Innovating Ahead of the Caregiver Cliff

“Home health” is a term we are poised to hear much more about in the coming years. According to a report Village Capital published in conjunction with Kaiser Permanente, people in need of home health care is expected to jump 84% by 2050, while informal caregivers (likely, family) are only estimated to increase by 13%. The report—the fruit of a Kaiser and Village Capital partnership to fund innovation that helps “people age well”—found that the predicted lack of family caregivers will create a demand for a larger home health workforce, as well as technology to support them and those they care for.

This forecasted disparity is the result of recent industry and social shifts converging. Baby boomers are growing older and enjoy longer lives than previous generations, doubling the amount of American adults aged 65 or older in the next 45 years, to create the largest aging population in our history. The U.S. Centers for Disease Control and Prevention reports that 75% of people over the age of 65 live with more than one chronic condition, so it’s safe to assume that America’s largest older population will yield an equally unprecedented growth in rates of chronic disease. Infrastructure and support systems must be established to help this expanding population manage their health.

According to AARP, nearly 90% of these older adults want to age at home rather than in a senior community or center; the occupancy of care facilities and centers for older adults dropped to an eight-year low in 2018. Historically, home care fell to family members, but social norms are changing in sync with baby boomers aging in place. A 2016 National Academy of Sciences study revealed that families are producing fewer children, and more of those children move further away from their parents when they’re adults, pushing America towards a “caregiver cliff.” The need for an abundance of qualified, available people to deliver homebound health care is imminent, and organizations supplying home aides will have to be able to attract and retain workers, and differentiate themselves to prove their value to consumers and payers.

A tumultuous workforce

Home health aides have the 3rd fastest-growing job in the country, coinciding with very high rates of turnover. They churn at a rate between 40% and 67% on a yearly basis, more than double the rate for registered nurses, staying with one home care agency for only about 15 months on average.

This struggle to recruit and retain aides is due, in part, to competing for the same workforce, but workers often leave due to unlivable wages. The median salary for home health aides in 2017 was $23,130—about $11.12 per hour—and 1/4 of these workers live below the federal poverty line. Most agencies don’t offer benefits to their staff, and many rely on Medicaid or food stamps. Qualified aides leave health care to earn more in retail or fast food positions.

To be competitive, home health providers will have to makes changes to entice and support their workforce. Washington state—currently working on its Long-term Care Trust Act— raised wages and offered home health aides training, and “as a result is qualitatively much better prepared for the elder boom than most other states.”

How technology can help

Beginning with recruitment resources, home health agencies can better lean on technology to appeal to workers. Agencies tend to rely on browser-based platforms like Monster.com to find new staff, but many prospective aides don’t have access to laptop or desktop computers. Low-income job-seekers are nearly twice as likely to use smartphones for their job searches and applications than those who earn higher salaries. Recruitment tools that alienate users will undoubtedly limit prospective applicants.

“To successfully compete for hard-to-fill positions, including home health aides, a diverse recruitment strategy should be implemented that starts with identifying where the candidates you’re looking to attract live and breathe,” Sonya Hinds, chief administrative officer for Interim HealthCare, told Home Health Care News. “The clear majority of Americans own a cell phone [or] smartphone of some kind. Mobile application gives the candidate a much more efficient process.”

Smartphones also give home health aides the opportunity to improve their skill sets, helping to forge career paths for improved retention. “Upskilling” workers with high-quality, specialized training is believed to provide a path for reduced churn. Using technology, there’s “a growing B2B opportunity, as health systems and long-term care insurers are heeding evidence that shows that reducing caregiver burnout can lead to cost savings in the form of reduced care utilization in the long run,” Village Capita’s Allyson Plosko shared with Home Health Care News.

For example, CareLinx, AARP’s preferred matched-based home health care partner, teamed up with CareAcademy to streamline worker onboarding and better their retention with training.

Digital tools could also be leveraged to better support workers on the job. Technology can assist aides with record-keeping and time tracking their in-home services, such as visit verification apps and coordinated care tools, to make things easier. According to research firm Home Care Pulse, the number 1 reason home health aides leave an agency is “poor communication,” especially the lack of coordination between the two. Innovating for care coordination not only prevents worker burnout but delivers the value-based care helping to make aging populations healthier.

Incentivizing better care

Older adults are now “the largest and fastest growing consumer of healthcare services around the world” and, combined with the industry shift to value-based care, are inspiring new incentives from payers and providers to incorporate technology for better outcomes and meet the demands of a growing population aging in place. The Centers for Medicare & Medicaid Services (CMS) now offer codes and bundled payments that open up opportunities for improved management and planning care models, while calling for innovation and interoperable solutions. CMS is allowing Medicare Advantage plans (covering 33% of older adults), to foot the bill on certain home health care needs, and in 2019 that will include a supplemental benefit providing for informal home health caregivers.

Medicare has also expanded to cover remote patient monitoring. As a result, people can receive care from the comfort of their own home, opening the gates for innovative tools to support adults aging in place and their aides. Telehealth and digital patient activity tracking help to reduce hospital events and readmissions, while software supporting coordination of care for providers improves communication and the experience of delivering care.

Nearing the “caregiver cliff”

Maine voters will cast their votes to decide on whether theirs will be the first state to guarantee universal home health care for people with disabilities and adults aging at home. “If passed, it will guarantee that every senior, every Mainer with a disability, gets the care they need to stay at home,” said Mike Tipping, of Mainers for Homecare.

The initiative would create a Universal Home Care Board, including representatives for care workers, committed to establishing decent compensation and working conditions for aides.
Supporters believe this would address the shortage of home aides. Nationally, it consumes roughly 79% of the median income to pay for 30 hours of home care, but in Maine, that number jumps to 102%. Maine boasts the country’s oldest population, but it’s estimated that every week 6,000 hours of needed home health care goes unstaffed.

Resources are quickly needed to find, train, and place health workers in the homes of older adults, and to support them in providing high quality care to their patients. CMS may be creating new incentives to build these solutions, but it’s in the hands of industry entrepreneurs and innovators to heed the call as we near the “caregiver cliff.”

“If we don’t find solutions to deal with an aging population, we’re going to be overwhelmed when the problem arrives,” said Jonathan Schleifer, executive director of the Fairness Project. “What’s exciting about the campaign in Maine is that they’re looking to solve a problem that is on the horizon today.”