Given that so many older adults prefer to age in place for as long as possible, the assistance of home health aides has become a major industry and means of helping people stay in their homes longer. But it’s a sector of the senior housing market that’s often recognized more for its challenges than for how it can empower families to live their best lives.
As both a consumer of home health aide services and a senior care industry insider, Matt Perrin, co-founder of the independent online senior living facility review site Ro & Steve, says the challenge families face when arranging stable and qualified in-home senior care services are pressing, and very real.
“For us as consumers, it just comes down to a stability issue,” he says, explaining how arranging appropriate care for his wife’s father, who lives with them in New Hampshire, has been an ongoing process that requires flexibility and a lot of advocacy. From simple logistics of making sure the Perrin family has coverage when they need it to making sure the caregivers they’re working with are a good fit for his father-in-law’s temperament and medical conditions, the whole endeavor is an ongoing process that has involved working with several agencies and many different caregivers.
[See: 7 Red Flags to Watch for When Choosing a Nursing Home.]
This is a common storyline for families dealing with an aging loved one who needs in-home care, and one that Pamela D. Wilson, a caregiving expert, advocate and speaker based in Golden, Colorado, says is only likely to get worse in the immediate future. “I don’t know that there is a solution,” Wilson says.
Drivers of the Caregiver Shortage
Sonya Hinds, chief administrative officer of Interim HealthCare, the oldest health care franchise company in the country, says that demographics are a major driver of the current pressures in the home health care industry. “There are 10,000 baby boomers who are turning 65 every day. We don’t have enough qualified and trained caregivers to take care of those 10,000 people who are quickly needing that in-home care. We’re not keeping up with the supply and demand.”
As the U.S. population continues to age and demand for in-home health aides increases, more businesses spring up to cash in on the boom. Not all of them are focused on caregiving; some are more interested in making a buck, Wilson says. “So many franchisees see a booming industry, and they don’t have a background (in caregiving) at all.” Part of the issue is that “agencies make money based on volume. You need a number of clients and hours to cover overhead, and agencies that have been around for longer and have a better revenue base tend to do better than newer ones,” she says.
Experience among caregivers who work for these organizations is also in short supply, Hinds says. “There’s a lot of schools and certifications and opportunities for caregivers to gain the credentials necessary, but they don’t necessarily have the experience,” of actually working with seniors who need that care, Hinds says. Experience only comes from doing the job of caring for someone.
And perhaps most importantly, it’s just plain hard work that isn’t always a long-term career choice for caregivers. “It’s not an easy job and it’s not for everyone,” Hinds says. “You pair that reality with the fact that many caregivers are only making minimum wage,” and that means caregivers are prone to burnout faster. Competition in the industry has also increased, which makes keeping good caregivers challenging for some agencies. This in turn generates turnover in staffing pools.
The Staffing Shortage Takes a Toll
Because of the various pressures in this space, “the people who need the care the most unfortunately may not have access to it,” Hinds says. The challenge of finding the right person to assist an aging loved one, whether it’s with bathing and toileting or trips to the grocery store, is a vast one for many families, particularly because some people are reluctant to ask for help and may not be comfortable with inviting strangers into their homes. “Trying to find that person who’s skilled and qualified and who wants to do it and who is going to be able to build a relationship with mom or dad — it’s a very dynamic kind of situation: Hinds says. “Many people are very selective about who they invite into their homes, and sometimes it’s very difficult to ask for that help. So when we do get to that point, we want to make sure we’re aligning them” with the right person.
Perrin relates the story of an especially good caregiver who worked with his family. The person didn’t turn up for an appointed session one day, having suddenly quit the agency for another job that offered slightly higher pay and some benefits. “We don’t begrudge her for it — she got a few more dollars per hour and a subsidy on benefits. But anytime we feel like we’re hitting a groove,” with the right mix of caregivers and coverage, “something happens.”
Part of the challenge lies in the nature of caregiving — “it’s not just finding a warm body to fill a four-hour gap on a Tuesday,” Perrin says. Rather, it’s critical to make sure that his father-in-law, who has Lewy body dementia, is comfortable with the caregiver and that the caregiver is comfortable working with him. That process takes time, and requires some intensive relationship-building.
When a good caregiver suddenly leaves an agency, it can deal an emotional blow to the senior and the family that’s come to rely on his or her help. “You get to know these people. We care about them. We hear about their lives. They do this hard work that is of immeasurable value to us as a family,” but often they aren’t making much more than minimum wage and for simple economic reasons, may need to move on.
[See: Easy Ways to Protect Your Aging Brain.]
Training, Recognition and Relationship-Building
That said, the solution probably isn’t simply raising pay for caregivers, though that is likely part of the answer. The standard business model many agencies use works out to families paying an hourly wage, often in the $25 to $30 range. Part of that cost might be covered by insurance or Medicare, but often, much of it isn’t. Of that fee, the agency usually takes half or more to cover its overhead costs. Wilson says that the more training a caregiver has, typically the higher the fee charged to the family, which can mean high prices to families depending on their loved ones’ needs. Many families struggle to afford those rates, so rate increases might prevent a lot of families from being able to afford home health aides.
So the solution is for agencies to take a smaller cut, right? Not necessarily. For their part, it may be difficult for some agencies to pass more pay on to the workers or offer any or better benefits because many are already operating on very slim margins. A business must make some amount of money in order to stay in business. Certainly, not all businesses in this space are run the same way and some are without a doubt gouging customers and workers. But many are doing the best they can by clients and employees in a difficult market. It’s a tough financial nut to crack.
Perrin urges agencies to consider how they can find other ways to add value for employees, in hopes of retaining their workforce. “Are there ways they could provide career development opportunities or some subsidy on health benefits? He says by thinking more broadly about the challenges and finding creative ways of addressing them, agencies might find they have reduced turnover and happier clients. “Are there ways they can look at their (financial) pie and reallocate and channel some of that capital to maybe a more impactful party,” such as finding ways to reduce overhead or finding a way of adding value to employees’ experience that doesn’t necessarily have to be monetary in nature. He says he thinks incremental progress will be the key to improving the situation in the senior home care field, and that recognizing the hard work many caregivers put in has to be part of the deal.
Hinds agrees that recognizing caregivers for their hard work is important. “It’s such a rewarding and noble profession, taking care of people who may not be able to take care of themselves. But this is a workforce that doesn’t always get the spotlight or recognition. They’re not doctors. They’re not nurses. But they’re the people on the front lines doing amazing and valiant work every day.” She says that by better recognizing their efforts in a variety of ways, more people might be inclined to enter this challenging profession, which could alleviate the shortage of caregivers that so many families are currently dealing with as best they can.
Better training should also be part of the solution. “Not all agencies are created equal, and not all agencies offer the same level of credentialing, training and oversight,” Hinds says. Wilson encourages agencies to offer employees more training, particularly with regards to boundary-setting, so that families don’t try to exceed the terms of the care relationships and make unreasonable demands on caregivers.
But offering training to in-home health aides can be challenging for agencies. “When you have a decentralized workforce that, by the nature of what they do, is always out of the office,” building training programs they can access takes creativity. Technology may be helping: Offering online or video training courses that aides can complete when they have time is an option that’s gaining traction.
Families may also need to be involved with training each new caregiver that comes to the house, Wilson says, and although this can be challenging, taking the time to invest in helping someone get up to speed on what works best for your loved one may lead to better longer-term results for everyone involved.
Find the Right Care Solution
If you’re seeking in-home health care, Wilson recommends meeting with agency staff to help assuage fears and help you find a better fit. She also recommends asking for a copy of the background check for each individual caregiver who’s being offered to your family. If you aren’t comfortable with anything you find in these documents, ask for a different caregiver. References from other families the provider has worked with may also help you get a better sense of who you’ll be working with and how they might fit into your family.
You should also ask about training and certifications. “Training is a differentiator,” Hinds says, and finding an agency that conducts regular training and offers employees opportunities for career development might signal that it’s a good one.
As Wilson notes, agencies that have been around for longer may have a more stable care model. Similarly, she says to look for agencies founded by individuals with a background in caregiving, such as a nurse or other medical professional. Avoiding agencies that appear to be set up solely to make money might be a smart move. “You have to (become a caregiver) because you love it. You’re not going to become a millionaire,” in this business, Wilson says.
[See: 11 Things Seniors Should Look for in a Health Provider.]
And, you need to take careful stock of your loved one’s needs and comfort level with working with an outsider. “Be very specific and honest,” about preferences and prejudices that your loved one may hold and how such could impact the patient-caregiver relationship, she says. It can be a tricky relationship to forge, so being open and honest from the beginning is generally the best approach.
“It’s a human business,” Perrin says, and as such, “a fantastic, incredibly kind caregiver may, for one reason or another, not be the right fit for a specific (senior) or family. There’s a big investment of time. And as much as we might try to avoid it, there’s emotion from the consumer’s perspective. We work hard to find the right mix and then keep them.”
Though it’s not a simple solution, Perrin says increasing communication and rolling with the punches has been the best way his family has found to cope with the challenges of in-home care. “We just really invest in the relationship with the individual” caregiver. By being open and honest with that person, Perrin says the hope is that the caregiver will reciprocate and let the family know if he or she is planning to change jobs. “We’re really trying to build a relationship so we can get some advance notice. Absent the challenge not happening, that’s the best thing we can have,” as advance notice offers the family “more time to find an alternative solution without upending our lives.”
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The Challenge of Senior In-Home Caregiving originally appeared on usnews.com
