Long-Term Care Series: Part 1
This article is the first installment in our Long-Term Care Series, where we'll delve into the future of long-term care in Michigan. Throughout this series, we will explore the opportunities and challenges facing the healthcare workforce dedicated to supporting our aging population.
By Kate Frieden with help from Tazkira Amin
America’s population is aging. In fact, the number of Americans 65 and older is expected to peak at 82 million by 2050. Michigan, in particular, is an older-than-average state. By 2050, Michigan’s population of 65 and older is projected to grow 30 percent, while the prime working-age population (aged 25-64) is only projected to grow 2 percent.[1]
As people age, their daily support needs may increase. However, most older adults prefer to age in place, continuing to live in their current homes and communities for as long as possible, rather than relocating to long-term care facilities. Over the past couple of decades, fewer older adults are living in assisted living and nursing homes, and more are living in traditional housing.[2] Additionally, the growth of technology in healthcare has made it possible for seniors to receive more treatment in their homes, making home care a viable option.[3]
Research points to the existence of multiple psychological benefits of aging in place. These include:
● Feeling independent or a high level of control over their lives
● Maintaining connections to their existing communities and long-time friends, which can potentially help older adults have more active social lives[4]
● The comfort of familiarity, which can strengthen older adults’ senses of identity[5]
Addressing the healthcare needs of senior citizens is becoming more important than ever, especially with the growth in the senior citizen population. Moreover, as more Americans and Michiganders are choosing to age in place – and since many need at least some assistance to maintain their quality of life and independence – the demand for home care workers has skyrocketed.
Home Health and Personal Care Aides
Two occupations that fall under the home care workforce are Home Health Aides and Personal Care Aides. Home Health and Personal Care Aides help older adults and people with disabilities with daily tasks necessary for independent living, like bathing, dressing, preparing meals, housekeeping, and providing transportation to outings. Home Health Aides are allowed to provide some health-related services to their clients, like helping patients with mobility exercises and checking their vital signs. They observe and document their patients’ health statuses to report back to their patients’ care teams. They are often supervised by Registered Nurses. Personal Care Aides, on the other hand, are not responsible for providing health-related services.[6]
Profile of a Home Health and Personal Care Aide
What are some characteristics of Home Health and Personal Care Aides in Michigan and, more broadly, in the United States?
Wages
In 2023, the median hourly wage for Home Health and Personal Care Aides in Michigan was $14.78. This was well below the median hourly wage of $23.11 across all occupations in Michigan.[7]
Labor Force
There were 96,808 Home Health and Personal Care Aides in Michigan in 2023. By 2033, the state is projected to have a shortage of 173,592 Home Health and Personal Care Aides. The turnover rate for this occupation was very high, at 86 percent in 2023.[8] Some factors contributing to high turnover in these professions include:
● Low pay
● Burnout
Demographics
Statewide, in 2023, 84 percent of Home Health and Personal Care Aides identified as female, while 16 percent identified as male. A majority of home health and personal care aides were white (59 percent), but a significant percentage were Black (30 percent). Nationwide, women of color, especially Black and Hispanic women, are overrepresented as Home Health Aides compared to other occupations. Furthermore, female Home Health Aides are more likely to live in poverty than male home health aides, regardless of their race or ethnicity.
According to a national report from PHI, in 2021:
● 15 percent of home care workers lived below the federal poverty level, and 42 percent lived in low-income households, or below 200 percent of the federal poverty level.[9]
● 15 percent did not have insurance.
● 55 percent needed to access some type of public assistance.
MHC Insight’s Take
Home Health and Personal Care Aides are in high demand, and their work helps older adults stay independent. However, there are many aspects of their jobs that make it difficult for them to stay in their positions in the long term. The next article in the series will explore the cost of employing Home Health and Personal Care Aides and the rise in family caregiving.
References
[1] Turner, Ani, Beth Beaudin Seidler, Samuel Obbin, Eric Lupher, Robert Schneider, and Eric Paul Dennis. “Michigan’s Path to a Prosperous Future: Population and Demographic Challenges and Opportunities.” Michigan’s Path to a Prosperous Future. Altarum and Citizens Research Council of Michigan, May 2023. https://crcmich.org/PUBLICAT/2020s/2023/prosperous-future-population.pdf.
[2] Mather, Mark, and Paola Scommegna. “Fact Sheet: Aging in the United States.” Population Reference Bureau, January 9, 2024. https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/; Toth, Matt, Lauren Palmer, Lawren Bercaw, Helena Voltmer, and Sarita L. Karon. “Trends in the Use of Residential Settings Among Older Adults.” The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 77, no. 2 (February 3, 2022): 424–28. https://doi.org/10.1093/geronb/gbab092.
[3] Centers for Medicare & Medicaid Services. “Medicare & Home Health Care,” August 2023. https://www.medicare.gov/publications/10969-medicare-and-home-health-care.pdf.
[4] USC Leonard Davis School of Gerontology. “The Value of Aging in Place.” USC Leonard Davis School of Gerontology (blog). Accessed July 26, 2024. https://gero.usc.edu/about/our-field/the-value-of-aging-in-place/.
[5] Ratnayake, Maggie, Shay Lukas, Sachi Brathwaite, Jessica Neave, and Harshitha Henry. “Aging in Place: Are We Prepared?” Delaware Journal of Public Health 8, no. 3 (August 31, 2022): 28–31. https://doi.org/10.32481/djph.2022.08.007.
[6] U.S. Bureau of Labor Statistics. “Home Health and Personal Care Aides.” Occupational Outlook Handbook, April 17, 2024. https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm; McLain, Kimberly B., Erin K. O’Hara-Leslie, and Andrea C. Wade. “What Is Home Health Care?” In Foundations for Assisting in Home Care. Open SUNY Textbooks, 2016. https://milnepublishing.geneseo.edu/home-health-aide/chapter/what-is-home-health-care/.
[7] Lightcast. “2023 Median Hourly Earnings,” accessed July 26, 2024, https://lightcast.io/.
[8] MHC Insight. “2024 Michigan Healthcare Workforce Index: Ranking the Health of Michigan’s Healthcare Occupations.” Michigan Health Council, 2024. https://www.mhc.org/_files/ugd/71b12d_79987a2745ab4999b25e9ffa4fabf744.pdf.
[9] Home care workers refer to Personal Care Aides, Home Health Aides, and some Nursing Assistants.
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