Shortage will require re-thinking how we value and pay home health workers

Direct-care health aide — helping the elderly bathe, dress and eat — is the fastest growing occupation in the U.S. But the labor shortage is dire.

As the baby boomers age, this sector of health care faces a dangerous shortage because the work is surely not “easy street” and the pay is crummy. Aides are often bitten, kicked or cursed at by patients with dementia.

Nursing homes and in-home health care agencies are struggling to find help, and about 20 percent of the workers in this field of care are more than 55 years of age and eager to retire.

Nursing aides, mostly women, do some of the nastiest work in nursing homes — changing diapers, taking guff from patients angry in pain and discomfort. The workers’ rate of occupational injury related to back or other muscle strain reportedly is greater than factory or construction workers.

Not surprisingly, turnover is high. Between 43 percent and 75 percent of these aides quit each year, according to various studies. That compares with 28 percent of all health care and social assistant jobs in 2012, according to government figures.

The median hourly pay for nursing aides is $11.74, according to the Labor Department. Some nursing aides start at $8.25.

The number of seniors 65 or older is estimated to reach 73 million by 2030. By 2020, experts calculate, we will need 50 percent more health aides than the number in the present work force.

Half of home health care workers reportedly live at or near the poverty level. These aides typically spent much more time with patients than family members do. Many seniors wouldn’t be able to live on their own without the help of aides.

Home health agencies blame the government for failing to increase reimbursement rates for Medicare and Medicaid patients while costs are rising.

A possible key to the looming health aide shortage is immigrants. About a quarter of the health care aides are immigrants. NPR recently carried a story about one of them. Elizabeth Castillo was born in central Mexico. She’s a U.S. citizen now. She has been working in El Paso, Texas, for the past 30 years for a home health care agency.

Castillo says she makes $7.75 an hour and she wants people to know that she has an important job. Speaking in Spanish, she says “I wear so many hats on this job I wish we were valued because we provide much more than companionship. I’m a social worker. I’m a psychologist.”

About a quarter of the home health aides are foreign born. Documented immigrants are seen as one of the best hopes to help relieve the labor shortage.

Paul Hogan, head of Home Instead, one of the country’s largest home care agencies, says about a quarter of his employees are immigrants.

Michael Elsas, president of Cooperative Home Care, agrees. He says the size of his agency has quadrupled in the past decade.

“This is a wonderful entry position and we shouldn’t be ashamed of that,” Elsas says. “But salaries need to be higher.

“We value the fact that people come and pick up our garbage every single morning. How do I know that we value them?” asks Elsas. “Because we pay these people more than we pay the worker who takes care of our elderly population.”

Cooperative Home Care runs training in English and Spanish, graduating about 500 aides a year. “But the country isn’t ready for the thousands of boomers that will retire every year.”

Immigrants may well be a piece of the solution. But only a piece of it. The future of home health care is uncertain, and presents a major problem for a host of this country’s seniors.