Academic journal article Care Management Journals

The Home Health Aide: Scarce Resource in a Competitive Marketplace

Academic journal article Care Management Journals

The Home Health Aide: Scarce Resource in a Competitive Marketplace

Article excerpt

Direct-care staff-home health aides and personal care attendants-are the very point where home care "touches the client." Yet our system of care delivery has never been designed for the needs of the direct-care worker. Today we are paying the price: Across the country, our industry is experiencing the highest rates of direct-care vacancies and turnover in its history. The very future of our industry now rests on bur ability to attract workers within an increasingly competitive labor market. In order to survive, let alone provide high-quality care, the home care industry must restructure paraprofessional employment.

In all geographic regions of this country, there is an ongoing inability to hire staff to provide the most fundamental care needed. The crisis for home care used to be lack of adequate business opportunities. Now agencies have to turn away requests for service for a lack of competent, appropriately trained staff.

-National Association for Home Care, February, 2000, Testimony to the U.S. Congressional House Committee on Education and the Workforce

The majority of paid care received by home care clients in the United States is provided by a "direct-care" paraprofessional- not a doctor, not a nurse, but a home health aide or personal care attendant.1 These directcare staff are the home care delivery system, the very point where home care "touches the client" (Gipson, 1998). Yet our system of care delivery is not now, and never has been, designed around the needs of the direct- care worker.

Today we are paying the price. Across the country, our industry is experiencing the highest rates of directcare vacancies and turnover in its history-rates so high that many home care agencies are forced to limit care, and increasingly, even turn clients away.

For the past three decades, our home care system was structured on the presumption of a seemingly endless supply of low-income individuals (usually women and, disproportionately, women of color) willing to work as aides and attendants. Both agencies and consumers presumed that these women would always be available to offer care and companionship-despite low-quality jobs that kept literally hundreds of thousands of paraprofessionals "working, but poor" (Himmelstein et al., 1996).

To undervalue, and even ignore, what we believe we have an abundance of is simply human nature. Like clean water or the air we breathe, we don't even think about how essential something is when it seems limit less. Similarly, managers and financiers within the home care industry never had to pay much attention to the supply of home care aides: Who among us just four years ago-facing the market constrictions of the Balanced Budget Act and knowing that welfare reform was throwing literally millions of women from welfare into lowwage work-would have predicted that today we would be experiencing a dearth of home health aides?

Yet, now direct-care staffing vacancies are spreading throughout nursing homes and home care agencies across the country. In the past year, 40 states have created legislation in response to, or formed special task forces to study, the long-term-care workforce crisis (Paraprofessional Healthcare Institute, 2000). The very future of the industry now rests on our ability to attract direct-care workers within an increasingly competitive environment. Therefore, we argue below that in order to survive, let alone provide high-quality care, the home care industry must not simply improve, but wholly restructure, paraprofessional employment.

LABOR AS A SCARCE RESOURCE

The current vacancies of direct-care staff are not due simply to our full-employment economy-to believe so is no more than wishful thinking. Many in our industry unfortunately will be shocked in the coming year when, as the economy begins to soften, high rates of vacancies remain.

In fact, direct-care vacancies will likely increase because our home care industry now faces a labor market that is profoundly different from the one upon which our long-term-care system was originally built. …

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