Doomed at the Start

Doomed at the Start

Shelby Cook

Staff Writer

In 2010, one-sixth of the US population was 65 years old or older. By 2030, that number will jump to a quarter of the population—or nearly 100 million people. As the senior population grows, so does nationwide concern over what will happen to these millions of Baby Boomers who will soon be in need of more intensive care.

In the past, seniors in diminished or declining health would be admitted to nursing homes or taken in by a nearby relative. However, these options are becoming less attractive, and less reliable. Consequently, the home health industry has become one of the largest growing markets. Experts predict that by 2022, the demand for direct-care, home health workers will grow by 37 percent. The demand for entry level aides alone will increase by 49 percent.

For those of you scratching your heads, wondering what a home health aide is: in a nutshell, their job involves coming to an elderly person’s house to perform simple, non-medical tasks for a few hours each week. These tasks can be anything from helping a patient walk up a flight of stairs, make a meal or get ready for bed. On the surface, the job might sound easy, but it isn’t for the faint of heart. The problems facing the home health industry are many, and it takes the right people to do the job well—people like Jeffrey Thomas, 49, of Rochester, New York, who became interested in the field after the passing of his father.

“I felt like I could be of benefit to people of that age, where I really didn’t get the opportunity to do that with my own dad,” Thomas explained.

Home health care is the “Goldilocks” of the eldercare world, so to speak: it’s cheaper and less disruptive than the altnerative, and it allows seniors to stay at home as they age, which, according to reports from the AARP, close to 90 percent of seniors would prefer to do, rather than relocate. Many seniors don’t need the round-the-clock help that a nursing home provides, but they do need help. And the costs are not negligible: the average price tag runs around $70,000 a year.

Part of the reason that the home health industry is experience such a boon is the fact that a lot of adult children with elderly parents are continuing to work later in life: just since the recession, the average age of retirement has increased from 57 to 62. Logistically speaking, these workers don’t have the time to provide the kind of care and attention their elderly parents may need.

On top of that, many of these adult children are still supporting their own kids: as of 2014, just over 32 percent of 18 to 34 year-olds were still living with Dear Old Mom and Dad. Thanks to shifting cultural norms and some rather bleak economic conditions, 18 to 34 year-olds living at home outnumber the 31 percent of 18 to 34 year-olds living with romantic partners for the first time since 1880. For workers trying to save for a delayed retirement while still supporting their financially dependent adult children, taking on the costs of caring for an elderly parent might actually be impossible.

Even when there is a family member (typically a spouse, sometimes a child) who is both willing and able to take up the cause, it’s easy for someone in that position to begin to feel overwhelmed. This is especially true for relatives who care for someone suffering from Alzheimer’s or any other mentally degenerative condition.

“They can feel trapped,” Thomas explained. “It’s so much time that needs to be devoted to this one person, and [these patients] frequently don’t want to leave the house … so that can be frustrating.” That’s where home health aides come in, and the demand for them is growing at an alarming rate.

But while the home health industry is in high-demand, it continues to experience high rates of turnover. Some estimates put it at around 60 percent. How can this be? To put it frankly: this is a low-wage, part-time, often thankless job that offers little opportunity for advancement.

Alana Semuels, in an article for the Atlantic, summarizes it well: “On average, home care aides work 34 hours a week, and make an average of $17,000 a year. One in four live in households below the federal poverty line, and one in three doesn’t have health care because their employer doesn’t offer it or because they can’t afford it.” Not exactly a glowing recommendation.

According to the Paraprofessional Healthcare Institute, of the ten most in-demand professions in 2012, all but one was paid less than home care aides, who out-earned only fast food workers. And oftentimes, the job’s basic requirements cost them more than what they’re earning: since most clients only need care for two to three hours a week, aides can have multiple clients they bounce between. Many home health aides swallow considerable transportation costs because their agency covers such a wide area.

Back in 2006, the National Association for Home Care & Hospice (NAHC) estimated that home care nurses traveled 4.8 million miles to be with patients. That’s more than double the average UPS driver. Thomas shared that the agency he works for does reimburse for miles driven between clients, but not to and from his home. Further, the rights afforded to workers by the Fair Labor Standards Act (FLSA) (e.g., overtime pay, minimum wage requirements) are not extended to home health aides; in the eyes of the (labor) law, a home health aide for an elderly patient is all but indistinguishable from the fifteeen year-old who lives down the street from you and babysits your kids on date night.

There’s also a personal aspect to the job that some people just aren’t prepared for. “You’re walking into people’s houses, and lives, and you’ve never met them before,” said Thomas. His clients, who he affectionately calls his “senior buddies,” are just that: buddies. When you’re not preparing a meal, or doing the laundry, you’re listening to their stories, hearing their past accomplishments and sharing yours. You’re ushered in, and then just as quickly ushered out. Thomas, who has been working as a home health aide for two-and-a-half years, has already had several clients pass away.

All of these challenges mean that the businesses whose job it is to provide care to elderly patients are struggling to attract qualified workers. Part of the problem with this, of course, is that even if people don’t start clamoring to fill these positions, the population is still going to age; the Baby Boomers will still constitute the largest senior citizen demographic our nation has ever seen; the number of people over age 65 is still going to reach nearly 100 million whether we’re ready for it or not.

Something, somewhere, is going to have to give.

The importance of a thriving home health industry is partly economic: nowhere in the country is unemployment zero percent. People need jobs, and this industry needs workers. Hiring people to work and earn a living locally means a more robust local economy. But beyond that, it’s also a matter of community, and of taking care of those who can no longer care for themselves. And, let’s face it: once we “solve” the issue of caring for aging Baby Boomers, we won’t be far off from having to address the issue of aging Millennials, who officially overtook Boomers as the nation’s largest living generation in 2015.

So what should we do?

Perhaps the most immediate step is to make the job of home health aide more appealing by extending certain labor-related rights to those working in the field. After all, shouldn’t a home health aide’s wages reflect the rapidly growing demand for their services? Recently, home care agencies filed a lawsuit against the Department of Labor asking to restrict their employees’ eligibility for minimum wage or overtime pay. In some ways, doesn’t this defy the very principles of market fundamentalism that so many business owners hold dear? Blocking access to higher wages seems to have undermined the market’s ability to correct the current—and inevitably worsening—supply shortage.

Then, there is also the issue of training. As I’ve mentioned before, this job is not for the faint of heart. Without proper training, education, and evaluation mechanisms in place, people may go into the field for the wrong reasons, or may take a job before fully realizing what it is that they’ve gotten themselves into. Of course, workers for whom this is the case do not typically last very long in the field, which means that turnover rates tend to run particularly high (and as any business owner knows, the costs associated therein are far from negligible).

Currently, there are no national standards for training or assessment of home care aides, although some states have established their own such programs. These programs, according to a congressional report from the US Department of Health and Human Services, are intended “to address a health workforce need to train competent direct care workers capable of caring for an aging population.” The program was funded through the Affordable Care Act, which allocated $5 million annually for three years to pilot the program in six states.

This is where chambers of commerce have an opportunity to make a difference in how we care for our parents and grandparents. The decision not to expand the Fair Labor Standards Act to home health aides was made all the way back in 1974. The job is not the same today as it was then, nor is the service market in which it exists. Reassessing this decision in order to determine its practicality in an evolving economy, more than 40 years after the fact, seems not just reasonable, but necessary.

Though a lawsuit intended to keep wages in the industry low may seem like a “pro-business” initiative at first glance, it’s important for chambers of commerce to keep in mind that the home health industry is rather unique in that “low wages” are not helping the industry, but in fact retarding its growth. Advocating on behalf of wage earners, though seemingly antithetical to the establishment of a “business friendly” environment, might be exactly what the home health industry needs from leaders of the business community, in order to grow to its full potential.

Attracting potential workers to the home health industry isn’t creating jobs; it’s putting people to work in jobs that already exist. The need is already there, and it’s only going to continue to grow. If this industry continues to be treated like an extension of the teenage babysitting industry then the jobs are not going to attract the right kinds of workers. And even if it does attract the right kinds of workers, those workers are unlikely to stay in the field if and when they realize that they cannot afford to accept such low wages.

When it comes to taking care of senior citizens—our parents and grandparents; former teachers, coaches, and mentors; neighbors and community members—don’t we want the peace of mind of knowing that we’ve put them in the most capable hands?

For more information on the home health industry, visit Click on the “Medicare” heading, and then select “Home Health Quality Initiative.”