A national crisis is looming for home health care: the number of workers delivering the service is not expected to keep pace with a growing demand as the population ages.
A chief culprit for the shortage is low pay tied to inflexible rates set by Medicare or Medicaid. It’s time for federal and state legislators to recognize the problem and insist on improved compensation for caregivers so they can meet the needs of people who want to live at home instead of in an institution.
Heavy demands are placed on home health care workers who are overworked and underpaid, often holding down multiple jobs and laboring up to 60 or 70 hours a week to make ends meet. Among them is Helen O’Gorman, of Buckland, a full-time certified nursing assistant at O’Connell Care at Home, based in Springfield, who also works for private home-care clients and runs a cleaning business.
She helps her clients with medical issues, picks up prescriptions, shops for groceries, prepares meals and assists with personal hygiene, such as showering.
O’Gorman, 57, says CNAs cannot rely on a single job, or “we’d all be broke. You have to do a bartending job, or a waitressing job, to be a CNA. It’s never going to make you financially independent. And you need to worry about burnout, too.”
Despite the stress and fatigue, O’Gorman says she enjoys working with people in need.
That’s a common theme expressed by home health care workers — including home health aides and personal care aides as well as nursing assistants —who are motivated by compassion.
Barton’s Angels, of Northampton, provides home care in western Massachusetts. Among its caregivers is 23-year-old Mary Wetzel, who says she and her colleagues often choose to work unpaid hours rather than neglecting needs of their clients.
The stress can be difficult. “There are days when it feels like your heart is going to break. And then you go home, and you have to do it again the next day,” Wetzel says. Nevertheless, she loves the job because “I have compassion for the human condition.”
But compassion does not pay the bills and low wages persist for home health caregivers who earn between $11 and $14 an hour, according to the U.S. Bureau of Labor Statistics. Their mean annual wage is about $24,000 nationwide, though the bureau reports that as of May 2017, Massachusetts ranked above the average: $28,810 for personal care assistants and $30,740 for home health aides.
Still, recruitment in Massachusetts is not keeping up with the ever-increasing demand for more home health care. “There’s massive demand for these workers,” says Hayley Gleason, interim executive director at the Home Care Aide Council of Watertown, a nonprofit association of home care agencies. “That’s a good thing. There’s huge growth.
“But, on the flip side, we’re really struggling with recruitment of people into this field. When the economy is better, oftentimes the low-wage industries struggle because there’s more competition.”
Wages for caregivers do not rise with the demand for increased services because about 75 percent of home care is paid at uniform rates set by Medicare, Gleason says. “In any other industry, if there was demand, prices would increase, and that would be passed on to the workforce. But because of how health care, as a system, is built, in that it’s structured on the government as a payer, it doesn’t have that ability. Unfortunately, it’s going to get much, much worse.”
The Bureau of Labor Statistics reports that the number of home health care workers in Massachusetts increased from 16,750 in 2006 to 27,020 in 2016. The need will continue to grow as the baby boomer generation — people born between 1946 and 1964 — ages and life expectancy increases.
“We have to talk about wages,” Gleason says. “We need to be increasing the reimbursement rate to agencies, so they can increase the wages for their workers.”
We urge the many candidates seeking state House and Senate seats pledge to make that a priority for the legislative session beginning in 2019. Home health care workers perform a critical job and deserve better pay.