NAHC, HCAOA Unveil Practical Solutions To Address Home-Based Care Workforce Crisis

For the first time ever, two of the largest associations representing the home-based care industry have joined together on a call to action regarding the workforce shortage.

On Monday, the National Association for Home Care & Hospice (NAHC) and the Home Care Association of America (HCAOA) released a report that details the needs of the nursing and home care aide workforces and specifically recommends policy changes and operational practices that can be implemented to address the workforce shortage in home-based care.

“What I think is truly innovative with this report is the collaboration of it,” Kristen Wheeler, NAHC’s executive director of private duty home care, told Home Health Care News. “This really brought the associations together in a way that hasn’t been done before.”


Industry leaders from across the home-based care space came together to form working groups to strategize and solidify actionable steps to address the issue, Wheeler said.

Some of the recommendations include higher wages and immigration reform, which are familiar concepts. Others, however, are more fresh.

Those include: creating agency-based peer mentoring for new hires during the first 90 days of employment; replacing weekly or bi-weekly pay with daily or on-demand pay; and engaging with nursing schools to institute rotations in a community or home care setting as part of a nursing school curriculum.


The industry also has to do a better job of educating policymakers about the financial implications that come with low-paying home care jobs while demand continues to rise, according to the report.

It also emphasizes the importance of collecting data that will show how the cost trend factors in home care are threatening the affordability of family-funded or private-pay care. Higher prices for care would then lead to more need for Medicaid support, something policymakers would have no choice but to pay attention to.

One of the main sticking points, Wheeler said, was for the industry to change the public perception of direct care workers and to put their struggles in the limelight.

“Two of the work groups focused on supply, benefits and retention and two of them focused on elevating the profession and really getting a more positive image of the profession out there,” Wheeler said. “Particularly for the direct care workers. Everyone understands what a nurse is and what they do. Oftentimes, there’s confusion out there as to what a home care caregiver or home health aide really does and what kind of skill level they actually operate under.”

Wheeler pointed to one comment specifically, made by Pattie Rodgers, the VP and director of operations at the Pennsylvania-based home care provider Waverly Care.

“The way private home care is paid can be contributing to misperception of the complexity of what we do,” Rodgers said in the report. “Clients, who pay $100 or more for a few hours of housecleaning, often balk at paying anywhere near that for home care.”

That perception needs to shift, Wheeler said, which is a massive undertaking.

“There’s a reason that people aren’t coming into the industry and it’s because they don’t even understand what’s great about the industry,” Wheeler said. “So it’s going to take time to get that information out there and into the public, but it has to start now with all of us.”

While this latest report is an example of how the industry can come together to try to enact change, it’s also crucial for states to band together in order to affect change at the federal level.

That could start by getting everyone on the same page with workforce training standards.

“I think the federal government really needs to implement benchmarking standards for people providing care in the home,” Wheeler said. “There certainly are some bad players out there that are in this just to take advantage of these very vulnerable folks and I think a national standard would start to change that. It’s astonishing how many states actually have zero regulations when it comes to this level of home care.”

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