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There Are Not Enough Personal Care Aides To Care For Frail Seniors. What Will We Do?

Howard Gleckman, Senior Contributor, Forbes (AND Bessie’s Hope solution below)

Workforce challenges have grown substantially over the last several years and health care providers will continue to see increasing staffing challenges, workforce shortages, wage and benefit costs, and employment law enforcement. To survive these changing dynamics and become more predictive in people strategies, health care providers will adopt a variety of workforce analytic technology. For example, regular employee pulse surveys for employee engagement or real-time labor management systems which allow staffing to be quickly and accurately adjusted on a per-patient-day (PPD) basis will become essential for managing labor costs and productivity

Health care organizations will also need to ensure deliberate talent acquisition strategies and an engaged workforce to increase employee retention, allowing them to better drive the level of quality, customer satisfaction, and financial performance. Due to the talent shortage, health care providers and even competitors will share staff and centralize back-office functions, allowing care centers to focus on what they do best – high quality patient care and service.

The role of leadership will be more important than ever. Developing cultures of continuous learning and ensuring an agile organization will be crucial with the changing demands of an organization’s shift to meet consumerism demands.

Post-Acute and Senior Care Asset Repurposing

From 2010 to 2017, the senior population aged 65 years and older increased nearly 26 percent, resulting in an increased need for senior care services. However, during this same time, the average daily census at skilled nursing facilities declined over four percent due to declines in utilization, length of stay, payment reform, alternative options, and client preference. Total licensed beds declined approximately one percent, and occupancy declined from 82 percent in 2010 to 79 percent in 2017. To adapt to the changing landscape, more SNFs will convert to senior housing alternatives, such as low-income or market rental apartments, specialized units like traumatic brain injury or mental health units, assisted living, or memory care assisted living, all of which have experienced increasing consumer demand.

The long-predicted shortage of personal care aides is here. And it is creating enormous challenges for frail older adults and people with disabilities living at home as well as for operators and residents of nursing homes and assisted living facilities.

This shortage inevitably will drive up costs for services that already are unaffordable for many consumers. They will increase financial pressures on Medicare and Medicaid and force older adults and others with disabilities to rethink how they receive care. At the same time, labor shortages will drive innovation and new technologies that could remake supports and services.

The US has known this was coming for years. As the aging population grew, the number of personal care aides to provide care at home or in nursing or assisted living facilities was not keeping up. But now the shortage is here.

A tight labor market

The long-term problem is all about demographics: The Baby Boomers are aging and, because they had relatively few children, there won’t be enough people of caregiving age—either relatives or paid aides– to help them. But even before we hit the demographic wall, the US is facing more immediate short-term problems.

The biggest may be the strong economy and the very tight labor market. The unemployment rate was 3.7 percent in October, the lowest in a half century. And with lots of other available jobs, it is increasing hard to recruit low-paid aides.

According to the advocacy and research organization PHI, home care workers earn a median wage of $11.03 an hour while nursing assistants in nursing homes earn $12.84 an hour. And their injury rates are among the highest of any occupation in the US.

By contrast, veterinary technicians make more than $16 an hour. A society that pays more to workers who look after pets than those who care for parents should not be surprised when people gravitate to easier and better-paying jobs.

How tight is the current market for direct care workers? The newsletter Home Health Care News reports that home care companies increasingly are requiring non-compete agreements that limit the ability of aides to move to other agencies or to work directly for their clients, who would then avoid paying the agency fees.

According to the newsletter, a lawyer who represents agencies said, “They don’t have enough of a labor force to satisfy their client demands.”

Regulatory answers

Government is looking to regulatory answers, including new rules to require higher staffing levels and more disclosure of facilities that are chronically short-staffed.

Last summer Jordan Rau of Kaiser Health News reported that many facilities have fewer staff than they report to the government. In response, the federal Centers for Medicare and Medicaid Services announced last week that it would urge states to boost inspections in an effort to end the practice. At the same time, some states have moved to mandate specific minimum staffing rules for nursing homes. Last spring, the New Jersey legislature tried.

But requiring minimum staffing won’t solve the problem. Many nursing homes will respond to these mandates by closing beds or otherwise changing their business models. This is a particular problem in long-stay nursing facilities where wages are largely driven by Medicaid. It makes little sense for the government to demand facilities hire more staff if its payment rates won’t support a decent wage for the workers they have.

Home care

But nursing homes are only a small piece of the problem. Fewer than 10 percent of those who require long-term supports and services live in those facilities. About another 8 percent live in assisted living facilities, which are unregulated by the federal government. But more than 80 percent live at home. How will they find aides?


How about technology? It undoubtedly will help. Facilities increasingly will install devices to monitor the well-being of residents. And some gizmos even are finding their ways into private homes. But caregiving remains a high-touch personal job and we are a long way from the time when human caregivers are replaced by robots.

The bottom line is that the law of supply and demand ultimately will win out, as it always does. The only way to increase the supply of aides is to pay them more, give them more benefits, make their work more rewarding, and give them opportunities for advancement.

Bessie’s Hope has created a solution to help—-

Twenty-five years ago, Bessie’s Hope created a solution to help with the unimaginable statistic that 60% of nursing home elders receive NO personal visitors. The solution: Relationship-driven volunteer programs that provide education and training to volunteers from preschool to adult ages. With the training, and with Bessie’s Hope facilitating elder care group visits for adult groups and youth groups and assisting families and individuals to be matched with elders who have no one, hundreds of elders DO have someone—the Bessie’s Hope volunteer. Compassion, empathy and respect for the elders are key.

The solution to help with the work force shortage is one that introduces high school students to the vast array of jobs and career paths in long term care. This introduction comes only after the training, the participation in the group visits, and the demonstration from the youth that they have respect, compassion and empathy for the elders. In addition, they have the awareness that the elders are resources of vast knowledge and wisdom, with so much to teach all younger generations on so many levels. They have a fondness for the elders, and they genuinely enjoy their company. All of these qualities are essential to being a good elder care provider.

The youth may participate in the Bessie’s Hope School-to-Career Work Force Development for Long Term Care. See the page of the same name on