Aware Senior Care Blog
By Kyle Murray, Web Content Manager, Aware Senior CareThis book tackles an issue that will affect all of us, indirectly and directly, at some point in our lives.
If we need assistance in old age, will there be reasonably cost-effective and quality solution there for me?
A Growing Problem"Who Will Care for Us: Long-Term Care and the Long-Term Workforce is a 2017 book by Economist Paul Osterman that assesses the challenges facing the long-term care industry and presents solutions to consider going forward.
Demand for long-term care will only increase as the Baby Boomer generation ages. The population of adults 65 and older will double its 2012 number by 2050 and an estimated 70 percent of those will need care.
Yet, the number of caregivers is not expected to match anywhere near that growth. As Forbes contributor Jody Gastfriend noted in a July article last year, family caregivers won't keep pace for a number of factors: "Declining birth rates, far-flung families, a rising number of women in the workforce, and the projected increase in Alzheimer’s disease and dementia are contributing to this supply/demand conundrum (Editor's note: The conundrum specifically being high demand for home care with a low supply of caregivers)."
Additionally, the number of paid caregivers (contracted privately or through a home care agency) won't make up the gap, as Osterman notes, due to low wages, high turnover, uncertainty of receiving enough hours, and little to no training (particularly the kind that can further a career in healthcare).
Osterman recognizes the significant roadblocks that hinder progress being made to enhance the quality of care. The complicated system we are familiar with today is often so confusing that it led to the creation of an occupation: geriatric care management.
Home care health aides, as Osterman calls caregivers, often find themselves disrespected by the medical staff in a client's care team. Some of the administrators he interviewed labeled the work as "minimum wage" or akin to babysitting. Osterman notes the position in the early years of its history was often staffed by women and immigrants (many of them both).
Caregivers develop a relationship and an understanding of their clients. They are the eyes and ears to their client's needs and can help reduce rehospitalization with clear communication with medical staff on the care team.
Hours are going to be a tricky issue to tackle as well. In our experience, families looking for home care need anywhere from 1-2 hours a day for 2-3 days a week to 24/7 round-the-clock care.
You don't want to force families to take on a minimum number of hours their loved one doesn't need but you also want to provide your caregivers enough work to make it worth their time.
As Osterman notes, caregivers for home care agencies make just under $20,000 per year which is just above the poverty threshold for a single person with no children.
Additionally, optimizing scheduling for caregivers and clients' needs no simple task as well. Without a large pool of qualified applicants to draw from, finding the right fit and chemistry for client and caregiver becomes increasingly more difficult.
Increasing the responsibilities of a caregiver seems like an attractive option to justify wage increases and provide better career opportunities. After all, they spend the more time with the client than anybody else in their care plan (EX: doctors, nurses, etc.).
However, Osterman notes that nurses unions have been historically opposed to sharing or abdicating these responsibilities while the unions/advocacy for home care workers don't have anywhere near the same influence.
Examples of Solutions for More Cost-Effective and Quality Care
-Add to the job responsibilities for caregivers to make the role a stepping stone for a career in healthcare. This includes additional training like hospital-to-home transfers, physical therapy, and wound care. Not only will this enhance a caregiver's career prospects, this will in turn justify an increase in pay.
-Increase wages for caregivers. With higher annual earnings, this will cut down on costs associated with turnover and attract more prospective caregivers. Cutting down on turnover means more consistent care with fewer expenditures related to hiring and training.
-Make rules and regulations regarding home health home care more streamlined at federal and state levels. Some states like Florida and Massachusetts require no additional training hours other than initial training while states like New York and Washington D.C. require 40 and 75, respectively. Additionally, some states permit caregivers to take on medication administration roles while others do not.
Who Will Care For Us?
I will say this book is an important read. After 120 interviews with a number of healthcare professionals involved in home care, like home care workers, public interest groups, doctors, government officials both federal and state, unions, and insurance company representatives, I'd say Osterman has a firm grasp on the issue we face as a nation regarding long-term care.
It's an in-depth, concise overview of this issue that recognizes the problems the industry faces while providing courses of action to consider.
On our current course, the number of the elderly and younger disabled who need long-term care will vastly outpace the estimated caregivers available (family or paid) to provide it. From my perspective, he's correct in stating that the job is respected by families/clients for the most part but many of those in positions of influence (government in particular) do not.
Without enhancing the job description and career prospects of home care workers, we can expect high turnover, more costly re-hospitalization visits, and inconsistent care at large.
Caregiving is demanding work, at times exhausting both physically and mentally. Our agency makes an concerted effort to reward our caregivers for their hard work and let them know they are appreciated. Good caregivers are the cornerstone of a quality home care agency.
The home care industry as a whole needs to do more to change the perception of home health home care aides in the medical field, in government, and as a society in general. We will need to if we hope to provide for those who need long-term care in the future.
The rules/regulations aspect gets tricky as states vary in a number of ways. Families in California overwhelmingly choosing private pay as their care option while those in New York prefer home care agencies with managed care plans.
I can't speak to what specific changes to make at a state and federal level, nor how we can restructure the funding methods to make care more consistent and cost-effective.
But, I believe we need to advocate for exploring solutions to the aforementioned issues because one way or another, we will need caregivers. Better to start planning now and taking action.