Home Health Aides Undervalued in U.S. Healthcare System

Although home health aides play a key role in keeping homebound older adults in their homes, there is a looming shortage of these workers.

Home health aides play a vital role in the care of homebound older adults and there is an alarming shortage of these key caregivers, according to researchers and a recent Alzheimer’s Association report.

Home health aides are critically important to keeping many older adults in their homes, a trio of researchers wrote in a recent Journal of General Internal Medicine editorial. “Without a strong community support system, we can expect inadequately supported older adults to continue to cycle through illness, repeated unnecessary hospitalizations, and potentially unwanted nursing home admissions,” they wrote.

There is a looming shortage of home health and personal care aides nationwide, according to the recent Alzheimer’s Association report. There were 3,083,310 home health and personal care aides in 2018, and 4,146,220 of them will be needed by 2028, representing a 34.5% increase, the report says.

A co-author of the Journal of General Internal Medicine editorial recently discussed the importance of home health aides with HealthLeaders. “There is a significant group of older adults who, over time, lose the ability to perform activities of daily living. Home health aides help to fill in some of those gaps. So, things like bathing and meal preparation can become just too difficult for some older adults. Without the support of home health aides, these older adults will lose the ability to remain at home,” said Jennifer Carnahan, MD, MPH, a practicing physician, Regenstrief Institute research scientist, and assistant professor at Indiana University School of Medicine.

Home health aides can reduce healthcare costs, she said. “In terms of lowering healthcare costs, we know that nursing homes, which are where many older adults often end up, can be highly expensive. Home health aides are usually less than 24/7 service, but they can provide the support that often prevents the high-cost investment of living at a nursing home.”

Home health aides also improve health outcomes, Carnahan said. “Everybody wants to define what a better healthcare outcome would be. The most important person to ask is the older adult themselves and their loved ones. They would say that staying at home is a better outcome. Home health aides help them maintain community living. Home health aides can also help identify medical concerns before other people realize what is going on. At lot of times, home health aides see these older adults every day or every other day, and they will notice if there is a change in mentation or their ability to function.”

Home health aides undervalued

Home health aides do not get the credit they deserve in the U.S. healthcare system, Carnahan said.

“They are often labeled as unskilled laborers. We don’t learn about them in medical school, even though they provide support for many older adult patients. We need to understand better how they fit into the entire picture. They are an afterthought—I learned about home health aides when I was acquiring additional geriatric training. We should think of home health aides as a vital part of the healthcare team even though they are not prescribing medicine or doing some of the things we think of as traditional medical care. They are contributing to care,” she said.

Carnahan and her editorial co-authors found that home health aides are not adequately compensated. “We looked at Bureau of Labor statistics and found that the median salary for a home health aide is $13.02 per hour. So, if you think about the recent discussions about elevating wages in other sectors of the workforce to $15 per hour, you can see how it might be more attractive to look at other types of employment. Home health aides are definitely undervalued in terms of compensation,” she said.

Including home health aides in care teams

Integrating home health aides into care teams can be beneficial, Carnahan said.

“This is a potential solution for making the pathways for communication easier. It is always easier to communicate with colleagues who are part of your company or the institution you are working for. If we can integrate home health aides into care teams, it can make things a lot smoother and easier. I have witnessed this problem in other arenas in healthcare, such as struggling to communicate with other health systems to try to get more information about a patient. When everyone is in the same health system, it is just easier to figure out what is going on with a patient,” she said. “Integrating home health aides with care teams also makes it easier to raise red flags. If a patient seems to be declining, everyone, including home health aides, can be on the lookout for decline. That way, you can nip problems in the bud.”

There are options to integrate home health aides into care teams, Carnahan said.

“A lot of this requires thinking outside of the box. Health systems could hire home health aides or contract with them. The way it is now is fractured. I work for the Indiana University Health Physicians, and any of the home health aides who are working with my patients are working for different companies. So, it is hard for me to find the home health aide who is working with Mr. Smith. Integration of home health aides could come through bringing them into the fold of a health system or partnerships between health systems and home health companies, where we have huddles once per week.”