Study predicts eventual caregiver shortage in Washington

“Why They Leave: Turnover Among Washington’s Home Care Workers” by Sahar Banijamali, policy analyst at SEIU Healthcare; and Amy Hagopian, assistant professor at the University of Washington Departments of Global Health and Health Services; and Dan Jacoby, professor of policy studies at UW. It analyzed results of a survey of 1,303 home care workers, interviews with 402 former home care workers from around the state, and national and state studies on turnover.

For the report, go to home care workers report.

Home care worker Rick Spromberg, 29, can’t make ends meet on a wage of $10.41 per hour, so the 29-year-old Longview resident recently started a carpet-cleaning business to help pay his bills. He juggles the business with the tasks of caring for a 40-something-year-old man with disabilities, including grocery shopping, running other errands and helping his client bathe.

“You cannot live on $10.41 per hour in today’s world,” Spromberg said. “That’s why I started a business.”

Spromberg isn’t alone. Low pay, inadequate benefits, lack of career advancement opportunities, and physical and emotional demands associated with providing home care to elderly and disabled people drive many home care providers into other lines of work. Between a quarter and half of home care workers in the state leave the profession each year.

That turnover, combined with a burgeoning senior population, are ingredients for a major worker shortage in the next 20 years, according to a study released this month by Service Employees International Union Healthcare 775NW, the union for state-compensated home care workers. The study’s authors said the way to avert the crisis is to increase pay and benefits and career advancement opportunities, a development that seems unlikely given the state’s current $2 billion budget shortfall.

“Currently, the bigger problem is some caregivers can’t get enough hours (because of state budget cuts),” said Adam Glickman-Flora, director of public affairs at SEIU Healthcare 775NW. “As the senior population expands, that will change. It will be easy for workers to find hours, but on top of that, we will need thousands of more people to meet the demand

in home care. This is a warning of a crisis over the next 20 years.”

Baby boomers began turning 65 in 2011. This year, the number of state residents 65 and older is expected to increase by more than 40,000 compared with 25,000 in 2011. If the number of Medicaid clients needing home care increases at the same rate as the general population, the demand for Medicaid home care will grow by 56 percent by 2030.

If the current rate of turnover remains consistent, that means the state will need to train about 400,000 new workers by 2030 to meet demand, according to the SEIU study.

“Some of that depends on family member availability, which is hard to pin down,” said Dan Murphy, director of legislative and policy analysis with the Aging and Disabilities Services Administration in the state Department of Social and Health Services. “There is no question we are going to have increasing demand for care and workers. It’s just really hard to be precise.”

The client base is already growing by 3 to 4 percent each year, Murphy said.

There are 42,000 state-compensated home care workers and an estimated 15,000 to 20,000 private-pay home care workers, Glickman-Flora said. State-compensated home care workers are those who serve clients on Medicaid. When possible, the state provides Medicaid patients with home care instead of sending them to a long-term care facility, because home care costs less and is preferred by many clients.

About 23 percent of the state-paid home care work force is new each year, which suggests about the same number left the profession, he said.

Workers leave for jobs with higher pay, benefits or opportunities for advancement, the study stated. State pay for home care workers starts at slightly more than $10 per hour. More than 21 percent of home care workers and their families live in poverty, which is $22,350 or less per year for a family of four, according to the SEIU study.

Some workers are edged out of the profession because state cutbacks reduced the number of hours their client was eligible for, and they can’t find another client to supplement those lost work hours, Glickman-Flora said. That was the situation Spromberg faced. While he hasn’t abandoned home care work, he began his own business to make up his losses in work hours.

New training requirements approved by voters in November and effective in January could accelerate turnover, said Samantha Waldbauer, case management service manager for the Southwest Washington Agency on Aging and Disabilities. Initiative 1163 increased mandatory training for home care workers from 34 hours to 75 hours and required background checks and Department of Health certification for home care workers. Certification can cost a worker more than $200, Waldbauer said. Some home care workers can’t afford it.

“Right now, we are very concerned the turnover rate is going to increase exponentially with the increase in training,” Waldbauer said.

The SEIU study recommends increasing hourly wages to $17.58 per hour, stabilizing work hours by stopping state cuts, improving health insurance benefits by expanding eligibility to people who work fewer than 40 hours per week and developing career advancement opportunities.

Rep. Jim Moeller, D-Vancouver, said increasing pay for home care workers isn’t realistic now. The state will be lucky to stave off more cuts to home care this year, he said. But that won’t be the case forever. Baby boomers have an interest in improving working conditions for home care workers because their future care may depend on recruiting and retaining home care workers, Moeller said.

“The aging voters needing these services are going to have more political clout so that translates into more benefits,” he said.

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