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COVID-19 Intensifies Challenges for the Home Care Workforce

The COVID-19 pandemic exposed and worsened major staffing challenges in the home care industry, but also allowed for innovation in how home care workers can deliver services and how agencies are able to support their workers. Currently there are approximately 2.3 million workers in the United States who provide clinical and non-clinical services to individuals in their homes, and the demand for home care services is expected to almost double in the next decade. Without recognition and further investment in the needs of this workforce, the industry will not be able to support the demand for services that is expected to increase significantly after the pandemic

Our team at RTI has studied the experience of the home care industry during the pandemic. We developed three issue briefs for the U.S. Department of Health and Human Services, Assistant Secretary of Planning and Evaluation (ASPE), on the challenges introduced by the pandemic, the new policies that affected the home care workforce, and what home care agencies themselves did in the face of these new challenges.

Like so many other health care industries, home care was hit hard by the COVID-19 pandemic. This was due, in part, to the fact that home care workers were not universally deemed as essential workers by local governments. This affected access to important resources like personal protective equipment (PPE) and COVID-19 testing, putting these workers and their clients at an increased risk for infection. While the pandemic did highlight the value of home care workers, the industry still faces many challenges. 

Home Care Workforce Challenges During COVID-19

Recruiting, training, and maintaining staff has been exceptionally challenging during the pandemic. Home care jobs have low wages and often do not provide full-time employment or comprehensive benefits. Agencies reported that staff left due to fear of exposure to the virus, which could potentially endanger their family members or other clients. The stress of the pandemic has also proven to be mentally and emotionally taxing on home care workers as they struggled to balance caring for their clients, their families, and their own health. Some agencies supported employees by allowing them to have flexible schedules to accommodate family and childcare needs, providing mental health and counseling resources, and even helping with transportation and grocery needs. Despite these efforts, many home care workers still chose to leave the field, and staffing shortages have reportedly increased over the past year. The threat that the virus posed also discouraged many potential new staff from joining the field. 

Infection control also became a major focus in the home care sector. Employees were not accustomed to working with the extensive amount of PPE needed to work safely in the pandemic. The agencies themselves did not have enough PPE at the start of the pandemic and whatever supplies they had were quickly depleted. Because home care agencies were not universally acknowledged as “essential,” they struggled to obtain PPE for their staff. Some reported working together with other home care agencies to obtain and share PPE. In addition to obtaining the PPE, home care agencies also needed to develop Covid-specific infection control processes and train their employees to be able to properly don and doff PPE. For this, some agencies turned to online resources such as the CDC guidelines or trainings available online, while others established their own medical advisory councils to inform and develop these procedures. 

Home Care Workforce COVID-Related Policy Changes

Some pandemic-related policy changes benefitted the home care industry. For example, telehealth and other virtual processes allowed home care workers to provide services without compromising their own safety or the safety of their clients. Workers provided medication reminders over the phone and conducted physical therapy sessions over video applications. Many agencies were also able to develop their own apps or online tools to screen staff and clients for symptoms, as well as to communicate with and support family caregivers when staff were not able to be there in person. 

Federal and state policy changes also helped ease some of the challenges faced by the workforce. The federal policy change that allowed non-physician practitioners to order home health and home care services made it easier for agencies to take on new clients. This helped to counter the loss of clients who halted their services early in the pandemic. Funding from the CARES Act was used to help agencies purchase PPE and other supplies, and payment rate increases from states allowed agencies to provide their employees with add-on pay, hazard pay, or retainer payments. 

Although they were often not considered “essential” in the early months of the pandemic, the home care industry provides invaluable services that allow clients to live safely in their homes. The pandemic underscored important challenges faced by this industry. The policy change that allowed non-physician practitioners to order home health services, and the ability to use telehealth were seen as instrumental in allowing home health employees to continue to work through the pandemic. However, further investment needs to be put into improving the wages and career opportunities for this workforce. For example, standardizing training requirements across states would improve availability of workers and allow them to continue to work regardless of where they were in the country. Prioritizing the needs of this workforce will ensure that they will be able to meet the growing demand for home health in the future. 

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Disclaimer: This piece was written by Natalie Mulmule (Public Health Analyst), Denise Tyler (Senior Research Public Health Analyst), Kristie Porter (Research Public Health Analyst), and Melissa Hunter (Research Public Health Analyst) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.