The disabled and the elderly are facing a big problem: Not enough aides

The disabled and the elderly are facing a big problem: Not enough aides
By Judith Graham
Apr 23 2017

Acute shortages of home health aides and nursing assistants are cropping up across the country, threatening care for people with serious disabilities and vulnerable older adults.

In Wisconsin, nursing homes have denied admission to thousands of patients over the past year because they lack essential staff, according to associations of facilities that provide long-term care.

In New York, patients in rural areas have been injured, soiled themselves and gone without meals because paid caregivers aren’t available, according to testimony provided to state legislators in February.

In Illinois, the independence of people with severe developmental disabilities is being compromised as agencies experience severe staff shortages, according to a court monitor overseeing a federal consent decree.

The emerging crisis is driven by low wages — around $10 an hour, mostly funded by state Medicaid programs — and a shrinking pool of workers willing to perform this physically and emotionally demanding work: helping people get into and out of bed, go to the bathroom, shower, eat and participate in routine activities, often while dealing with challenging behaviors.

Experts warn that this labor problem portends even worse difficulties as America’s senior population swells to 88 million people in 2050, up from 48 million today, and requires more assistance with chronic health conditions and disabilities. 

“If we don’t turn this around, things are only going to get worse,” said David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association, which represents nursing homes.

“For me as a parent, the instability of this system is terrifying,” said Cheryl Dougan of Bethlehem, Pa., whose profoundly disabled son, Renzo, suffered cardiac arrest nearly 19 years ago at age 14 and receives round-the-clock care from paid caregivers.

“We’ve gone through hundreds of . . . workers, and there have been times I’ve found Renzo sitting in a recliner, soaking wet, because his diapers hadn’t been changed. And at times I wasn’t sure if he was being fed well or treated well,” Dougan continued. “It’s exhausting, mentally and physically. You live with a constant sense of crisis.”

Rising demand

For years, experts have predicted that a rapidly aging population’s demand for services would outstrip the capacity of what is called the “direct care” workforce: personal care aides, home health aides and nursing assistants.

The Bureau of Labor Statistics estimates that an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014. Yet the population of people who tend to fill these jobs, overwhelmingly women age 25 to 64, will increase at a much slower rate.

After the recession of 2008-2009, positions in Medicaid-funded home health agencies, nursing homes and community service agencies were relatively easy to fill for several years. But the improving economy has led workers to pursue higher-paying alternatives — in retail services, for example — and turnover rates have soared.

At the same time, wages for nursing assistants, home health aides and personal care aides have stagnated, making recruitment difficult. The average hourly rate nationally is $10.11 — a few cents lower than a decade ago, according to PHI, an organization that studies the direct-care workforce. There is a push on now in a handful of states to raise the minimum to $15 an hour. 

For-profit franchises that offer services to seniors who pay out of pocket are also having problems with staffing.

“All the experienced workers are already placed with families. They’re off the market,” said Carrie Bianco, owner of Always Best Care Senior Services of Torrance, Calif., part of a national chain with franchises in 30 states.



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