Shortage of home health care workers endangers the elderly

We human beings have a funny way of ignoring problems, even big ones, that we don’t have yet but are almost certain to have sooner or later. Unless a nursing home is in your plans for a happy future, home health care will not be a “maybe” if you live long enough, which most of us are very much hoping to do. Even if you can count on family members to look after you when you can’t look after yourself, the chances are slim that you have enough of them to provide as much care as many of us will require. We are going to need outside help to stay at home when we get elderly and frail.

For some, like Saugerties centenarian-plus Pauline Delson, a wonderful team of home health care workers is in place. I met her and her principal aide Samantha at her well-kept home where Samantha was sewing a small rip in one of Pauline’s favorite jackets, a task above and beyond the call of duty. Pauline is a lively, engaged senior whose son lives nearby and communicates closely with her aides. She is very appreciative of the excellent care she gets

But for the many I spoke with and heard about who are not so fortunate as Pauline, where are these essential service providers going to be found? In the Hudson Valley, a shortage of 9000 workers is projected by 2026. According to, 17% of Saugerties residents are seniors (over 3000 people), and 45% of those elders live alone. So plenty of people are in need of home health care right now, maybe even an elderly relative of yours, but can’t find it.


But wait, if there is and will be such a demand for home health care workers, why aren’t there enough? The answer is unsurprising: home health care workers are paid very low wages (typically between $11-12 per hour, sometimes with overtime hours available, sometimes not). In addition the jobs are “dead-end” positions with no option for advancement, either in rate of pay or training for higher-level jobs in the field. Although many home health care workers are in fact people with a gift for healing as well as the disposition to work with the frail elderly, many more need training to acquire the skills required to care for them safely and competently.

It’s a very hard job, much harder than routine child care, and takes a toll on home health care workers that is physical, mental, emotional, and psychological. It requires an understanding of gerontological issues and conditions that people need training to grasp as well as practical and communication skills that need to be taught and learned. The point is that almost all home health care workers have either major or minor gaps in qualifications at some level that need to be addressed through training.

And through no fault of their own, training at the needed depth isn’t available. Agency training is brief and supervision inadequate, and these workers can be so poorly compensated that clients often have to supplement wages or pay extra for overtime out of their own pockets to receive adequate care. Not to mention, there is the private-pay market for workers who are not trained even to minimal agency standards. The luckiest may be those whose close relatives have the time and ability to care for them appropriately and can get minimally compensated through the (NY State) Consumer Direct Personal Assistance Program.

Agency benefits for workers vary greatly. Workers’ compensation and liability is mandatory as is social security, but paid leave, sick days, and health insurance are rarely, if ever, provided. Of course if a worker is hired privately, many employers leave retirement to the employee to figure out, along with how to manage if they get injured on the job, as many do. The only fair (and by the way, legal) way to employ someone in your home on a private-pay basis is to do all the paperwork involved in payroll or hire an agency to do it for you. Now we’re talking more serious money, which few have to spend.

The majority of elderly people who need home health care rely on Medicaid to pay for it. This in itself can involve a major accounting project in order to qualify, but even then the same issues with low pay and a lack of benefits makes the job undesirable for all but the saintly few whose life calling is to care for others without expecting or receiving much in return. And the Medicaid reimbursement rates to agencies have not kept pace with rising costs of living or, more important to agencies, the cost of workers compensation. Of course the majority of the agencies being private for-profit doesn’t help the elderly, either.

So how bad is the shortage right now? The Ulster County Office for the Aging (OfA), as of this writing, has 142 eligible people on its wait list, people whose needs for housekeepers, personal care aides, or both cannot be supplied by the agencies with which the OfA contracts. The OfA, which only works with people who are not eligible for Medicaid (their staff can help people determine eligibility and advise others of things they can do to become eligible) prioritizes people on the wait list according to the urgency of their needs, but some people wait for many months to get help at home. 

Caring for an elderly person at home is many times more cost effective than providing care in what Saugerties resident (and director of Health Care is a Human Right) Susan Weeks calls “the nursing home industrial complex,” where many deteriorate rapidly, and those who don’t mostly find conditions trying. Since Medicaid pays for both, why are people and programs to keep people in their own homes so poorly funded? It doesn’t make fiscal sense and many feel that it reflects devaluation of elders in our culture and society, reflected in the inadequate wages, benefits, and training available to the people who care for them. Disrespect all around, according to one home health care worker I spoke with.

Caring Majority, an activist organization focused on improving pay and working conditions of home health care workers, thus improving availability and quality of care for the elderly and/or disabled people who need them, will screen a short and very moving documentary on this issue 5:30 p.m.-7 p.m. Tuesday, Oct. 29 at Saugerties Trinity Church. The gathering will feature a discussion led by a Caring Majority facilitator following the film. Come to learn more and find out what you can do about it.

In the course of interviewing a great many people for this column, I spoke with several who run not-for-profit agencies working in the area of helping those who care for elderly relatives in their homes or advocate for paid home health care workers, as well as to a number of people who either give or receive home health care. The amount of information I was unable to include here very nearly outweighs what you’ve just read. I hope to write a future column on all the wonderful people and agencies working in this field. Let me know if you’d like to read it.

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