"Who will take care of the aged and the younger disabled?" Part of the answer may be skilled home health aides, according to Paul Osterman's book, Who Will Care For Us?: Long-Term Care and the Long-Term Workforce.
Baby Boomers and the Younger Disabled
When the last of the Baby Boomers turn 65 in 2030, older people are expected to constitute 20% of the American population. According to the Institute of Aging, many older Americans are likely to live to 85+ years of age and live with health and financial limitations. Moreover, based on 2010 data, nearly one-third of non-institutionalized older adults (11.3 million) lived alone. This data is in keeping with an AARP survey finding that 78% of older Americans strongly concurred with the statement that they strongly agreed with the statement that “they wanted to stay at home and delay going to a nursing home for as long as possible.” In his book, Who Will Care For Us?: Long-Term Care and the Long-Term Workforce, Paul Osterman reflects on a 2015 report where 33 million Americans cited difficulties living independently? He then echoes a question that society has yet to address effectively: “Who will take care of the aged and the younger disabled?”
Home Health Aides
His proposed solution, pertaining to the proportion of younger and older people with varying disabilities who wish to live at home with dignity, is skilled home health aides. The author based his findings on 120 interviews conducted with different stakeholders e.g., direct-care workers, providers, government officials at federal and state levels, foundation staff, consultants, members of public interest groups, unions, doctors, lawyers, and insurance company representatives.
Home health aides are either trained and federally reimbursed or they are personal assistants, subject to state-by-state variations in the level of training needed to perform these duties. Because aides are mostly women and some of them may be immigrants, the profession does not have the status needed to swell its ranks in order to address the coming “silver tsunami.” The median income for home care aides in 2015 was $15,019. Additional formal education is rewarded with a 9% pay boost compared to 45% in other professions.
Who will pay?
Who will pay for this necessary transformation is always a thorny question. The total 2013 long-term care costs were more than $300 billion, with 20% being funded by out-of-pocket patient payments, 8% by insurance, and 72% by a mixture of publicly funded health programs, of which over two-thirds came from Medicaid. Because long-term care for the elderly is funded by Medicaid – usually thought of as providing health-insurance for poor people, including children – and health insurance for older Americans are funded via Medicare, it becomes more difficult to align costs and savings. In addition, only 12% of people between the ages of 40 and 70 have long-term care policies and this level of market penetration has not changed in more than a decade. Many of these policies will also only kick in after a waiting period of 100 days.
What are some of the experts doing?
However, the author mentions some of the experts leading the battle to reframe the national discourse and who are acting now instead of later. Mount Sinai has a Visiting Doctors program in which young gerontologists visit their patients in their homes and these professionals have reported favorably on home health aides. The United Hospital Fund has a transition model that supports family caregivers. Other agencies mentioned are the Visiting Nurse Services of New York, Cooperative Home Care Associates, PHI, the Penn Center for Community Health Workers, and City Health Works in Harlem.
Key takeaways that will ultimately save the system money and ensure that the home health aide will be the eyes, ears, and continuity needed by the vulnerable individual:
• Expanding the job description for direct-care workers as their roles in the long-term care ecosystem will only grow
• Enhance skills e.g., physical therapy, wound care training to generate the knock-on effect of making this a more attractive career option
• Streamline health laws e.g., AARP reports that 31 states home health aides to administer oral medicines and 19 do not
• Understand the larger system in which the workers are embedded
• Integrate home health aides more deeply into the hospital-to-home transition of each patient (especially if family caregivers will be largely absent because of work responsibilities)