After 25 years in the home care business, Griswold Home Care franchisee Stephen Rymal feels like he’s back to square one. The New Jersey franchise owner is trying to rebuild his business — particularly his caregiver ranks — since the COVID-19 pandemic threw it into turmoil.

His problems began in March of 2020 when New Jersey went on lockdown for several weeks. Many clients temporarily paused care and dozens of workers were sidelined. Although most clients have returned, many caregivers haven’t.

“We’re still trying to figure out why,” Rymal told McKnight’s Home Care Daily Pulse.

Rymal’s predicament reflects how the COVID-19 pandemic made an already concerning workforce shortage in the home care industry even worse. Prior to the pandemic, the Bureau of Labor Statistics projected  home care would need to add 600,000 workers annually between 2020 and 2030 to keep up with demand from an aging nation. When the pandemic hit, the industry lost 104,000 jobs between March and April of 2020. Although it has added back those jobs and about 16,000 more, that isn’t nearly enough to keep pace with the booming demand for in-home care.

Main culprit: low wages

Low wages are the biggest problem. The median wage for home health and personal care aides nationally is $14.15 an hour. But workers can easily find jobs that pay more. Rymal pays his caregivers $15 an hour, but Walmart and Amazon are paying more than $18 an hour for online fulfillment and warehouse jobs in his area, according to the job site Indeed.

Stephen Rymal

“Companies like Amazon were offering sign-on bonuses,” Rymal said. “They were guaranteeing benefits. They were guaranteeing higher wages. I think my workers have gone to places like that.”

A recent report by the Economic Policy Institute said wages for home care workers must increase to a range between $19.58 and $28.98 an hour — depending on the region — in order for the industry to attract good job candidates.  

But low pay isn’t the only barrier to workforce recruitment and retention in the home care industry. Insufficient training, inconsistent certification requirements, lack of a career ladder and disrespect are also cited as reasons workers leave home care or don’t consider it as a career option. 

The Biden administration’s $1.7 trillion Build Back Better plan addressed some of those issues by providing billions of dollars in federal funds to increase wages, improve training and certification for caregivers. However, that plan stalled in Congress last year and may not be revived until after the midterm elections this fall.

The search for solutions 

Facing the laundry list of challenges, industry groups and home care companies are working aggressively to find solutions to the worker shortage. Last month, the National Association for Home Care and Hospice, the Home Care Association of America and national provider Bayada Home Health formed the Home Care Workforce Action Alliance to lobby Washington and states to keep addressing the crisis head on.

“Everything from funding to scope of practice to credentialing of the workforce are all in play,” NAHC President William Dombi said at a virtual press conference announcing the alliance. 

In late May, New York State healthcare organizations, including the New York State Home Care Association, brainstormed on ways to boost workforce recruitment and retention in the Empire State during a virtual summit. John Rabbia, senior manager for healthcare consulting firm SimiTree, said telemedicine could be one solution by potentially offering home healthcare care workers greater flexibility.

“Offering field clinicians a half day or even a full day where they are able to make telehealth visits for patients who are more stable is something that would be very attractive,” Rabbia explained. “When folks are leaving the setting, they are going to settings where remote work is an option.” 

Other ideas are in play. InHome Therapy is capitalizing on flexible scheduling to recruit speech, occupational and physical therapists for 154 openings in eight states. InHome Therapy COO Meaghan Chitwood told McKnight’s Home Care Daily Pulse the company lets workers set their own schedules and work as much or as little as they choose.

“It’s going to really resonate with people coming out of school now because you can have flexibility,” Chitwood explained. “You can do 10 visits a day, four days a week. We have some therapists who work seven days a week. We don’t have office hours.” 

Other companies are focusing on providing more career paths for home care workers. Last year, LHC Group partnered with University of Louisiana at Lafayette’s College of Nursing and Allied Health Professions to provide in-person and virtual degrees to its staff. The partnership could also provide the company a pipeline to potential job seekers.

But flexible schedules and educational opportunities may not attract workers to home care if the industry doesn’t raise the stature of direct care workers, many of whom are women and people of color, industry stakeholders say. 

In this regard, the timing, ironically, may be right for the industry. Parker Wells, founder of Santa Ana, CA-based Care to Stay Home, thinks the industry is finally acknowledging direct care workers, thanks to the pandemic. He told McKnight’s Home Care Daily Pulse the pandemic not only shined a light on the valuable work home caregivers perform but also taught home care agencies they must consider the needs of workers, as well as the needs of their clients, to succeed.

Parker Wells

“A more human element was exposed during the pandemic,” Wells said. “Workers had kids home from school or family members getting sick. Before the pandemic, a lot of organizations might have assumed personal problems at home will stay at home and that won’t affect what is going on at work. Now we know it’s just not the case.”

That kind of recognition, along with flexible scheduling, better pay and career advancement could be the building blocks for a stronger caregiver workforce in the decades to come.

Editor’s note: In terms of labor problems, there has never been a time like today. In this ongoing series, McKnight’s Home Care will explore the various facets of the workforce shortage, how home care is responding to it and the innovation that is propelling the field forward with new and sometimes unconventional solutions. 

Coming Wednesday: How the gray workforce affects home care agencies’ ability to attract and retain workers. 

Learn more: McKnight’s online Workforce Development Forum is happening this Wednesday and Thursday. Sign up for free!