As the U.S. population ages, the demand for in-home care is rising.
By "2030, we will have more people over the age of 65 than under the age of 18," Vicki Hoak, executive director of the Home Care Association of America, said. "I don't know if we're ready for that.
The association is a leading trade organization representing home care agencies and their suppliers across the U.S. Its focus is on non-medical personal care that is not covered by Medicare.
"I just really believe that every American should have a right to stay in their home and receive the care as they age," Hoak said.
According to AARP, a growing number of Americans say they want to age in place, at home, rather than in a nursing facility. As a result, the demand for in-home care is skyrocketing.
Getting in-home care services depends on your health, insurance, financial circumstances, and personal needs. AARP notes that those costs can be covered by an individual or their family, long-term insurance, state or government programs such as Medicaid, or even nonprofit organizations.
"Home care is kind of unlike any other health care delivery model. It's 1 to 1 care that's unusual for like 8 hours," Hoak said.
The problem is that the demand is dramatically outpacing the supply of direct care workers.
"I can tell you for the 25 years I have been representing these folks, we've always talked about [not having] enough workers. The changes after the pandemic became so much more," Hoak said. "We were seeing 25% of people calling an agency needing care turned away because we didn't have. The workers. And I often think about my mom, who I love dearly. What would I have done if I couldn't find a worker? I would have had to quit my job. And that's where many times these families are struggling."
So just how much of a disconnect is there between the demand and supply for in-home care? Scripps News caught up with Dr. Amanda Kreider, a health economist at the University of Pennsylvania. A paper she co-authored earlier this year on home care had some surprising findings.
More states working to pay family members to care for their loved ones
Nationwide, Medicaid pays for in-home health care in some form or another in all 50 states. But in select states, Medicaid will pay relatives.
"Given all the recent reports about shortages, we thought maybe the number of workers had actually declined over time, but that's actually not what we found. So, the number of home care workers has actually increased pretty substantially over the last couple of decades. Actually, it's increased faster than the size of the U.S. population. So that's not the problem," Kreider said. "But on the flip side, it seems like the demand for these services has increased really substantially and since 2013 and has increased faster than the size of the workforce."
The report found that "the number of home care workers per 100 home and community-based services (HCBS) participants declined by 11.6 between 2013 and 2019, with preliminary estimates suggesting that further declines occurred in 2020."
Kreider says while the U.S. isn't alone in its struggle to provide care as the population ages, the way insurance works here isn't helping.
"Typically, when people get older, they enroll in the Medicare program, and Medicare actually doesn't cover long-term services and supports. And really, I think something that's kind of missing in the U.S. is a comprehensive insurance program for long-term care that covers, you know, everybody. A lot of people end up having to pay for [long-term care] out of pocket until they don't have enough money anymore, and then they spend down their income and enroll in Medicaid," Kreider said.
But experts say the insurance system isn't the only aspect of in-home care that needs to change.
"These people are so valuable. I always like to say they're like the backbone of long-term care in this country because they allow people to stay at home," Hoak said. "And yet, unfortunately, they're not valued as much as they should be."
Hoak says workers deserve better pay and that the industry needs more help from lawmakers.
"And I'm not going to mince words. They need to be paid more," Hoak said. "Right now, 30% of our workforce are people who are not born in this country. Everyone recognizes that we've got to look at some immigration reform to bring in people from other countries to be home care aides."
And that means giving them an avenue for a stable work life.
"We also talk a lot about career paths. You know, when we talk to our workers, they say, I need better wages, I need better benefits, and I want to be recognized and valued, and I want to have a career path that if I come in as a home care aide," Hoak said. "What are my steps that I can do to make more money and be promoted like we all are?"
By caring for others, we just receive the care we desire as we age.
