At her home health care agency in the District, Venus Ray quizzes 65 job applicants assembled before her: Can they cook? Do they know the right way to wash their hands? Can they safely transfer patients into wheelchairs? If they give wrong answers, speak English poorly or — God forbid — forget to turn off their cellphones, she asks them to leave.
By the end of the session, Ray has dismissed 42 of the applicants, almost two-thirds, even though she’s in dire need of employees.
Ray is executive director of Health Management Inc., which employs about 410 people, including 395 home health aides. With business booming, she is constantly looking to hire more, and she holds group interviews once or twice a month.
“There’s a huge demand, and it’s only going to get larger as the years go by,” Ray said. With the nation’s aging population, she added, many people “will tell you that they are more comfortable in their home.”
The demand for workers by Ray’s company mirrors national trends and is fueled in part by stepped-up efforts to keep seniors and the disabled out of nursing homes. The growth is likely to pick up in coming years as the new federal health law tries to reduce hospital readmissions and expands programs such as Money Follows the Person, which encourages Medicaid recipients to receive care at home.
But experts warn that a shortage of qualified labor is looming. Workers often lack the training and support needed to properly care for patients, and poor working conditions lead to high turnover, experts say. In addition, salaries are low: In 2009, the median national hourly wage for direct-care workers — a term that includes home health aides — was $10.58, substantially below the $15.95 median for all U.S. workers. Nearly half lived in households that received food stamps, Medicaid or other government aid, according to PHI, an advocacy group for direct-care workers.
In addition, experts say, regulations about training and background checks for direct-care workers vary across states, and often leave consumers without adequate protection.
“I see tremendous challenges on the care side and the consumer side,” said Peggy Powell, national director of curriculum and workforce development at PHI, which is based in New York. “My fear, my deep concern, is that in this quick switch [to provide care at home], there is the potential for care to get worse and for the direct-care workers’ job to get harder, with less support and training.”
There are several types of direct-care workers, and their titles often vary:
l Certified nursing assistants provide basic clinical care such as taking blood pressure and caring for wounds. They also help with the activities of daily living such as eating, dressing and bathing. They usually work in nursing homes or assisted living facilities and have at least the 75 hours of training required by the federal government for positions at a Medicare- or Medicaid-certified facility.
l Home health aides provide similar care but in private homes and under the supervision of a nurse or therapist. If they’re employees of a home care agency, these aides also may need at least 75 hours of training because the federal requirement extends to agencies that serve Medicare and Medicaid patients.
l Personal care aides work in the home and help with everyday activities such as bathing and also perform light housekeeping and cooking chores. There are no federal requirements for their training, which is generally minimal. About a quarter of these workers are not employed by agencies, according to PHI.
In some states, certified nursing assistants and home health aides can administer medication, although some states require that they get extra training to do that. Personal care aides cannot.
More than 3.2 million people work in direct care, according to 2008 data from the federal Bureau of Labor Statistics. That is 52 percent more than in 1998. Jobs in direct care are projected to account for four of every 10 new health-care jobs between 2008 and 2018, according to PHI.
The Washington area is expected to need an additional 10,000 direct-care workers over the next five to seven years, estimates DC Appleseed, a nonprofit public policy group. In the past seven years, the number of licensed home health care companies has increased from 10 to approximately 35, said Bruce Griffin, president of the board of directors of the Home Health Care Association of Washington, D.C.
Venus Ray begins her group interview by asking: “Why do you want to be a home health care worker? What’s your passion?”
Many describe caring for a loved one, while others say they have been drawn to the field by their deep religious faith. Latreaviette Stewart, 21, says she decided to become an aide after caring for her grandmother, great-aunts and her mother’s best friend, who recently died of breast cancer. She just completed a home health aide program at the University of the District of Columbia Community College.
Pamela Nfor, a 34-year-old aide from Cameroon who has a child with disabilities, says she enjoys seeing how clients, even those who are depressed and can’t go out, improve under her care. “I love the job, and I hate the money,” she tells other applicants, who erupt in laughter.
Emotions run deep during the morning’s activities. One West African woman passionately describes how God revealed her vocation to be in home health care after she prayed intensely, while another woman nearly breaks into tears when she’s asked to leave after her cellphone goes off. Both women fail to pass the interview process.
Later, Ray said that she once had to dismiss an entire group of 12 applicants after all of their cellphones rang.
The applicants provide a visual snapshot of national trends. Direct-care workers are disproportionately minorities, and 23 percent are foreign-born. Almost 90 percent are female. The average age is 42, but the number of workers older than 55 is increasing rapidly, according to PHI.
To ensure a qualified workforce, experts say, it’s important to increase wages, improve training and beef up licensing requirements.
“It’s really important to figure out how to build career ladders for these workers so that they can advance and see this as a real career,” said Bob Konrad, a researcher at the University of North Carolina at Chapel Hill. “We have to turn these folks into really active and engaged people in the health policy world.”
This article is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy research and communication organization that is not affiliated with Kaiser Permanente.