Confronting the Growing Shortage of Care Workers For Older Adults

A nurse pays a visit to a patient at her house. (Photo courtesy of LightRocket/John Greim via Getty Images)
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Every conversation I have with senior living facility and home care agency owners swiftly turns to one topic: a critical shortage of caregivers. The issue is not new. For years, the long-term care industry’s capacity to employ has been hampered by poor pay, low prestige, and physically and emotionally hard job. The supply of foreign-born workers, who make up approximately a quarter of all direct care workers, has been further reduced by Trump’s harsh immigration policy.
The covid-19 epidemic exacerbated these issues. Over the last 16 months, covid-19 has killed over 160,000 people, including approximately 2,000 employees. While schools stopped offering in-person learning, aides, who were largely women, were unable to secure childcare for their children and were forced to abandon their positions. Only approximately half of facility-based employees have agreed to be vaccinated, putting their employment in jeopardy. Now that hospitality and other industries are scrambling to find willing workers, caregivers have a plethora of job options, many of which are less demanding and pay better.
Recruiting and retaining employees
New people are progressively returning to senior housing as the pandemic subsides. However, given the staffing constraints, a sluggish recovery may be all that these facilities can take.
Home care agencies, on the other hand, are in a unique predicament. Consumers desire to avoid facility care, especially for post-acute rehab, hence demand for their services is fast increasing. However, those agencies are also experiencing acute staffing shortages.
What can senior service providers do post-pandemic to recruit and retain staff?
Pay them more to begin with. Service for a low wage Workers are requesting and receiving pay hikes. Home care staff can look for work elsewhere if they want to make more money than they did before the pandemic, which was less than $11 an hour on average. While several providers paid covid-related bonuses to their employees last year, they’ll almost certainly have to make such hikes permanent this year.
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I’m aware that clinicians who rely primarily on Medicaid reimbursement claim that the program does not pay enough to justify salary hikes. They could be correct. It doesn’t matter, though. If they want enough employees, they’ll have to find the money to pay them more.
In addition to rises
However, increasing hourly salaries is insufficient. The Gerontologist, a publication of the Gerontological Society of America (GSA), recently issued a special issue on direct care workers. Many of the articles reaffirm that simply increasing wages will not be enough to attract and keep quality workers.
Several studies revealed that giving direct care employees greater autonomy, boosting management support and training, and providing possibilities for advancement are the best methods to keep them.
This isn’t surprising, because these variables enhance employee morale in practically every industry. However, in the frequently hierarchical world of aging services, they have had a hard time gaining traction.
That isn’t to imply that pay isn’t important. Taiwan has reorganized compensation for home care employees, ensuring a minimum monthly wage but also connecting compensation to their volume of labor and the complexity of the care their customers demand, rather than just the number of hours they put in.
While Taiwan is clearly not the United States, the new payment model has resulted in a huge rise in the supply of caregivers. This new paradigm may have lessons for the United States.
The ambiguous market
Separately, we’re getting a better understanding of the gray market for home care employees. These are self-employed individuals who are frequently hired through word of mouth or internet markets such as Craigslist. Some people work under the table, don’t pay taxes (and so aren’t eligible for benefits like Social Security), and don’t have health insurance. Many of them are unlicensed and untrained. There is very little information available about the quality of care they give.
These aides, on the other hand, exhibit greater features of job satisfaction than aides who work for agencies in many aspects. Because they are self-employed, for example, they typically have the liberty and freedom to provide the best care for their clients. Their clients’ safety is jeopardized by their lack of a license. On the other hand, it allows aides to sidestep often-burdensome and ineffective guidelines about the type of care they are permitted to offer.
According to a new RAND Corporation study by Regina Shih and colleagues, one-third of families who employ aides to care for relatives with dementia use the gray market.
There is no other option.
Efforts to improve working conditions and boost the skills of direct care workers have been excruciatingly slow, despite an expansion in demand for care and mounting labor shortages. The Institute of Medicine recommended 13 improvements to improve the geriatric workforce in 2008. Only one, requiring medical professional training, has been implemented after more than a decade.
Families and providers have no option in the rapidly changing market for post-pandemic care. There will just not be enough workers to care for vulnerable elderly individuals without major reforms./nRead More