Throughout the COVID-19 pandemic we saw an increase in people’s desire to age at home. Headlines pointed to rising fears of nursing homes and other institutional settings, while social distancing restrictions brought us closer to home and community than ever. Still, for those beginning to need support in the home during this period, many challenges emerged including limitations on the ability of family members to care for them due to COVID-19 restrictions and a lack of access to supports such as home health or personal care workers that worsened during the pandemic.

With the pandemic ending, many people facing age-related health issues and considering options for retirement are now more seriously assessing options for home care for themselves or their loved ones. Many family members struggle with the financial and emotional burden of taking care of an aging parent, partner, or friend and hope to fill in the gaps in care with paid home care services.  Those services—referred to as long-term services and supports (LTSS) —are expensive and often difficult to arrange in ways that meet the needs of families.  Finding the right home health worker or personal care aide is challenging and services are expensive and generally not covered by insurance; families are left to cobble together a sub-optimal caregiving strategy.

For some low-income individuals, the Medicaid program offers support to help individuals and families to access and finance those LTSS services, including through personal care benefits and certain limited and targeted waiver programs called home- and community-based services (HCBS), which varies by state.  However, gaps remain for those making too much to qualify for Medicaid but not enough to pay for these services themselves.  While many families believe that their Medicare benefits cover home care, they are often surprised to learn that program does not; Medicare generally only offers home health services on a limited basis after a hospital stay.

Most families then must find ways to organize their caregiving approach to keep loved ones at home, with the most notable challenge finding, arranging, and paying for the right home care aide.  This is no easy task.  The sector is not well organized and home care workers are paid poorly for the work they do; about half of home care workers are surviving on incomes below 200% of the federal poverty level, which makes it difficult for individuals or home care agencies to attract and retain paid caregivers.  Low wages also contribute to rapid turnover within the industry, which leads to frequent changes in staffing.  Individuals aging at home struggle with accessing consistent care and are less able to form meaningful relationships with caregivers. Limited compensation and rapid turnover also diminish the ability of these workers to do their jobs well, as they are often struggling financially to support themselves, while taking on the responsibility of caring for another person. Furthermore, there are no federal training requirements for personal care aides, and home health aides require only 75 hours of training, which varies widely by state, and core skills and competencies are loosely defined, which leads to poor quality of care for older adults.  Both qualitative and quantitative studies show home health workers feel a lack of quality supervision, which further contributes to low retention and poor health outcomes for our aging adults.

To address the current flaws in our home health care options, financial and professional support for paid caregivers needs to increase;  industry stakeholders and policymakers should be open to innovation in the sector and find ways to encourage new options for families. At the same time, families can look to emerging options in the sector to help them.  Care coordination services, like Wellthy, can help direct people to high quality caregivers and caregiving organizations.  Additionally, increased funding through public programs and private insurance options can help increase wages and professional support for home care workers and personal care aides.  As part of that effort, new models of payment and delivery could emerge that incentivize the use of paid caregivers as means of keeping people at home instead of institutions.   Better information on available services and the quality of care could further support the sector.

Those who we entrust with the care of our beloved family and friends should have resources available to provide our aging population with quality care and support in the home.

Want to help support home care workers? Call or write your representatives in support of increased funding and expansion of home and community based supports and long term services and supports offered through our public programs like Medicaid.