Category Archives: Home Health Workers

U.S. Home Care Workers: Key Facts (2019)

Source: PHI, September 3, 2019

From the abstract:
This research brief provides the latest annual snapshot of the U.S. home care workforce, including key demographics and a variety of wage and employment trends. This year’s research found that nearly 2.3 million home care workers earn a median hourly wage of $11.52 and about $16,200 annually. One in six home care workers lives below the federal poverty line and more than half rely on some form of public assistance.

Key Takeaways:
– Nearly 2.3 million home care workers provide personal assistance and health care support to older adults and people with disabilities.

– From 2016 to 2026, the home care sector will need to fill 4.2 million home care worker job openings.

– With a median hourly wage of $11.52 and inconsistent work hours, home care workers typically earn $16,200 annually.

Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission

Source: California Future Health Workforce Commission, February 2019

From the summary:

California’s health system is facing a crisis, with rising costs and millions of Californians struggling to access the care they need. This growing challenge has many causes and will require bold action by the new governor, legislators, and a broad spectrum of stakeholders in the public and private sectors. At the core of this challenge is the simple fact that California does not have enough of the right types of health workers in the right places to meet the needs of its growing, aging, and increasingly diverse population.The California Future Health Workforce Commission has spent nearly two years focused on meeting this challenge, issuing a new report with recommendations for closing California’s growing workforce gaps by 2030…..

…..The Commission’s final report includes a set of 27 detailed recommendations within three key strategies that will be necessary for: (1) increasing opportunities for all Californians to advance in the health professions, (2) aligning and expanding education and training, and (3) strengthening the capacity, retention, and effectiveness of health workers. Throughout its deliberations, the Commission has focused on the need to increase the diversity of the state’s health workforce, enable the workforce to better address health disparities, and incorporate new and emerging technologies.

While advancing all 27 recommendations over the next decade will be important, the Commission has high-lighted 10 priority actions that its members have agreed would be among the most urgent and most impactful first step toward building the health workforce that California needs.

To make these proposals a reality, the Commission also recommended establishing statewide infrastructure, starting in 2019, to implement the recommendations in partnership with stakeholders, to monitor progress, and to make adjustments as needs and resources change. This statewide effort will need to be paired with strong regional partnerships to advance local workforce and education solutions.

The Commission’s 10 priorities for immediate action and implementation are:
1. Expand and scale pipeline programs to recruit and prepare students from underrepresented and low-income backgrounds for health careers….
2. Recruit and support college students, including community college students, from underrepresented regions and backgrounds to pursue health careers….
3. Support scholarships for qualified students who pursue priority health professions and serve in underserved communities….
4. Sustain and expand the Programs in Medical Education (PRIME) program across UC campuses….
5. Expand the number of primary care physician and psychiatry residency positions….
6. Recruit and train students from rural areas and other underresourced communities to practice in community health centers in their home regions….
7. Maximize the role of nurse practitioners as part of the care team to help fill gaps in primary care….
8. Establish and scale a universal home care worker family of jobs with career ladders and associated training….
9. Develop a psychiatric nurse practitioner program that recruits from and trains providers to serve in underserved rural and urban communities….
10. Scale the engagement of community health workers, promotores, and peer providers through certification, training, and reimbursement….

Together, the Commission’s prioritized recommendations will:
● Grow, support, and sustain California’s health work-force pipeline by reaching over 60,000 students and cultivating careers in the health professions.
● Increase the number of health workers by over47,000.
● Improve diversity in the health professions, producing approximately 30,000 workers from under-represented communities.
● Increase the supply of health professionals who come from and train in rural and other underserved communities.
● Train over 14,500 providers (physicians, nurse practitioners, and physician assistants), including over 3,000 underrepresented minority providers.
● Eliminate the shortage of primary care providers and nearly eliminate the shortage of psychiatrists.
● Train more frontline health workers who provide care where people live…..

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions

Source: Carolyn C. Foster, Rishi K. Agrawal, and Matthew M. Davis, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Historical Mismatch Between Home-Based Care Policies And Laws Governing Home Care Workers

Source: Lisa I. Iezzoni, Naomi Gallopyn, and Kezia Scales, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
Americans generally want to remain in their homes even if they develop chronic health problems or disabilities that qualify them for nursing home care. While family members or friends provide the preponderance of home-based support, millions of Americans use paid personal assistance services (PAS). Inexorable demographic trends are increasing the numbers of people who need paid home-based PAS, with this need rapidly outstripping the capacity of the paid PAS workforce. While many factors contribute to this widening discrepancy, its roots reach back more than eighty years to asynchrony among various policies affecting home-based supports for people with functional impairments and policies affecting home-based PAS workers. Finding solutions to the growing gap between demand for the services and the PAS workforce requires policies that cut across societal sectors and align incentives for consumers, workers, and other key stakeholders.

Related:
Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises
Source: Susan Jaffe, Health Affairs, Vol. 38, No. 6, June 2019

Care For America’s Elderly And Disabled People Relies On Immigrant Labor

Source: Leah Zallman, Karen E. Finnegan, David U. Himmelstein, Sharon Touw, and Steffie Woolhandler, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
As the US wrestles with immigration policy and caring for an aging population, data on immigrants’ role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants’ role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants’ role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2 percent of health care workers and 23.5 percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5 percent) of direct care workers and 30.3 percent of nursing home housekeeping and maintenance workers were immigrants. Although legal noncitizen immigrants accounted for 5.2 percent of the US population, they made up 9.0 percent of direct care workers. Naturalized citizens, 6.8 percent of the US population, accounted for 13.9 percent of direct care workers. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans.

Home And Community-Based Workforce For Patients With Serious Illness Requires Support To Meet Growing Needs

Source: Joanne Spetz, Robyn I. Stone, Susan A. Chapman, and Natasha Bryant, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
Home health and personal care aides are one of the largest groups of health care workers in the US, with nearly three million people providing direct care for people with serious illness living in the community. These home care workers face challenges in recruitment, training, retention, and regulation, and there is a lack of data and research to support evidence-based policy change. Personal care aides receive little formal training, and they experience low pay and a lack of respect for the skill required for their jobs. High turnover and occupational injury rates are widely reported. There is little research on the factors associated with higher-quality home care, the extent to which worker training affects client outcomes, and how regulations affect access to and quality of home care. Health care leaders should seek to fill these gaps in knowledge, support the establishment of training standards and programs, implement Medicaid reimbursement strategies that incentivize improvements in pay and working conditions, reform regulations that now prevent the full utilization of home care workers, and create sustainable career pathways in home care policies.

Conservatives Pushed a Strategy to Weaken Home Health Care Unions. The Trump Administration Bit.

Source: Rachel M. Cohen, Nick Surgey, The Intercept, May 31, 2019

Earlier this month, the Trump administration announced a new rule barring home health care workers from paying union dues through their Medicaid-funded wages. The new Department of Health and Human Services rule, which will impact more than 800,000 workers and was immediately met with a legal challenge, followed years of planning by anti-union activists to promote such measures in states across the country, and, more recently, on the federal level.

In anticipation of a crushing blow to public-sector unions by the U.S. Supreme Court last summer, conservative groups ramped up their efforts to bring the federal government’s attention to the issue of Medicaid-funded union dues, according to an audio recording obtained by The Intercept and Documented.

On an invitation-only call with donors last June, leaders with the State Policy Network — a corporate-backed umbrella group of right-wing think tanks across the country — raised the issue of directly deducting union dues from Medicaid-funded paychecks, what they call “dues-skimming.” Vinnie Vernuccio, a labor policy adviser to the State Policy Network told donors that its plan was to end this practice by getting “an administrative rule passed at Health and Human Services” and passing federal legislation with the assistance of Rep. Cathy McMorris Rodgers, R-Wash…..

Improving Job Quality for Direct Care Workers

Source: Paul Osterman, Economic Development Quarterly, Volume 33 Issue 2, May 2019
(subscription required)

From the abstract:
The prevalence of low wage work is a major challenge for American labor markets and health care is an industry in which many of these low wage workers are found. This paper provides data documenting these facts and then discusses strategies for upgrading job quality for long-term care workers who constitute the majority of low wage employees in health care occupations. In addition the paper briefly discusses approaches for upgrading the employment opportunities of low wage employees who are in the health industry but in jobs that are not health care specific.

The Role of Training and Work-Related Injury on Home Health Workers’ Job Satisfaction: Analysis of the National Home and Hospice Care Survey

Source: Hanadi Hamadi, Janice C. Probst, M. Mahmud Khan, Aurora Tafili, Home Health Care Management & Practice, OnlineFirst, Published April 13, 2019
(subscription required)

From the abstract:
The purpose of this study was to describe personal, job, agency, environmental, and ergonomic factors that affect job satisfaction among home health workers (HHWs). A cross-sectional design was conducted, and data from the National Home and Hospice Care Survey (N = 3,274) were analyzed using a multilevel structural equation model (generalized structural equation model). HHWs with excellent training knowledge were about 1.5 times more likely to report a higher degree of job satisfaction compared with those with poor training knowledge, and those who reported a work-related injury were 66% more likely to report lower job satisfaction score. Job satisfaction is associated with work environment, leadership support, and work-related training. Future research and a follow-up survey are needed to understand HHWs’ workforce and be better positioned to meet their need so that they may meet the need of the aging population.

State Options for Making Wise Investments in the Direct Care Workforce

Source: Madeline Twomey, Center for American Progress, April 10, 2019

From the introduction:
Policymakers must invest in strengthening the direct care workforce in order to improve the quality of care delivered to patients and to achieve better value for every dollar spent on long-term services and supports.

This report outlines a number of actions that lawmakers can take to support the existing direct care workforce while increasing the number of available workers. Several states have already taken innovative approaches to addressing workforce shortages, including implementing payment reform to incentivize workforce initiatives. Additionally, states have increased wages and invested in workforce development and training in order to attract and retain direct care workers. In order to meet the growing demand for LTSS, state lawmakers should prioritize policy changes addressing workforce challenges, and the federal government should make investments to support states implementing meaningful reform.