While there are currently over two million home health care aides in the U.S., the nation could face a shortage of direct care workers as the Baby Boom generation ages over the next few decades. As author Paul Osterman recently told the New York Times, if nothing is done to draw more workers into the long-term care industry, the U.S. will lack at least 350,000 paid care providers by 2040.
In his new book Who Will Care for Us? Osterman explores the challenges faced by this precarious and frequently overlooked workforce. Though home care workers—who are predominantly women and immigrants—are essential to the well-being of elderly and disabled patients, they receive little respect, tend to be poorly trained, and earn a national median wage of about $10 per hour. Through interviews with these workers, Osterman finds that home care aides experience unstable work environments, including high turnover, incidences of physical injury on the job, and erratic scheduling. Osterman notes, “Talking with home care aides makes it clear that for many of them the number-one issue is hours.”
According to the 2012 American Community Survey, only half of all home care aides work full-time (thirty-five or more hours per week). Instead, as the figure below shows, many home care aides work well under eight hours per day for a given client, and therefore must piece together multiple cases in order to make ends meet. One aide interviewed by Osterman discussed the difficulties of scheduling, and asked of her employment agency, “Give me longer than three hour cases. I work every day and don’t even make part-time.”
In his book, Osterman proposes restructuring direct care workers’ jobs to offer increased training. As he explains, integrating these workers into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers.
Retraining home care aides in this way, Osterman argues, would also provide opportunities for these workers to expand their skills and fill more roles in their day-to-day jobs, thereby increasing their hours and job stability, and putting them in better positions to negotiate higher wages. As he writes in an op-ed for the Wall Street Journal, “With less regulation and better training, they could become as integral to health-care teams as doctors and nurses.”