At the age of 72, my dad experienced a variety of healthcare concerns which required him to leave his rural community in Montana to be hospitalized in a larger town about 60 miles from his home. Once he was discharged, he was placed in a nursing home in the small town where he lived. He required skilled nursing care, and this was meant to be a short- term stay for rehabilitation to prepare him to return home. Medicare covers skilled care in a nursing home for up to 100 days (20 days fully covered, with a daily copayment starting on day 21) following a hospital stay. This limited coverage often results in patients being discharged too soon. This was the case in my dad’s situation. He wanted to go home, but as a family we didn’t realize that additional time in rehab likely would have been a better option to help him regain his strength more fully.
My dad’s care remained quite heavy when he was released, with my mom as his primary caretaker. My mom was still working part time and it was often stressful to leave my dad alone—he was prone to falling down the stairs and it was difficult to keep him safe due to his desire to do things on his own without assistance. In a small town like the one my parents lived in, in-home support through a home health service was non-existent, so my mom did the best that she could.
The reality of senior home health care in the United States
Unfortunately, my story isn’t unique, and this was more than a decade ago. Today, the difficulty finding in-home health care is increasing nationwide in both urban and rural areas with many people waiting for months to receive help—if they can get help at all. According to PHI (a national organization committed to strengthening the direct care workforce by producing research and analysis, leading federal and state advocacy initiatives, and designing workforce interventions and models), there is a turnover rate of 40 to 60 percent annually in the home- and community-based services (HCBS) industry. This exorbitant rate of turnover is driven by low wages, lack of advancement opportunities, and worker burnout.
The shortage of home health care workers is set to reach epic proportions as our population ages. According to the U.S. Census Bureau, there are an estimated 73 million Baby Boomers (defined as people born between 1946-1964). The oldest of this generation turn 76 in 2022 and by 2030 all boomers will be at least age 65. A 2021 report by industry market analytic firm Mercer states that by 2025, the U.S. is estimated to have a shortage of approximately 446,000 home health aides. This is a grim outlook for the already struggling HCBS industry, and the people they serve.
PHI estimates that the home-care workforce nationally numbers around 2.6 million and about 1 million more home-care workers will be needed by 2030 as the baby-boom generation finishes aging into retirement. What does this looming healthcare crisis mean for the surge of aging Baby Boomers who are planning to live in their homes as long as possible?
Aging in place: What is being done
Home health care services allow people to age in place, which is the preferred option for most elderly adults. Aging in place means the ability to live in your own home safely and independently for as long as you wish and are able. This was the case with my dad who did not want to go back to the nursing home and leave the home where he raised his family and resided for nearly 40 years. The lack of home healthcare assistance will put additional stress on family, neighbors, and friends who step in to fill the gap. There will be an even bigger gap for individuals who don’t have a support network to rely on.
The good news is that government aid for home health care has been a focus for the Biden-Harris administration, which committed to $150 billion in home care funding as part of the Build Back Better economic plan, even though it failed to pass in 2021. This funding was meant to help keep elderly and disabled people in their homes rather than nursing homes by providing more support for HCBS.
Additionally, in August, Medicaid’s Money Follows the Person (MFP) demonstration program received $25 million in planning grants from the U.S. Department of Health and Human Services to expand access to home- and community-based services across five additional states and territories. This program incentivizes workers by providing recruitment and retention bonuses, pay increases, and student loan forgivenessfor direct support professionals. Funds are also used to develop certification and training programs to improve quality of care and help retain home health care professionals. Hopefully these incentives will draw more quality home care professionals to the field, even if it is a temporary position as workers pursue higher education in healthcare.
More needs to be done to manage the growing needs of an aging population. Tribal, local, state, and federal lawmakers will be watching where these boomers live to help decide funding for critical public services designed specifically for older people—such as senior citizen centers, job-training programs, and Medicare Part B health insurance.
Planning for your future
Do you have a plan for aging in place? It is an easy topic to put off when we are healthy and quite normal to think, “that will never happen to me.” I certainly did not think I would be in a position of helping my family figure out how to manage medical care at home, nor did I realize how hard it would be to find help. Navigating the health care system is a lot to manage when you’re in the thick of it and the costs of in-home care and long-term care can be shockingly unexpected. Fortunately, my dad was able to live in his own home until his death. Had he lived much longer, and without skilled in-home support, staying in his home might not have been possible.
It is worth taking some time to talk to your family about the future, whether you are the adult child of an aging parent or planning to age in place yourself. There are resources available to help research services that are available in your area and to evaluate the costs such as Eldercare Locator and SeniorCare.com. If staying in your home isn’t feasible at some point, due to things like too many stairs or overwhelming maintenance, there are other options to consider, such as retirement communities and assisted living. Planning for the unexpected both financially and to have a support system in place will bring some peace of mind just in case the “it won’t happen to me” occurs!