home health care

Are individuals who need care where they should and can be? You may have noticed last week. There were four articles and press announcements within just a few days – sourced separately that belong together. No insurance or government program is all that transparent or straightforward, but policy and practice variations across states seem to have one victim – the person who needs care.  They ability to obtain that care at home (or in the right setting) depends on the state you live in and what the policy, practices, and costs in that state. Genworth’s newly-updated report is revealing about long-term care costs in multiple settings and categories.

Caregiving is hot – but practicality is not.  The letters to the editor in today’s WSJ print edition were on point following Ezekiel Emanuel’s May 3 article about the Independence at Home program. The article described care in the home provided for an 87-year-old diabetic, post-stroke, oxygen dependent woman receiving six hours of daily home care, supposedly more than she would receive in a nursing home. One doctor observed: “What happens at the seventh hour when she needs help in transferring, falls from her wheelchair or when her blood sugars go out of control?” What happens indeed? And the next letter: "The backbone of home care remains 'Low-paid, low-skill home service workers who cook, clean, bathe and help clients around their home.' And the process for overseeing this industry of workers who help the neediest elderly – actually it’s not much of a process at all. And the distinction in the media between private duty non-medical home care, home health care, geriatric care management, or hospice care in the home?  Not much. 

The US faces a shortage of professional in-home care workers.  The Bureau of Labor Statistics has projected both the growing availability of home care jobs and the shortage of people to fill them. Some states will confront daunting shortages within the next few years: Minnesota will need to fill almost 60,000 direct-care and support positions by 2020, particularly as the state shifts funding toward care in the community rather than in nursing facilities.  The problem is worse in Alaska – where many care workers are nearing retirement age themselves.  Over time, as AARP has predicted, the care gap will widen as boomer population ages – and their care needs catch up with them.  And finally, in nursing, the future has arrived. “Between 2006 and 2016, the U.S. Department of Labor (2007) projected that registered nurse job growth in the home healthcare sector (39.5%) will be larger than in the hospital sector (21.6%).”