Report: In-Home Caregivers Undervalued in Team-Based Care Models

Despite providing the majority of paid hands-on care in the home, home health, home care and personal care aides are often underutilized and undervalued when it comes to team-based home care initiatives.

That’s according to a recent report published in Journal of the American Geriatrics Society.

Put together by researchers from the Washington, D.C.-based advocacy organization LeadingAge and its long-term services and supports (LTSS) research center out of the University of Massachusetts Boston, the report examined key barriers to the inclusion of in-home caregivers on care teams.


Known as the LeadingAge LTSS Center @UMass Boston, the nonprofit research center is a collaboration between LeadingAge and the University of Massachusetts Boston that conducts research surrounding America’s aging population.

In the report, researchers noted that home caregivers comprise the largest group of formal providers that deliver services in the home.

In fact, more than 2.1 million caregivers were employed by home-based care agencies, individuals and families in 2017. While already a big total, that figure is estimated to grow to roughly 2.6 million workers by 2030, thanks largely to the country’s rapidly aging population and the preference of older adults to remain at home.


Even so, these caregivers are often overlooked as potential members of care teams — even though they have the ability to improve the overall quality of care for the older adults they serve.

“Despite the fact that [caregivers] are the closest formal care provider to the home care client and their families, they are often invisible to the rest of the team providing services,” Robyn Stone — co-director of the LeadingAge LTSS Center @UMass Boston and senior vice president of research at LeadingAge — told Home Health Care News in an email. “They are undervalued, and so the opportunities for using the skills and insights that [a caregiver] can provide are missed.”

There are a number of inclusion barriers for in-home caregivers, according to the report, including inadequate investments in training and variation in state delegation laws that limit caregivers’ scope of practice.

Additionally, more clinical-focused team members often fail to recognize the potential contributions the home health, home care and personal aides bring to the table.

While there’s room for improvement, several providers and educational organizations are working to further incorporate in-home caregivers into team‐based care models. They include the Program of All‐Inclusive Care for the Elderly (PACE) participants and the California Long-Term Care Education Center, as well as St. John’s Well Child and Family Center.

Unfortunately, similar programs aimed at improving the standing of home health, home care and personal care aides are sometimes short-lived, according to Stone.

“I was a bit taken aback by the finding that even when pilots have been conducted to explore integrating [caregivers] into teams, the programs have been short-lived,” Stone said. “Furthermore, there has been no real evaluation of the role that [caregivers] can play in team-based approaches to home care delivery.”

Broadly, the report urges policymakers, payers and providers to invest in the training and education of caregivers. It also pushes for the use of payment incentives and reward systems that incorporate caregivers to a greater extent.

Additionally, the report calls for an expanded nurse delegation to allow caregivers to do more with appropriate supervision.

“Addressing these challenges is no easy feat,” Stone said. “It needs a multifaceted approach.”

Another major challenge that is preventing home care aides, in particular, from achieving a loftier status in care teams: skyrocketing turnover rates. In 2017, for example, the median caregiver turnover rate across the home care industry was 66.7%.

That number hit an all-time high of about 82% in 2018.

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