On Thursday, members of the Senate Committee on Health, Education, Labor & Pensions held a subcommittee hearing to address the dire shortage of health care workers in the U.S.
The hearing, led by Sen. Bernie Sanders (D-Vt.) and Sen. Susan Collins (R-Maine), addressed labor shortages in primary care, behavioral health and more. Lawmakers, however, stopped short of mentioning one of the largest labor gaps that needs to be addressed: the home-based care workforce.
“It is no secret that our country faces many health care crises,” Sanders said during the hearing. “And in the midst of all of those [issues], for whatever reason, our nation … does not have enough doctors, nurses, dentists and other medical professionals. Why that is, I’m not sure.”
The lack of qualified professionals in all health care spaces, especially in rural areas, is undoubtedly noteworthy. But the sheer number of home health aides, caregivers, nurses, therapists and other professionals with home-based care expertise needed to meet consumer demand over the next 10 years is especially startling.
By the end of the decade, 1.3 million new workers will be needed in the direct care workforce alone, for example. An additional 6.2 million workers will be needed to fill slots that have been left vacant by retirees or those that have died, according to a recent report from PHI.
In home care specifically, 4.5 million more workers will be needed as the U.S. population ages and aging-in-place demand increases.
“This year’s employment projections are not that different than previous years, but that doesn’t make them any less shocking,” Stephen Campbell, a data analyst at PHI and the lead author of the report, previously told Home Health Care News. “There will be more new jobs in home care than in any other occupation, but this workforce is among the least visible and most undervalued.”
Recruiting and retention troubles have become the top barrier to growth for home care agencies in the U.S., according to the latest Home Care Pulse Benchmarking Study. The demand for services is there, but the lack of qualified and willing workers has created a supply-demand imbalance, Erik Madsen, the CEO of the Idaho-based research and education firm told HHCN.
“Home care owners are realizing, ‘Look, for us to grow, I need to go out and make sure I’ve got adequate caregivers to meet the demand that is coming,’” Madsen said.
To make matters worse, health care professions in the home-based care field are often most difficult to staff. Nursing positions are typically trickiest, a recent survey from the workforce research organization Center for State & Local Government Excellence found.
The survey, which had 288 respondents, tracked key challenges facing state and local governments.
Of those surveyed, 75% said that nursing positions offered challenges from a recruiting perspective. About 60% said physician roles — the most prominent subject in the subcommittee hearing — were hard to fill.
“By 2023, the U.S. will have a shortage of up to 139,000 physicians,” Sanders said. “Primary care alone will be facing a shortage of up to 55,000 physicians. And by the way, as we all know, this does not take into account what COVID-19 has done to the health professions.”
Primary care access is one of the deepest cracks in the health care system. Innovators such as VillageMD are working on improving that in underserved areas with a “home-centric” approach.
But the lack of urgency in regard to home-based care workers during governmental hearings like Thursday’s shows that advocates in the space still have a long way to go.
Collins, to her credit, has long been a lawmaking ally for home-based care providers.
“This workforce shortage has been with us long before COVID,” Collins said. “We need to break that cycle, at a time when our nation is aging and as more and more people are living longer with increasing health needs. These shortages have serious consequences. … That is why one of my highest priorities in the Senate has always been to increase funding for workforce programs.”
Collins has also been an advocate for an equitable home health telehealth reimbursement structure, especially over the last year.
“I think telehealth is another avenue to address the mismatch in supply and demand,” she said.
Overall, home-based care received less than a minute of consideration during the hearing, which lasted 90 minutes overall.
Sen. Maggie Hassan (D-N.H.) expressed her support for the increase to federal funding for home- and community-based services (HCBS), along with concern over its temporary nature.
The $1.9 trillion American Rescue Plan increases the potential federal match to Medicaid HCBS by 10%. Yet that bump only lasts through March 31, 2022.
“Under the American Rescue Plan, Congress increased federal funding for HCBS to help more people access the care they need, in the settings that best suit their needs,” Hassan said. “But this funding increase is temporary. Congress needs to make long-term, sustainable investments in the home health and community-based workforce that’s going to ensure access to quality comprehensive health services for older adults and individuals with disabilities who choose to remain in their homes.”
Temporary relief, while appreciated, can cause problems for home-based care providers. For instance, if that bump in funding were to increase pay for workers, it would put providers in a precarious position if it eventually disappeared.
Dr. James Herbert, the president of the University of New England, acknowledged Hassan’s question over the importance of home-based care briefly before moving onto behavioral health once again.
“We need additional funding to support that. The home health care workforce is absolutely critical in terms of maintaining health, especially of our older populations,” Herbert said. “I would simply support your assertion that the funding needs to continue post COVID.”
Outside of the hearing, it’s not as if the workforce challenges in home-based care have gone completely unnoticed. The Biden administration included $400 billion in its American Jobs Plan proposal for an increase in funding for HCBS.
That funding would be used to improve low-wage caregiving jobs, while aiding providers in their recruiting and retention efforts.
Companies featured in this article:
Center for State & Local Government Excellence, Home Care Pulse, PHI
