Nationwide Caregiver Shortage Felt By Older Adults

“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.

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.”

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?”