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Finding a qualified person to provide in-home care for a loved one can be a herculean task. Demand has overwhelmed a job sector characterized by low wages, limited opportunities for advancement, high turnover and significant amounts of mental and physical stress.
The COVID-19 pandemic has only exacerbated existing problems in the home-care sector. Still, home-health agencies report that hiring has gotten a bit easier recently.
“It’s not as bad as it was during the height of COVID,” said Lakelyn Hogan Eichenberger, a gerontologist and caregiver advocate for Home Instead, a home-care agency. Still, she said: “We’re hiring. We’re always looking. There’s no shortage of need.”
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Eichenberger noted that the industry has a lot of work to do as it tries to elevate the caregiver profession. “We have some care pros who have been with us 16 years, and others who see the job as a stepping stone to another career,” she said.
When it’s time to find care for a relative or friend, you’ll first want to identify what kind of care services are needed and how you might pay for them, according to AARP. Do you want to use an agency, which may cost more, or will you look for a private provider, for whom you’ll need to think about payroll issues, vacation time and sick leave?
The Home Care Association of America breaks down care that’s provided in the home into three types: home care, home health and hospice.
Home care, or personal care, does not require a referral from a doctor and is often sought by families or by individuals themselves who need help with things like dressing, bathing or taking medications at the right time.
Home health is provided on an intermittent basis for wound care or after a specific episode or injury. It requires a doctor’s order and a plan of care.
Hospice, meanwhile, is end-of-life care.
There are 4.6 million direct-care workers in the U.S., including 2.4 million home-care workers, 675,000 residential-care aides, 527,000 nursing assistants in nursing homes and about 1 million direct-care workers employed in other settings, according to the Paraprofessional Healthcare Institute (PHI). Direct-care workers include a range of care professionals such as certified nursing assistants, home health aides, personal-care aides, caregivers and companions.
The direct-care workforce added nearly 1.5 million new jobs over the past decade, growing from 3.2 million workers in 2011 to 4.7 million in 2021, according to PHI. It’s projected to add an additional 1.2 million jobs from 2020 to 2030 — more new jobs than any other single occupation in the country.
As existing workers leave to take jobs in other fields or exit the labor force entirely, PHI estimates there will be some 7.9 million direct-care job openings from 2020 to 2030.
Finding qualified workers to fill those jobs will be tough. The median hourly wage for direct-care workers was $14.27 in 2021, according to PHI. At least partly as a result of those low wages, 40% of direct-care workers live in low-income households, and 43% rely on public assistance, such as Medicaid, food and nutrition assistance or cash assistance, PHI said.
The pandemic has also taken a toll on people working in direct-care settings and has created shortages of those workers.
“It has been particularly hard to find professional caregivers due to conditions created by the COVID-19 pandemic,” said Jennifer Olsen, chief executive officer of the Rosalynn Carter Institute for Caregivers. “The immense pressure that health systems have been under has greatly impacted the services that caregivers rely on, which has burdened families.”
People who are looking for help with a loved one are seeing the effects of this, Olsen said: “The decline in professional care workers is fast becoming one of the biggest problems for family caregivers — especially as we are seeing an increase in the number of aging adults.”
Without paid help, the burden of caregiving falls primarily on families and friends. According to the National Alliance for Caregiving and AARP, 47.9 million Americans, or 19.2% of the adult population, provided care to a family member or friend who was 18 or older in 2020, up from 39.8 million, or 16.6% of the adult population, in 2015.
Still, there are things you can do to make finding care easier, experts say.
Anticipate the need and call early
If you call the day before you need a caregiver, you might not find anyone who is available, so if you know your loved one will soon need care, don’t wait. Eichenberger recommends calling several agencies and asking how long it might take to get set up with care. There are often waiting lists, and getting on those lists ahead of time is crucial.
Be as flexible as possible
While most families want someone to help their loved one in the morning with feeding and dressing, and again at night, it can be easier to schedule care at off-peak times such as late morning or afternoon.
“If you can be flexible on the time of day when the patient needs help, that can make it easier to find someone,” Eichenberger said.
Weigh the risks versus benefits of different types of caregivers
Agencies often require clients to book a minimum number of hours per day or week. If you can’t afford those minimums, you may need to find a private caregiver.
There are risks and benefits to both routes.
One advantage of hiring through an agency is that they handle the vetting and training of employees, as well as things like payroll. It’s also often easier for an agency to find a replacement if a regular caregiver is absent than when you hire someone privately to provide care.
On the other hand, a freelance caregiver may have more flexibility when it comes to the hours they work and the services they provide. Be sure, however, to carefully screen and vet anyone providing care in your home or the home of a loved one.
Think outside the box
Be creative as you think about how to meet the needs of your loved one. For instance, you can contact local faith communities such as churches or synagogues, which might have volunteers who can help provide basic care, said Becky Hadiaris, coordinator of the family caregiver support program at the Southern Maine Agency on Aging.
You can also check with local universities and community colleges to see if they have a list of students who would be able to provide basic care or companionship for an older person. Students often have relatively flexible schedules and may be looking for experience and a reference for their resume in addition to a paycheck, Hadiaris said.
“Think outside the box,” she said.
