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.”
A growing force
There are several types of direct-care workers, and their titles often vary:
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.
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.