As the population ages, home care aides are essential to the lives of chronically disabled, impaired and elderly clients. They assist with self-care, daily activities and monitoring of routine health needs that allow the elderly to remain in their homes.

As a result of this growth, the health care industry offers a good option for lower-skilled workers in a sluggish job market. The jobs, however, are characterized by low wages, unstable hours and low insurance coverage. The median pay for home care workers hovers below $10 per hour.

The Kansas City Fed is working with workforce development organizations, educators and health-care practitioners to explore opportunities to improve the employment outcomes for home care workers.

Paraprofessional Healthcare Institute, a national organization that works to improve the quality of direct care jobs, estimates that over half of workers live in households with incomes below 200 percent of the poverty line, which is about $15,130 annually for a family of two. PHI also estimates that more than half of workers rely on public assistance, and a full third do not have health insurance.

Industry facing change

The industry, which once took for granted high levels of turnover, is facing change.

With increasing demand and flattening levels of workers entering the field, job churn is costly and less acceptable. Changes in health care policy, driven by the Affordable Care Act, also are affecting the industry.

“The health care industry is increasingly complex,” said Michelle Melendez, director of workforce training and leadership development at First Choice Community Healthcare, which serves low-income residents in the Albuquerque metro area. “We can’t afford high turnover anymore,” she said.

Efforts to reduce costs, while at the same time increase customer satisfaction, have focused greater attention on the role of home caregivers, who are at the front lines of ensuring customer satisfaction.

“Home caregivers can be the link to better quality care,” said Raul Araujo, advisory council member for the New Mexico Direct Caregivers Coalition, which represents both professional and family caregivers. “We need caregivers to be knowledgeable of all the resources available to a patient,” he said.

Professional organizations are seeking to take advantage of this increased recognition to improve employment opportunities. For example, the coalition manages a credentialing process that allows workers to demonstrate a greater array of competencies to employers, and increases the recognition and professionalism of the job.

Need for competency standards

Credentials, however, are a rarity in a field with few standard educational requirements. Differing state and federal rules also make it hard to assess or compare educational requirements, competencies and quality standards.

But preparing workers for the job is just part of the equation.

“The big challenge is the quality of the job,” said Steve Edelstein, PHI policy director.

“Our philosophy is, invest more, expect more and you will stabilize the workforce and provide better care,” he said.

He said investing in a fairly paid, stable and qualified workforce includes clarifying job competencies, aligning training programs so that health care workers can gain the skills desired  by employers and ensuring key job benefits, such as health insurance, sick leave and paid vacations. The benefits of this investment can include increased productivity, reduced turnover costs and higher quality care.

Both the public sector and private employers have a part in this investment, industry sources say. By one estimate, approximately 73 percent of direct health care services are paid by public sources, such as Medicare, Medicaid and other government programs. Aligning public policy with direct health care priorities, experts say, holds the promise of added jobs, employer incentives and higher quality care.

(Source: Investing in Quality Jobs and Quality Care, by Steven Shepelwich , Senior Community Development Advisor)