Home Care Agencies Are Desperate For Workers Amid Nursing Shortage

There is a nursing shortage everywhere. Staff nurses are leaving for lucrative travel positions. ICU nurses are burnt out and leaving the bedside for, well, anything but bedside nursing. And home care nurses are in short supply. While hospitals and healthcare systems can hire travel nurses to fill voids, mandate overtime, assign too many patients, and “figure it out” - home care agencies are finding it harder and harder to fill the voids. 

Every year, according to the AARP, an estimated 12 million Americans who are infirm, chronically ill, or disabled individuals depend on some form of in-home care, according to the National Association for Home Care and Hospice (NAHC). Many are 65 or older and have serious underlying medical conditions.

Historically speaking, home care nurses are some of the lowest-paid nurses. According to Payscale.com, home care nurses make on average $28.69 per hour while a surgical nurse makes $32.14 per hour. Furthermore, according to data, home care nurses with 10-19 years of experience only make $30.24 an hour on average. This is lower than the average pay for a surgical nurse. 

The ongoing nursing crisis is one that there is no foreseeable end to, unfortunately, but the home care nursing shortage is one that requires immediate attention and action. Furthermore, this shortage related to home care isn’t just nurses. There is also an ongoing shortage of certified nursing assistants and home health aides. 

The Maine home-based care program, Catholic Charities, has a waitlist 925 people long; those applicants sometimes lack help for months or years, according to officials in Maine, which has the country's oldest population. 

Katie Smith Sloan, CEO of Leading Age, which represents nonprofit aging services providers, says the workforce shortage is a nationwide dilemma.

"Millions of older adults are unable to access the affordable care and services that they so desperately need," she said at a recent press event. State and federal reimbursement rates to eldercare agencies are inadequate to cover the cost of quality care and services or to pay a living wage to caregivers, she added.

Effect on Patients

Without home care nurses, home care agencies have had to deny referrals. As a result, patients requiring home care are either remaining in the hospital, are putting stress on loved ones to care for them, or are risking injury by not having the proper individuals to care for them. 

The staffing shortage that Bayada has experienced late is unprecedented, according to David Totaro, the chief government affairs officer of the Moorestown, New Jersey-based Bayada Home Health Care.

Specifically, it has had to deny service to approximately 50% of all new case referrals due to a lack of staffing. That has not improved, even as the pandemic has eased.

“Our denied referrals have increased from half of all new cases to a record 64% in the tri-state area of Pennsylvania, Delaware and New Jersey, which is our largest coverage area,” he said. “We today are declining nearly two out of every three new home care cases due to a shortage of available caregivers.”

Effect on Families

The home care nursing shortage is affecting families across the country. Recently, the NY Times met with the Mead family from New York whose 7-year old son suffers from spinal muscular atrophy, a rare muscle-wasting disorder, and requires around-the-clock nursing care. Prior to the pandemic, the shifts were fully staffed and the parents would serve as a back-up when a nurse was not available. 

Now the family goes upwards of 36 hours without any nursing care. And they aren’t the only family begging for home care nurses. Parents are taking to social media asking for anyone with specific experience to lend a few hours in order to get their loved ones home from the hospital. 

Madeline Michael recently posted on Facebook asking for help filling holes in their son’s home nursing schedule. Some hospitals require around-the-clock nursing care for a specific number of days or weeks following initial discharge from the hospital. This depends on the medical needs of the child. 

Their son, tentatively due for discharge on December 7th, will not be able to be discharged without the nursing coverage. As a result, this young family is desperately seeking local nurses to help fill those vacancies. While appealing on Facebook is a great idea, it often doesn’t yield the results needed. Furthermore, willing individuals must apply to the home care agency, Bayada in this case, and go through the entire onboarding process. This can be long and might not be completed in time to help the family. 

Unlike the Mead family, Michael’s son will not be discharged from the hospital. And they aren’t the only family seeking nurses. Long-term units and trach vent units are full in hospitals waiting for patients to be discharged. But without the nurses and aides to care for the patients, they remain hospitalized. 

The Fix

Sad to say, there is no quick fix. This will continue to be an ongoing dilemma even once COVID is no longer a concern. The pandemic merely sped up a problem that was going to hit the nursing profession head-on. As an increasing number of baby boomers retire, individuals live longer, and there are treatment options available for chronic medical conditions - the need for home care nurses is going to continue to rise. 

More than half of Americans will need formal long-term care and services as they age, according to LeadingAge. According to professionals and government officials, without funding from the government to improve wages, training, and recruiting and retention efforts, the number of home care workers will only continue to decline and the shortage will become even more drastic. 

According to home care nurses, the biggest deterrent is pay. While federal guidelines allow Medicaid programs to cover in-home nursing care despite a family’s income, states generally pay home care nurses at much lower rates than they would for equivalent care in a hospital or other medical center. However, Medicaid is reimbursing for similar charges and fees as in the hospital. 

Jen Semple, a registered nurse in South Carolina, worked as a home care nurse for one patient over the last four years despite hourly pay that rose just $1 during all that time. When the pandemic began, she cut her home care hours to administer vaccines for a local health care system, at an hourly wage $7 higher than she had been earning. 

Jarred Rhatigan, a 31-year-old nurse from Nassau County, worked part-time several days a week for Caring Hands, a home care agency, making roughly $40 per hour. Once a vaccine became readily available, he dropped all those shifts to administer vaccines at sites across areas of New York for upwards of $75 an hour. This in turn allowed him to pay down his student loan. 

While both Semple and Rhatigan were sad to leave their home care jobs and patients, the pay difference was too much to walk away from. Money talks, even for nurses, and in the end home care nursing positions can not compete against hospital positions from major healthcare corporations.