Number of Home Health Workers Per Capita Grows as Behavioral Health Status of Seniors Declines

While the number of home health workers per capita available to seniors in the U.S. is increasing, those employees are seeing a population with more behavioral health challenges than they have in years past.

Those are just a few select findings from the American Health Rankings 2019 Senior Report from the United Health Foundation, a not-for-profit arm of insurance giant UnitedHealthcare.

The data comes from more than a dozen sources, including the Centers for Disease Control and Prevention, the Administration on Aging’s State Program Reports and the Dartmouth Atlas of Health Care, in addition to other sources.


Among the findings: The number of home health aides nationwide has increased 44% since 2013 — up from 93.8 workers per 1,000 seniors 75 and older to 135.5 per 1,000.

Access to home health aides is one of 34 different factors that contributes to making a state healthier for seniors, according to the report.

“We see a significant difference in the states that have the highest number of home health care workers — Minnesota [with] about 264 home health aides per every 1,000 adults age 75 and older — and states that had the least,” Rhonda Randall, executive vice president and chief medical officer of UnitedHealthcare National Markets, told Home Health Care News.


UnitedHealthcare National Markets is an arm of UnitedHealthcare that partners with employers that covers health benefits for active employees and retirees.

Florida — the state with the fewest home health workers per capita — has 32 home health workers for every 1,000 adults age 75 and older.

Hawaii is the healthiest states for seniors, according to the report, followed by Utah, Connecticut, Minnesota and Colorado, respectively. The least healthy states for seniors are West Virginia, Oklahoma, Louisiana, Kentucky and Mississippi.

While home health plays a role in earning states a high overall senior heath ranking, Randall says top states usually perform well in many measures — some of which also include social factors and access to gerontologists.

Behavioral health of seniors declining

Despite the growing availability of care, behavioral and social factors pose a growing challenge for seniors today.

“We’re seeing there is an increase in the rates of depression, challenges with mental health and the suicide rate among seniors has been rising over the last few years,” Randall said.

Today, 16% of seniors 65 and up struggle with depression, according to the report, up 19% from 2018. Additionally, excessive drinking among that population has increased to 7.4%, up 12% from 2016.

Meanwhile, the number of seniors who chose not to go to the doctor because it’s too expensive is also increasing. In the past year, 5.2% of seniors reported forgoing doctor visits for financial reasons.

Randall is hopeful that recently expanded Medicare Advantage benefits can help address at least some of these problems.

The Centers for Medicare & Medicaid (CMS) recently announced that MA plans may begin covering benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions starting in 2020. That could include different services to address mental health and other social determinants.

“We’re really happy about that policy change and allowing Medicare Advantage plans more opportunity to innovate,” Randall said.

However, there’s no quick fix to improve seniors’ behavioral and social health, she said. In addition to awareness and access, markets need professionals who are qualified to support and care for those individuals.

“The next area is policy. Are there any policies that are prohibitive or that need to change in order to attract more professionals?” she said. “So when we’re looking at what’s the solution, it’s often not a single solution. It’s a comprehensive call to action.”

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