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Shortage in Direct Care Workers: How Home Health Agencies Can Help


    While there is currently an alarming shortage of nursing professionals in the US, another looming crisis, this time in the pool of direct care workers, stands to hurt the entire healthcare ecosystem, including home health care, if left unchecked.

    Direct care workers refers to nursing assistants/aids (nursing homes, hospitals, assisted-living facilities, other community-based settings), home health aides (homes or community settings), and personal care aides (private or group homes).

    A major factor causing the shortage is the aging population of the U.S., which sees roughly 10,000 baby boomers turning 65 every day, according to some statistics. About 70% of these individuals have severe needs for long-term services and support, and 80% of those 50 and above want to stay in their homes as they age according to the American Association of Retired Persons (AARP).

    These realities trigger an increase in demand for direct care workers. According to the new report by the Global Coalition on Aging (GCOA), the U.S. will be lacking 151,000 direct care workers by 2030, and this deficit will grow to 355,000 by 2040. In addition, home care employment was 3% lower in December 2020 than it was in February 2020, while residential care employment was 7% lower and nursing home employment was 9% lower over the same time period.


    The Crucial Role of Home Health Care Aides 

    The home health industry must not overlook the significant role that home health care aides play. In a nutshell, they provide basic services to elderly, ill, or disabled persons at the place where their patients are most comfortable: their homes. The care they give is a big part of what allows patients to continue living in their own homes and prevent them from moving to nursing homes or readmitted to hospitals.

    A few of their tasks include taking vital signs, assisting patients in moving around their home, and administering basic medications. With additional education, they may also operate certain medical equipment like ventilators. They also provide support on a personal care level, like driving patients to and from medical appointments, assisting them in purchasing groceries and preparing meals to ensure specific dietary guidelines are followed, as well as grooming and dressing patients.

    The work that home health care aides do is very personal and therefore vital in the home health industry. They help patients achieve an independent, happy, and healthy life, which is, after all, the ultimate goal of the healthcare industry.


    Direct Care Workforce Challenges

    To address the current crisis, we must understand the challenges that the direct care workforce is facing.

    Overall, there are approximately 4.6 million direct care workers in the U.S. and most of them receive low wages and poor benefits despite their demanding work nature.

    All these factors often lead to high turnover rates across the industry, running between 40% and 60%. As a domino effect, turnover results in poor patient outcomes and can be costly for providers in terms of reduced care quality, recruitment and training expenses, and negative impacts on employee morale.


    Efforts by the Government and Direct Care Associations

    Recently, a group of Senators introduced the ‘Supporting Our Direct Care Workforce and Family Caregivers Act’ bill, a sister bill to the House’s Direct Care Opportunity Act, which aims to provide $1 billion in grants to states and other eligible entities to support innovative projects and programs focused on recruitment, retention, and training for direct care workers, as well as family caregivers.

    Furthermore, an advocacy organization that represents non-profit home-based care agencies and other providers of aging services also released a report on improving long-term care in the US—it includes a number of strategies like relaxing immigration policies for foreign workers and opening opportunities to nontraditional workers to increase the labor pool, giving direct care workers the flexibility to work across different healthcare settings and state boundaries, exploring alternative funding sources on top of Medicaid’s, and investing in training, education, and other career development programs.


    What Home Health Agencies Can Do In-house

    In conjunction with the efforts of direct care associations, home health agencies can contribute in a number of ways to alleviate the workforce challenges in direct care.

    Beyond giving better compensation and health benefits, improving clinician’s work experience where they can focus more on patient care with less administrative burden can also trigger higher retention rates. Agencies can explore innovative solutions from their EMR or outsourcing partner that impacts clinician satisfaction such as efficient scheduling technology or EMR charting services.

    Agencies can also focus efforts on creating better career mobility for direct care workers. This will lead to opportunities for staff to develop their skills and knowledge in various areas they might want to explore. Lastly, education and regular training programs are vital to avoiding turnover and keeping engagement high. When they feel valued, they value their jobs in return.


    Creating an Integrated Career Development Program for Clinicians

    Explore ways to structure your in-house processes to reinforce career development opportunities for clinicians. This should also include collaborative workflows with partner providers.

    For instance, your outsourced QA program should support continuing education of clinicians to improve competencies both in patient care and documentation. Specifically, data on clinician performance should be captured and analyzed via periodic reports to get a comprehensive view of areas that need improvement. Data-driven insights improve the coaching and training experience for clinicians, which contributes to better engagement and, ultimately, patient outcomes.


    Is your Home Health Aide Staffing Adequate?

    Take this survey by the National Association for Home Care & Hospice (NAHC) which helps CMS gather information on the adequacy of home health aide staffing as part of the 2022 proposed home health rate update rule.