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Nationwide Caregiver Shortage Felt By Older Adults

America’s aging population suffers as in-home aides can’t cover the need for care

Home Aid Worker
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In a small town in Maine, a paid in-home caregiving aide’s shift ends at 2 p.m. The worker leaves a peanut butter and jelly sandwich for the client’s dinner. A cooler with drinks sits by the bed.

In another part of the state, a veteran coping with incontinence is unable to find a care worker to help him. He sleeps on trash bags and relies on a housemate to help him get to the bathroom.

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America is facing a shortage of in-home caregiving aides — professionals who perform a multitude of tasks to help aging people unable to fully care for themselves in their homes, either because they have no family to help or to supplement family care. That shortage is particularly apparent in Maine, which has the highest percentage of residents 65 and older in the United States. Nearly 11,000 hours of personal care are going unstaffed each week in the state. And at two of its health systems, at least 100 people each week can’t be discharged from hospitals because they won’t get the necessary post-treatment care, according to Jess Maurer, executive director of the Maine Council on Aging.

“It’s heartbreaking,” says Betsy Sawyer-Manter, CEO of SeniorsPlus, the designated Area Agency on Aging for western Maine. “Some people simply go without care.” 

Caregiver Shortage
Home health and personal care aides projected job openings, 2018 to 2028
Heather Jones

Need for in-home aids expected to grow dramatically

Maine is not the only state facing a critical caregiving shortage. In Wisconsin, 23,165 caregiving positions are open throughout the state, but only 19,600 people in that state who are not currently in the labor force are looking for work of any kind. At the Area Agency on Aging in Lackawanna County, Pennsylvania (total population roughly 215,000), 33 people are on a waiting list for caregiving help. One person has been on that list for a year.

“There are people going without baths,” says Jason Kavulich, director of the Lackawanna County Area Agency on Aging, who has been in the human services field since 1999. “This is the worst ever.”

Our aging population, in general, wants to age in place and avoid nursing homes, which means in-home caregivers are in high demand, whether paid directly by clients or through long-term care insurance, nonprofit organizations, state funding or government programs such as Medicaid. There are nearly 2.3 million such aides in the U.S., but the positions of home health and personal care aides are projected to grow at a rate higher than the average for all occupations over the next decade. The federal Bureau of Labor Statistics projects employment for these jobs will grow by about 25 percent by 2031. More than 700,000 openings for such workers are projected each year, on average, over the next decade.

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Many people who can’t get paid caregivers must rely on family and friends to help them with daily tasks. But what happens to people when those people aren’t available? “They get by,” says Kavulich. “And it’s hard. It happens a lot in rural America. We just don’t have the resources.”

Caregiving culture needs to change

And nursing homes don’t appear to be the solution. Some 3 out of 5 U.S. nursing homes have limited new admissions now due to staffing shortages, according to a June survey by the American Health Care Association of 759 nursing home providers. And nearly 3 in 4 are concerned that they may have to close their facilities over staffing problems.

“The whole issue of nursing services is also critical,” says Sawyer-Manter, noting that Maine is hurting in this regard too. “We have 1,662 clients that need nursing services, and that equates to 5,000 hours a month that we also can’t staff.” She adds, “What we’ve heard is that some of the home health agencies have stopped taking long-term care clients in their homes because it’s a one-hour visit. It’s not worth their time to send a nurse out. The reimbursement rates are inadequate to cover costs.”

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Since the pandemic, the scenario has only gotten worse as the Great Resignation prompted caregivers to reconsider their pay, working environment, job benefits, consistent hours and path for advancement. More virtual work opportunities in other fields are also available now, giving workers in rural communities new employment options.

“It’s thousands of people, thousands of workers we need to take from somewhere else,” says Mauer. “From McDonald’s, call centers, restaurants. We’re going to have to bring workers from somewhere else into jobs. What will it take? What will we need to pay people to leave a job at Target?”

To Kristin Dahlquist, owner of Home Instead in South Denver and Littleton, the culture around caregiving needs to change to support the families in need. “There is a need to elevate the profession, which demands the attention of every home agency. We need to make sure we are treating them well, offering an attractive job with high starting wages, benefits, 401(k), bonus structures and professional development.”

But Kavulich doesn’t think “throwing money at the problem” is the answer. “There’s an agency offering a $30,000 signing bonus here,” in Pennsylvania, he says, “and, despite offering bonuses, they are still struggling with recruitment. It’s a good agency, but they’re suffering like everyone else.” Instead, broader recruiting, training and retention approaches in every state are necessary to build a workforce with pipelines connecting development experts, training providers, educational institutions and community-based organizations. Kavulich hopes that two pilot programs in Lackawanna County — one offering reimbursement for college tuition to health care students working as caregivers and one involving consumer reimbursement for personally hired caregivers — will make a difference. “These might stem our bleed,” he says.

Sawyer-Manter says Maine has a “number of new initiatives” aimed at trying to make the jobs more attractive, including career ladders for advancement, opportunities to specialize in forms of care including Alzheimer’s and dementia, and alternately mixing up the clients so caregivers work with different populations in need of care. “Years ago, I heard that people would go to career centers and say they want to be a direct care worker and would be told that’s a dead-end job. How do we make it a job that is highly valued?”