“On the Job, 24 Hours a Day, 27 Days a Month,” by Andy Newman, New York Times

“Home health care is the fastest growing major job category in the country, one of the most emotionally and personally demanding, and one of the worst paid. Elder-boomers living longer and seeking to “age in place” rather than in institutions have created a demographic explosion that even a 150 percent increase in home care workers in the last decade, to nearly 2.3 million, cannot keep pace with. Nationwide, hundreds of thousands of ailing people entitled to Medicaid-funded home care are on waiting lists. But home care workers’ labor happens behind closed doors. The workers are mostly women of color, and about one-third are immigrants. As a result, many advocates say, their work is systematically and systemically devalued, dismissed as “domestic care” and reimbursed at rock-bottom rates by state Medicaid programs. It is a vicious circle. Because these have always been poor-paying jobs, they are seen as lousy, low-skill jobs. And because they are seen as lousy, low-skill jobs, they pay poorly.”

LTC Comment (from Stephen A. Moses, President, Center for Long-Term Care Reform):

 

Read this! And welcome to the wonderful world of HCBS, home and community-based care, touted by analysts for decades as the answer to Medicaid’s problems of high cost and institutional bias. As “rebalancing” from nursing homes to home care continues apace, the chickens are coming home to roost. It is very difficult to provide and ensure quality care in “adult home” settings which lack the economies of scale that nursing homes provide.