Home is where the jobs are

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By Livia Gershon

In 2010, people ages 65 or older made up just under 14 percent of the Massachusetts population. By 2015, the figure was up to almost 16 percent, according to analysis by the UMass Donahue Institute. In 2030, it’s expected to exceed 22 percent.

Among the many changes that the aging population will bring, one of the largest is the need for home care workers. Many older adults prefer to stay in their homes as long as possible, even if they start needing close medical supervision or assistance with tasks like bathing and dressing. Two kinds of home care jobs—personal care aides and home health workers—are expected to be among the very fastest-growing occupations nationwide between 2014 and 2024, according to the U.S. Bureau of Labor Statistics (BLS).Who will fill all these positions? Right now, the home care industry and the educators preparing the next generation of workers are trying to figure that out.

“Finding good, qualified people is difficult,” said Laurie Bender, president and owner of the Natick and Northborough offices of Home Instead Senior Care, a franchise home care business. “Unemployment is very low in Massachusetts. People have a lot of options for what they’re going to be doing.”

Bender said her strategy for handling the labor shortage is making sure her workers feel supported and respected on the job. Going into a stranger’s home can be stressful, and sometimes even unsafe, she said, recalling one client suffering from dementia who had a gun collection in his home. She said she takes extra care to check out the home situation and then introduce the workers to their clients before sending them to a house alone.

Bender said respect and regular raises go a long way in helping to retain employees, but the uncertain nature of the work represents a challenge. Clients may stop needing assistance with little notice if they have to go into a hospital for more intense care. And it’s especially rough on workers when a client they’ve grown close to dies.

“It’s emotionally draining being a caregiver,” Bender said. “When you lose a client, there are some people who move on to the next client, but there are some people who need a break.”

Beyond the hard work and sometimes erratic hours, home care has another problem as an occupation: It doesn’t pay very well. As of last year, the jobs typically paid between $13 and $14 an hour, according to the BLS. Many workers are paid, directly or indirectly, through MassHealth and other public sources, so raising their pay isn’t an easy matter, though some unionized personal care aides have reached a contract with the state to raise their pay to $15 an hour by 2018.

Even some agencies paid directly by their clients or their families have trouble bringing workers’ pay up. David Price, owner of Milford-based BrightStar Care, another franchise company, said most of his employees rely on public benefits to supplement their wages, but he can’t afford to pay more.

“My cost is all labor,” he said. “I’d love to pay my aides more. I’d just have to charge my clients more.”

Home care as a stepping stone?

One way to encourage more people to join the home care workforce is to re-define the jobs as part of a professional career path. University of Massachusetts Medical School is working with six state community colleges and the Department of Higher Education to develop a curriculum to do just that.

“What we are trying to do is create career ladders for direct care workers,” said Leanne Winchester, project director of the Direct Care Workforce Development project at UMass. “Core competency training and home care are one of the ways a direct care worker can get where they want to be.”

Quinsigamond Community College (QCC) in Worcester is among the colleges offering courses using the new curriculum. Kathleen O’Connor, coordinator of the school’s home health care program, said QCC has offered courses in both English and Spanish to prepare students for work as personal care aides. She said the Spanish class has been particularly popular, reflecting an industry in which many workers are immigrants.

For graduates of that course who want to continue their education in health care, O’Connor said the school offers classes that can help students learn English while also learning health care-specific customer service and math skills.

“Some of our students who were in the personal care aide program, they came to us for additional training and became nurse assistants,” she said, adding that some of the students are now training to become licensed practical nurses.

Winchester: Immigrant outreach is vital

Winchester said the project includes supports that target limited-English speakers, often new immigrants, with materials available in four languages.

Beyond bringing much-needed workers into the home care field, Winchester said reaching out to immigrants can help the industry benefit from workers who have advanced degrees or licenses in health care from their home countries but need a path to regain their footing as health care professionals in the U.S.

Another reason to recruit more bilingual immigrants and English learners into home care is that some older people speak a language other than English. James Fuccione, director of legislative and public affairs at the Home Care Alliance of Massachusetts, said that will be a bigger issue in the future.

“The elder population now tends to be English-speaking,” he said, “But some of the population that’s aging into the point that they’re going to need this kind of care is bilingual.”

Already, Fuccione said, there are home care agencies in some parts of the state that focus particularly on matching clients who speak Portuguese, Russian, Cambodian, or Spanish with workers who speak their language.

Hayley Gleason, assistant director of the Home Care Aide Council, based in Watertown, said turning home care into a real career path, would attract more young people—including both immigrants and U.S.-born workers—to the field. She said the Council wants to see pay rise for all home care workers.

But Gleason also envisions a system where young workers start out as homemakers, taking care of housekeeping tasks for clients, and move up to more advanced, better-paying jobs as they gain experience and train for more complex tasks. She said the chance to advance, eventually becoming a supervisor who trains other home care workers or going on to be a nurse or a doctor, can make up for the fact that starting wages really don’t reflect how important these jobs are.

“The reality is we’re never going to pay them what they’re worth,” Gleason said. “Fifteen dollars an hour is wonderful, but it’s never going to be enough.”