay and working conditions but also in fostering a culture of respect and appreciation for the indispensable work they do. Public awareness and recruitment campaigns, powered by strategic marketing and advertising direction, can accelerate this transformation, paving the way for a future where home care workers are rightfully valued and celebrated.
In the meantime, if you are a home healthcare organization struggling to recruit and retain quality homecare workers and you do not compete with our current clients, Tronvig would be happy to give you home healthcare recruiting, advertising, or strategy support on these issues.
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Image licensed to Tronvig / Consumer Directed Choices
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