Home healthcare system is in crisis

Mar 2012
57,898
39,449
New Hampshire
#1
We keep hearing the foreboding statistics: 10,000 baby boomers in the United States turn 65 every day; our aging population is expected to double in the next 20 years and swell to 88 million by 2050; 75 percent of Americans over 65 live with multiple chronic health conditions, ranging from diabetes to dementia.

It is no secret, either, that the nation's already-strained health-care system is trying to keep sick and longer-living seniors out of hospitals, assisted-living facilities and nursing homes and instead in their own homes, which is where they want to live out their golden years. But that has shifted the caregiving burden onto family members, who are increasingly stressed and often supplemented by personal-care aides (also referred to as certified nurse assistants, personal-care assistants or home health aides) employed by thousands of home-care agencies across the country.

The U.S. spent an estimated $103 billion on home health care last year, a number predicted to reach at least $173 billion by 2026, according to the Centers for Medicare & Medicaid Services, which put total health expenditures in 2018 at about $3.67 trillion. This presents a looming national dilemma for the workforce and entities that hire, train and try to retain them, as well as the public and private sources that pay them.

Federal and state governments set fixed reimbursement rates for Medicare and Medicaid recipients, effectively capping workers' wages, and there's little political will to raise rates.

America's $103 billion home health-care system is in crisis as worker shortage worsens
 
Feb 2011
16,898
6,045
Boise, ID
#2
We keep hearing the foreboding statistics: 10,000 baby boomers in the United States turn 65 every day; our aging population is expected to double in the next 20 years and swell to 88 million by 2050; 75 percent of Americans over 65 live with multiple chronic health conditions, ranging from diabetes to dementia.

It is no secret, either, that the nation's already-strained health-care system is trying to keep sick and longer-living seniors out of hospitals, assisted-living facilities and nursing homes and instead in their own homes, which is where they want to live out their golden years. But that has shifted the caregiving burden onto family members, who are increasingly stressed and often supplemented by personal-care aides (also referred to as certified nurse assistants, personal-care assistants or home health aides) employed by thousands of home-care agencies across the country.

The U.S. spent an estimated $103 billion on home health care last year, a number predicted to reach at least $173 billion by 2026, according to the Centers for Medicare & Medicaid Services, which put total health expenditures in 2018 at about $3.67 trillion. This presents a looming national dilemma for the workforce and entities that hire, train and try to retain them, as well as the public and private sources that pay them.

Federal and state governments set fixed reimbursement rates for Medicare and Medicaid recipients, effectively capping workers' wages, and there's little political will to raise rates.

America's $103 billion home health-care system is in crisis as worker shortage worsens
When a profession is facing a vast worker shortage relative to need and part of the reason is underpayment (i.e., pay is not good enough for enough people to want to do the work), organized labor often points to itself as the answer. This case is no exception. Labor unions like the SEIU have tried (successfully in some places, less so in others) to cast their nets around tens of thousands of home-health aides and say they're now union-represented based on the notion they're de facto Medicaid/Medicare employees, even though they're not. This has been challenged in the courts (here's one example, and there are probably a dozen or more others), both in the manner some of them went about holding a vote for representation, as well as the mere legality of unionizing workers against Medicaid/Medicare even though they're not government employees, along with other shady tactics.

Where it gets interesting is that if a union was really successful at legitimizing the profession, raising its pay, enhancing training/skills/qualifications, it would put this unions' interests at odds with nursing unions' interests:

"Reinhard cautioned, however, about possible resistance from nursing unions “that feel only nurses should be able to do certain things.”"
 
Jul 2013
40,370
26,459
On a happy trail
#3
When a profession is facing a vast worker shortage relative to need and part of the reason is underpayment (i.e., pay is not good enough for enough people to want to do the work), organized labor often points to itself as the answer. This case is no exception. Labor unions like the SEIU have tried (successfully in some places, less so in others) to cast their nets around tens of thousands of home-health aides and say they're now union-represented based on the notion they're de facto Medicaid/Medicare employees, even though they're not. This has been challenged in the courts (here's one example, and there are probably a dozen or more others), both in the manner some of them went about holding a vote for representation, as well as the mere legality of unionizing workers against Medicaid/Medicare even though they're not government employees, along with other shady tactics.

Where it gets interesting is that if a union was really successful at legitimizing the profession, raising its pay, enhancing training/skills/qualifications, it would put this unions' interests at odds with nursing unions' interests:

"Reinhard cautioned, however, about possible resistance from nursing unions “that feel only nurses should be able to do certain things.”"
That's only been going on for the last forty years. Employers hate hiring expensive nurses when they can hire aides at less than half the price. Problem is though...... the hiring of RNs, in study after study, actually decreases the death rate of a patient group, while the hiring of more aides and expecially doctors in proportion to RNs, tends to increase it.
 
Likes: OldGaffer
Feb 2011
16,898
6,045
Boise, ID
#4
That's only been going on for the last forty years. Employers hate hiring expensive nurses when they can hire aides at less than half the price. Problem is though...... the hiring of RNs, in study after study, actually decreases the death rate of a patient group, while the hiring of more aides and expecially doctors in proportion to RNs, tends to increase it.
Expecially? Well on that note, I'm sure if we just hired MDs to provide 1-to-1 round-the-clock monitoring of every single person in need of assisted living and/or nursing home care, the patient death rate would drop dramatically. So do you support that? Be careful, because if you say no, you're condemning the elderly to premature death!

It's intellectually dishonest to try to characterize "employers" as the ones that exclusively "hate hiring expensive nurses." Nobody wants to pay exponentially more than they have to, not even the patients themselves. If you just adopt a position that we have to hire the most expensive and most trained people to do everything all the time, based on the assumption that it reduces death rates, then there is zero hope we'll ever have cost control in our health care system.

We have the world's most expensive health care already, and even the people receiving the care don't want to pay more for medical experts to wipe their asses and wash their bed sores, even the ones that have millions and millions in the bank refuse to pay more for their assistance late in life.

If we don't like having the world's most expensive health care, we need to find economical ways to provide care.
 
Likes: orangecat
Jul 2013
40,370
26,459
On a happy trail
#5
Expecially? Well on that note, I'm sure if we just hired MDs to provide 1-to-1 round-the-clock monitoring of every single person in need of assisted living and/or nursing home care, the patient death rate would drop dramatically. So do you support that? Be careful, because if you say no, you're condemning the elderly to premature death!

It's intellectually dishonest to try to characterize "employers" as the ones that exclusively "hate hiring expensive nurses." Nobody wants to pay exponentially more than they have to, not even the patients themselves. If you just adopt a position that we have to hire the most expensive and most trained people to do everything all the time, based on the assumption that it reduces death rates, then there is zero hope we'll ever have cost control in our health care system.

We have the world's most expensive health care already, and even the people receiving the care don't want to pay more for medical experts to wipe their asses and wash their bed sores, even the ones that have millions and millions in the bank refuse to pay more for their assistance late in life.

If we don't like having the world's most expensive health care, we need to find economical ways to provide care.
Your ignorance of the healthcare system and the differences in responsibilities of the various healthcare professions is pretty deep. You really need to checkout the job descriptions of the various professions. And who has responsibility for who. If you think that aides are allowed to make autonomous decisions you are greatly mistaken.

Physicians spend little to no time being educated in bedside care. In fact I had to instruct my own surgeon yesterday in the need for treatment for the prevention of a decubitus. He had no idea what to order for it.
 
Feb 2011
16,898
6,045
Boise, ID
#6
Your ignorance of the healthcare system and the differences in responsibilities of the various healthcare professions is pretty deep.
No it isn't. There are numerous interest groups at play here.

There are the elderly who (as a group) have tons of money but expect and demand to be required to spend virtually none of it on end-of-life assistance and care.
There are younger generations of taxpayers who (as a group) cannot even afford their own health care, let alone the blindingly expensive elderly end-of-life care that is barreling toward them.
There are labor unions that want to scoop up home health aides in their web of dues-payers, people who are employees of no one except their singular elderly recipient of the care.
There are labor unions that represent nurses that don't want home health aides or other helping professions to become too legitimized and trained as a professionals because it would subject the work they could otherwise monopolize to price competition.
There are political parties attempting to pander to the elderly because the elderly vote in such higher proportions than the younger generations.
There are private assisted living and nursing home companies who are licking their lips vying for the enormous amount of public and private money that is going to have to be spent caring for the trillions of dying baby boomers.

What my original comment was about was that what's good for one or two of these interest groups is inherently bad for one, two or more other of these interest groups.
 

Blueneck

Former Staff
Jun 2007
55,137
42,572
Ohio
#7
We keep hearing the foreboding statistics: 10,000 baby boomers in the United States turn 65 every day; our aging population is expected to double in the next 20 years and swell to 88 million by 2050; 75 percent of Americans over 65 live with multiple chronic health conditions, ranging from diabetes to dementia.

It is no secret, either, that the nation's already-strained health-care system is trying to keep sick and longer-living seniors out of hospitals, assisted-living facilities and nursing homes and instead in their own homes, which is where they want to live out their golden years. But that has shifted the caregiving burden onto family members, who are increasingly stressed and often supplemented by personal-care aides (also referred to as certified nurse assistants, personal-care assistants or home health aides) employed by thousands of home-care agencies across the country.

The U.S. spent an estimated $103 billion on home health care last year, a number predicted to reach at least $173 billion by 2026, according to the Centers for Medicare & Medicaid Services, which put total health expenditures in 2018 at about $3.67 trillion. This presents a looming national dilemma for the workforce and entities that hire, train and try to retain them, as well as the public and private sources that pay them.

Federal and state governments set fixed reimbursement rates for Medicare and Medicaid recipients, effectively capping workers' wages, and there's little political will to raise rates.

America's $103 billion home health-care system is in crisis as worker shortage worsens
Part of the problem is they're making it harder for independents. I could never work for an agency, they take almost half your money, offer no benefits quite often bounce you around from client to client to fill their needs, and it's really important as a caregiver to establish a relationship with the client (and their families) that includes trust and understanding what their priorities are.

For the last few years I'm seeing more and more the regulating agencies involved in hiring independent caregivers requiring redundant paperwork and proof that we're not billing for hours we didn't work, etc. More often than not I stay over what I bill for because of unexpected conversations so in my case at least, they're getting more than their money's worth.

But what I see a lot of also is caregivers who are older and suffering a lot of physical problems of their own. Like me, although with my new hip I should be able to do everything I did before and more with much less pain than I had before.

It's not any easy job for a million reasons, but it's better in a lot of ways than working at Walmart. I think a lot more people would be willing to do this work if it were treated as a more important service. Many see home health providers as personal servants, show them little respect or gratitude. That attitude really needs to be adjusted badly.
 

Blueneck

Former Staff
Jun 2007
55,137
42,572
Ohio
#8
No it isn't. There are numerous interest groups at play here.

There are the elderly who (as a group) have tons of money but expect and demand to be required to spend virtually none of it on end-of-life assistance and care.
There are younger generations of taxpayers who (as a group) cannot even afford their own health care, let alone the blindingly expensive elderly end-of-life care that is barreling toward them.
There are labor unions that want to scoop up home health aides in their web of dues-payers, people who are employees of no one except their singular elderly recipient of the care.
There are labor unions that represent nurses that don't want home health aides or other helping professions to become too legitimized and trained as a professionals because it would subject the work they could otherwise monopolize to price competition.
There are political parties attempting to pander to the elderly because the elderly vote in such higher proportions than the younger generations.
There are private assisted living and nursing home companies who are licking their lips vying for the enormous amount of public and private money that is going to have to be spent caring for the trillions of dying baby boomers.

What my original comment was about was that what's good for one or two of these interest groups is inherently bad for one, two or more other of these interest groups.
Agreed except I don't see unions as a problem. Nurses generally want as many aides as they can get so they don't have to do personal care or housekeeping. Many of them don't treat the aides as peers, but that's not because of the union, it's just a snob thing.

Compared to nursing homes or hospitals, home health is a bargain. And by and large it's a better situation to have part time home health care for the elderly in coordination with families than a choice of one or the other. Having an aide come in for a short time daily or even once or twice a week gives the family a break and the client too. If the only option were for families to provide the care entirely on their own, they would opt for a nursing home. Sometimes just having part time help allows someone to stay at home rather than an institution.

Those who would see the workforce as skilled and unskilled, trained or untrained and pay them accordingly shouldn't be in charge of deciding what caregivers and aides are paid because we do the most work, put up with the most difficult behaviors imaginable and are constantly treated as disposable and lazy by the administrative end of the healthcare industrial complex.

We should be paid better. We're worth it.
 
Mar 2012
57,898
39,449
New Hampshire
#9
Agreed except I don't see unions as a problem. Nurses generally want as many aides as they can get so they don't have to do personal care or housekeeping. Many of them don't treat the aides as peers, but that's not because of the union, it's just a snob thing.

Compared to nursing homes or hospitals, home health is a bargain. And by and large it's a better situation to have part time home health care for the elderly in coordination with families than a choice of one or the other. Having an aide come in for a short time daily or even once or twice a week gives the family a break and the client too. If the only option were for families to provide the care entirely on their own, they would opt for a nursing home. Sometimes just having part time help allows someone to stay at home rather than an institution.

Those who would see the workforce as skilled and unskilled, trained or untrained and pay them accordingly shouldn't be in charge of deciding what caregivers and aides are paid because we do the most work, put up with the most difficult behaviors imaginable and are constantly treated as disposable and lazy by the administrative end of the healthcare industrial complex.

We should be paid better. We're worth it.
Agree. I have a friend whose mom has a home health aide. The mom is a true pain in the butt from what I understand. Demanding etc. Wants a female of a certain age and must be a person that is happy all the time. She also is stingy with her money. Her aide is a very nice woman but only has minimal training no college degree. At some point I wonder if they were paid more why wouldnt they use an LPN? From what I hear, at least around here the pay difference is about 6-8 bucks an hour. That has to be the dilemma I would think, if they get paid more you end up in college degree territory.
 
Jan 2019
772
266
Tempe, AZ
#10
No it isn't. I had home healthcare after my hip replacement 7 mos. ago, and my knee replacement 9 weeks ago. If I experienced a crisis, I somehow missed it. :zany: