Overlooked No Longer: Why It’s Important to Give Home Care Workers a Seat at the Healthcare Table

The demand for more home care workers is on a direct collision course with United States population demographics. The country is aging rapidly: By 2040, the number of Americans over 65 will nearly double, according to the Urban Institute, and the number of adults 85 and older will nearly quadruple. Moreover, the vast majority want to spend the remainder of their lives at home despite the likelihood of having one or more chronic conditions.

While this may sound like a growth opportunity for America’s home care industry, employers are finding it harder than ever to recruit and retain enough workers to meet escalating needs. The median caregiver turnover rate jumped from 65% in 2021 to 77% in 2022 according to a report by Home Care Pulse, a company that provides data and training to home care agencies. Although these numbers are below the peak of almost 82% in 2018, they still signify a looming supply gap. 

Time for a reset

Home care workers face numerous obstacles to steady employment. Among the most obvious are low pay, unpredictable hours, feelings of isolation, physically demanding work, unpaid travel time, and challenging family dynamics.

Less apparent, however, is the inconsistent attention given to the real work involved in-home care, and the perception that the low barrier to entry requires little or no skill. The truth is home care workers perform a wide variety of tasks that support clients’ health, from overseeing nutrition and mobility to assuring medication adherence. Yet many report feeling cut off from information about how to handle their clients’ often complex health needs. 

Fortunately, efforts to support home care workers are now focused on changing the conversation to one of opportunity, rather than one of low-quality jobs and attrition. This is due largely to the growing realization that caregiver time spent in the home is valuable and that workers’ close relationships with clients in their home settings can provide an important lens into physical and behavioral health. Changes as subtle as shallower breathing, increased fatigue, or lack of adequate food can alert a caregiver to the need for intervention. And when such input is treated as central to patient care, home care workers report greater satisfaction and pride in their jobs.

Connecting home care to health care

So how do we make sure that the knowledge that home care workers have makes its way into the system appropriately? A multidisciplinary research program aimed at elevating the value of home care workers has been tackling this question since 2022. Dr. Madeline Sterling, professor of medicine at Weill Cornell Medicine explained in the Cornell Chronicle that when home care workers get a new client, they often have no idea what medical conditions they will face and often lack access to educational resources. Yet evidence suggests home care workers want education. In one study, for example, her team found that caregivers who received training in heart failure—a chronic condition for which they routinely provide care—had significantly higher job satisfaction when compared to a group with no training.

In addition to disease-specific training, there is mounting evidence that bringing caregivers' observations about clients to care teams via direct communication can better guide care coordination, improve outcomes, and reduce costs. One model, for example, sends caregivers a weekly text message that includes a brief survey on the client’s physical and behavioral functioning, home safety, and social determinants of health needs. The survey observations are then transmitted to the Clinical Support team, consisting of data scientists, nurses, social workers, and community health workers, who use the responses to connect at-risk clients with community services and resources or to alert appropriate care providers.

First-year results from the thousands of clients who participated in the program show that there was a 31% decline in emergency department utilization, a 37% decline in inpatient admission compared to the previous year, and 70% of clients were reconnected to healthcare. Furthermore, over 1 million observations were captured, prompting 4,000 proactive interventions.  

Caregivers benefited, too. Net Promoter Scores were 17% higher for those involved in the program compared to those who did not participate. Additionally, when asked about their health and well-being, nearly 50% expressed interest in better understanding their clients’ conditions or needs to relieve their stress and worry for them.

The way forward?

Elevating the role of home care workers in supporting today’s soaring demand may be largely a matter of tapping the full potential of the job. As one worker expressed: “My role is being observant. It’s easy and takes just a few minutes to have a conversation that I wouldn’t otherwise have had. Maybe we catch something before it gets to be a problem. It could save a life.” Testing and developing new ways to support this capability and helping caregivers expand their horizons with training, supervision, technology, and closer coordination with healthcare teams seems an investment worth making.