Who will care for us?

A PBS report last summer painted an alarming picture of the pressures that are building on the home care industry. Caring for the aged has historically been “women’s work,” and for that reason, underpaid. In fact, according to the report, nationally, half of home care workers rely on public assistance and one in four lives in poverty. And because it’s so difficult and uncompensated, there’s a 67 percent turnover rate.

Two local home care administrators echo those concerns about having adequate numbers of employees to meet the need.

By 2022, baby boomers will be driving the home care market. The need will be huge and it will overtake providers.

“By 2022, baby boomers will be driving the home care market,” says Daniel Hedgepath, owner and administrator of Home Instead Senior Care. The largest demographic in history has impacted every aspect of culture and the economy since the late 1940s, and now, late in life, most desire to age in place. The problem is many don’t have family nearby to provide in-home care. In Hedgepath’s case, he says that’s 40 percent of his clients.

“The need will be huge, and it will overtake providers,” he says. Even now in the over five years he has owned and managed the franchise, business has grown by 300 percent, even if the margins have not.

Jacob Buffington, executive director of Visiting Angels Living Assistance Services did some of his own research a couple of years ago, finding there are 600 -700,000 seniors in Georgia needing home care, and only 2,000 registered CNAs or certified nurses’ aides.

Home care is not the same as home health care, which requires skilled nursing care for short visits that are covered by Medicare. Home care is typically private pay and involves longer visits by CNAs for either hands-on services such as transfers and some medication management (but not administration) or hands-off care such as light housework, companionship or meal preparation.

Home care agencies find they are in competition with hospital, nursing homes and hospice for CNAs, who, by law, also must be state certified to work in those fields.

Certification requires 96 hours of classroom training, 24 hours of supervised training, and successful completion of a state board test.

“It’s rigorous,” Buffington says. “CNAs have to know how to administer CPR, approach people with dementia, lift patients so they don’t hurt the patient or themselves, make beds appropriately, and a variety of other skills.”

Some answers on the horizon

One immediate answer to the shortage of qualified home care workers is what’s called a personal care aide (PCA), says Buffington. These workers can go through training and be certified through a specific agency but their certification isn’t transferable to another facility or agency as are the CNAs with state certification.

Hedgepath sees several developments that he thinks will help ease the shortage of hands-on caregivers, including:

Technology will play a greater role in thecare of older adults in their homes in the next 5 to 10 years, he says.There are already home video monitoring systems but soon there will be security systems with artificial intelligence capacity. Examples include facial recognition software that can recognize the presence of everyone who is physically in the senior adult’s home and systems that can monitor sleep patterns.

Expanded scope of care. Over the last 20 years, health care providers restricted their scope of care to a specific service such as home care, medical home care, hospice, etc. Now all the specialty providers will offer more services although that will require additional licensure.

Medicare coverage. Last year, the Center for Medicare and Medicaid Services announced the possibility for Advantage insurance plans to offer some coverage for home care, which, to date, is always private pay. So far, Advantage plan providers in Georgia haven’t indicated their intent or premium rates. The next enrollment period when this could happen will be later this year.

National experts say that if boomers want quality care and help staying out of hospitals and nursing homes, the key is having trained and well-compensated home care workers. As Paul Osterman, author of “Who will care for us?”said on the Newshour, “We’re going to need help, and we’re going to wonder where it is and why it’s not forthcoming. And then we will complain. And there will hopefully be a politician who will see it in his or her interest to make this their issue.”