Home-Based Care Staffing By Geography: Where Workforce Woes Are Worse

Home-based care staffing shortages are more dire in certain parts of the country than others, a fact that could disrupt the home care and home health industries overall.

The shortages in the South and Pacific Northwest are even more pronounced when factoring in the high percentage of seniors with self-care disabilities and other barriers to daily activities.

Those findings came from a recent study led by the University of California at San Francisco (UCSF) that highlighted how those geographic discrepancies are leaving home-based care needs unmet, especially in rural parts of the country.

“It’s hard to find workers in rural areas, especially in personal care,” Susan Chapman, one of the study’s authors, told Home Health Care News. “Personal care aides in rural areas have unique challenges with transportation, travel time from one client to another, isolating work, internet connectivity and so many others. Those are things we knew before on a surface level, but this makes it all the more worrisome that we don’t have workers in these areas.”

Chapman is a professor in the school of nursing at UCSF and has been researching the health care workforce — with a focus on non-licensed personnel — for over two decades.

For her team’s most recent study, Chapman partnered with the University of Montana’s Research & Training Center on Disability in Rural Communities to take a look at whether there were personal care aides available in areas where seniors needed them most.

The answer, of course, is complicated.

“In the most rural areas — for the most part — you’ll find there are the fewest workers,” Chapman said. “Rural areas have specific issues, where you typically find less of a younger workforce while younger workers are moving out more often. Rural areas typically have an older population and higher rates of disability.”

The highest rates of reported self-care disability were concentrated in the South and Southeast, according to the research. Other areas like parts of Maine, the Pacific Northwest and New Mexico had reported rates of self-care disability ranging from 3.9% to 8.7%.

The research from UCSF backs up a study published by the consulting firm BerryDunn that showed staffing shortages were more regional than originally thought.

“I had thought that staffing was pretty dire throughout the country, but what we’re seeing is that it’s very regional,” Lindsey Doak, BerryDunn’s national study leader, told HHCN. “If you look at the responses from Washington state, it looks dire. There is an extremely negative impact on their outcomes and they’re having an extremely hard time with nursing aides. When we looked at the Midwest, there wasn’t that type of response.”

The reason for that discrepancy could be due to many factors, Doak said.

The agency per population could be different in certain regions. Those with less competition on staff can save some on costs, while saving some on costs for staff where others have to pay a premium. Other regions could simply be better at recruiting nurses or personal care aides than others, Doak said.

Earlier this year, a law was passed in Washington state that required employers with 15 or more employees to disclose the wage scale or salary range in every job posting.

That should help with salary competitiveness and transparency, Rachel Manchester, the executive director of Providence Hospital at Home, told HHCN.

“Washington state also has no income tax so we are lucky to be able to recruit from other areas where this may be in place,” Manchester said. “We are having quite a few hiring events in an effort to recruit new caregivers with pretty good success, except in a couple of our smaller markets, but that is pretty routine.”

The Washington-based home health arm of Providence has also been offering part-time and flex hours as ways to retain and recruit caregivers.

The ability to serve the maximum amount of patients in their respective communities in home-based care will always depend on the industry’s ability to hire, Manchester said.

“While I’m not saying we have lots of people we are turning away, I’m saying that in the care continuum, the struggles are about what they always have been,” Manchester said. “And we are predicting growth in 2023.”

What many agree on in the industry is that home-based care workers need to be compensated at a better rate, no matter the region.

“We found that nearly 19% of personal care aides lived below the poverty level and for all other occupations that was 6.8%,” Chapman said. “First of all, we need to pay them more. Home care agencies alone may not have the money. We [also] need to figure out how to make this an easier job for them in rural areas. Paying for transportation, paying for time traveled between clients – these are things that could work and are critical to adding to the workforce.”