A nationwide shortage of in-home caregivers is expected to create about 1.4 million new job openings by 2026 because of the rising demand as the U.S. population grows older.
In Arizona, nearly 41,000 new jobs for direct-care workers are expected to open over the next seven years to try to meet the increasing need, according to Stephen Campbell, a policy analyst for the Paraprofessional Healthcare Institute, a nonprofit based in New York City. The institute works to improve long-term services for the elderly and those with disabilities.
These crucial home-care workers in Arizona — including personal-care aides and home-health aides — assist the elderly and physically disabled in their homes. Aides help with bathing, dressing, cooking, cleaning, laundry and running errands so that clients can remain in their homes rather than move to assisted living or nursing facilities.
The jobs can be difficult as many elderly patients suffer from illnesses or cognitive impairments, and the pay often tends to be around minimum wage, with no employee benefits. Employee turnover is generally high.
Judy Clinco, founder and president of Catalina In-Home Services, said there has been little planning by public agencies, health-care providers and families for the long-term late-in-life care of seniors as the “tsunami of (aging) baby boomers” has hit.
Clinco, a registered nurse who founded the home-care agency in 1981 when her mother needed support to remain in her home, said, “Families have not had discussions about what is needed now and in the future for their parents, and where it will be provided as they age.” Discussions about costs and what families can afford also must take place, she said.
In many families, adult children usually take care of their aging parents. But there are families who cannot because of their jobs or they live out of state or they need help because of their parents’ declining health. Then there are seniors who never had children or married.
That’s where the home-care worker comes to fill those needs. Their work is vital to senior citizens who want to remain in their homes as long as possible.
As the home-care industry, communities and government officials grapple with these facts, they also have to face the fact that the turnover rate of employees in the industry is high and must be remedied as Americans live longer and 10,000 baby boomers will be turning 65 each day until 2030.
Among the main reasons home-care workers leave their jobs is low pay, part-time hours, shifting schedules and lack of benefits, industry experts say.
“Born to be a caregiver”
Sabah Bouhamouda, a native of Algeria in North Africa, has worked in home care for nearly 10 years and has found her niche with Catalina In-Home Services, where she has worked for four years.
“I just love my job. It is nice to feel that you are helping others,” said Bouhamouda, 46. “I feel like I was born to be a caregiver.”
She said she works with three clients ranging in age from their 80s to 100.
“I help them with personal care such as bathing, dressing, preparing their food, laundry and cleaning. I work nights and stay in their homes,” she said.
Bouhamouda said it takes a special person to be a caregiver.
“You have to care about people and be very, very patient. It can be difficult when they are sick and don’t feel good, or have dementia or Alzheimer’s,” she said. “You are a stranger in their home and they may be mean to you, but it is the disease. You can’t take it personal. You have to make them feel safe and build trust.”
She praised Catalina In-Home Services for refresher courses and training every six months to teach workers the latest methods and techniques in helping clients.
Bouhamouda said she earns $13 an hour, gets overtime pay, health benefits, mileage and the company pays her AAA membership.
“They treat workers with respect, give us support during our work shifts when we need it,” she said, explaining that she has access to a nurse if a client becomes sick. “We get briefed about each client before we decide if we want to work with them or not.”
Another agency she previously worked for paid her $7 an hour and after three years she earned $9 an hour. She received no mileage or benefits, and received limited training in earlier jobs.
For Brenda Merino, being employed as a home-care worker for eight years was enough. She began at age 18 and left at age 26. During that time, she served more than 30 clients who were elderly or physically disabled.
Most of her clients were 65 to nearly 90 years old. Some had strokes and others were doing relatively well. Some remained in their homes while their spouses had to be placed in an assisted living facility.
It was Merino’s nature to want to nurture and help people by doing the “little things that we all take for granted,” like being able to bathe, groom, cook and clean.
“I enjoyed going into their homes and accomplishing tasks they weren’t able to do. I liked spending time with them and getting to know about their lives,” she said.
However, Merino found it difficult when her clients died.
“I was attached to them and it was super hard for me to let go,” she recalled.
She also agreed with Bouhamouda that pay and benefits have to improve to attract and retain workers.
Merino, 36, now works as a part-time driver delivering food, earning $12.37 an hour.
Carol Browne retired from the health-care industry five years ago at age 70, earning $12.50 an hour as a patient care technician at a hospital. She began working as a nursing assistant in a nursing home in the late 1970s. Her duties included changing bed linens, bathing, grooming and feeding patients.
“I treated my patients like I would treat my mom. It is a lot of work. You are dealing with human beings, not car parts,” said Browne.
“Some can be crabby. But they are aching and they can’t do for themselves like they used to. They are lonely and their friends have died,” she said about her days in the nursing home.
To earn more money, on weekends she traveled to Green Valley and worked in private homes, caring for two to three elderly women. This was in the 1980s and she was paid $5 an hour.
When she returned to Pima Community College and took courses and earned a certification, she advanced to a patient care technician and also became a phlebotomist.
“I remained in the medical field working with the sick because I saw this as a calling. I wanted to help people. I worked on patients pulling out needles and putting in catheters,” Browne said.
“I was slugged by a patient and passed out. I was bitten by a patient and I had to undergo an exam to make sure I did not have HIV. That scared me. I was very lucky.
“I comforted families who were scared. I talked to a woman in the parking lot who was crying in her car. There is an emotional toll.”
One day, Browne said she found out a young man working at a Dunkin’ Donuts was earning more money than she was, and that just didn’t sit right with her.
“Although you may love your job very much, workers have to get paid more than the guy at the Dunkin’ Donuts,” she said.
Tight labor market
By 2026 in Arizona, the home health care industry will have a total of 129,784 projected job openings, including the nearly 41,000 new openings to meet rising demand, falling just below the number of forecasted openings in retail sales, cashiers, fast food and customer-service jobs, said Campbell, of the nonprofit Paraprofessional Healthcare Institute.
“These occupations have low barriers to entry and offer wages that are similar to those in home care, so competition for workers will continue to be tight,” said Campbell.
W. Mark Clark, president and chief executive officer of the Pima Council on Aging, said the industry knows that wages and benefits have been an issue. He said home-care workers are usually paid more than the Arizona minimum wage of $11 an hour.
Also, there are some exemptions in state law that require businesses to provide workers with paid sick time.
Some agencies provide some level of health care coverage, said Clark, “unfortunately, like all employer-sponsored health care, all have co-pays and deductibles, which can make it hard for employees to make use of it.”
He also said businesses only have to provide health benefits for employees who work more than 30 hours a week, and many home-care workers are hired as part-timers.
Getting high school students interested in home-care careers through the Pima JTED Career and Technical Education District is one way of bringing youths on board to fill projected job openings. The district offers training for a personal assistant/caregiver who works in the home.
“At the end of the day, it comes down to costs and revenue,” said Clark. Agencies are funded by the state and “we turn around and pay the providers,” he said, explaining that the council on aging owns PimaCare at Home, the only home-care provider in the county whose workers are represented by a union.
The agency was launched in December 2010, when the county closed its Pima Health System long-term care program.
As Americans live longer, about 17 percent of adult children care for their parents at some point in their lives, and the likelihood of doing so rises with age, according to a study by research economists Gal Wettstein and Alice Zulkarnain at the Center for Retirement Research at Boston College.
By 2035, for the first time in U.S. history, older people will outnumber children, according to the U.S. Census Bureau. Jonathan Vespa, a Census Bureau demographer, predicts “78 million people 65 years and older compared to 76.7 million under the age of 18.”
Initially, the family caregiver may be able to provide the care for their loved one, but as the person declines in health they will need more assistance, said Clinco. If a person is low-income, they may qualify for the Arizona Long Term Care System under the Arizona Health Care Cost Containtment System for fixed-income seniors and those with disabilities.
If qualified, a family can get care paid for by the state provided a company or a family caregiver is trained by a state-contracted agency. Such caregivers must meet certain standards, including continuing education, submit to a background and fingerprints check, and undergo a state review for compliance.
However, home-care companies are not licensed by Arizona, and there is a shortage of well-trained professional caregivers, said Clinco, who requires her employees to have more training and skills than is required by the state. In addition to ongoing training, she hires workers with experience.
Many families cannot afford to pay an agency for a professional caregiver, said Clinco, explaining that not all seniors have purchased or qualify for a long-term-care policy from a private insurer.
In the Tucson area, an agency charges between $23 to $27 an hour for services, which covers business-related costs, including benefits, taxes and payroll, said Clinco.
Many families have to turn to neighbors or people they know or are recommended to them to care for their loved ones, Clinco said.
Others take to the internet and look for help through online classified employment ads.
This so-called “gray market” worries Clinco, because a stranger with no training or background checks enters a home to care for a vulnerable person and there is a greater potential for abuse and neglect.
Clinco, an advocate for clients and caregivers, founded a training institute in 2001 for caregivers working in home care, assisted living facilities and nursing homes.
“The client needs skill, compassion and reliability, and caregivers need to be valued, appreciated, receive higher wages and continued training,” said Clinco, adding that more than 3,000 certified nursing assistants have gone through the institute.
“In Arizona, dog groomers, manicurists and pedicurists require significantly more hours of training, including practical experience, compared to up to three days of training required for home-care workers by the state’s long-term-care system,” said Clinco.
“The worse thing that can happen to a dog is a bad hair day,” Clinco said. “The worse that can happen for an elderly, vulnerable person is death.”
“As baby boomers age, they will see the writing on the wall, and their voices can rise to make demands on some federal government subsidy to provide for home-care services,” said Clinco.
“We cannot afford to ignore long-term-care issues,” said Anna Maria Chávez, the National Council on Aging’s executive vice president and chief growth officer.
“The nation is ill-prepared to address the growing crisis and lacks a coordinated, national public-private system for adequately and efficiently delivering high quality long-term supports and services.”
The national agency has worked on educating politicians and communities about this issue over the years, said Chavez.
She said the council supports a bipartisan effort to establish a national long-term-care insurance financing system that would be fully paid for and increases affordable options for working Americans.
The insurance would not exclude buyers because of pre-existing health conditions. Among benefits the financing system would create are market opportunities for private insurance and significant savings to the Medicaid system, according to a brief from the council.