By Mark Friedman
In his recent book “M.I.T. economist and human resources expert Paul Osterman examines trends in the labor force market for caregivers. He basically concludes “it’s an absolute train wreck waiting to happen.” As owner of a home-care agency, in the present moment, I believe differently. It’s a train wreck that is here and now.
While this , The future of U.S. caregiving: High demand, scarce-workers, affirms many of Osterman’s assumptions, I have experience from two perspectives. I know how difficult it is to recruit and retain qualified caregivers for work in private duty home care, and I have seen how consumers have changed the dynamics and demands of that care. These changes have been recent (within the last 24 months), significant, and, in my opinion, irreversible.
Caregiving in the home is unique for several reasons. Unlike caregiving in an assisted living, skilled nursing facility or hospital setting, it is challenging to assign a caregiver for set hours, firm schedules, and guaranteed pay, week in and out. In my industry, caregivers usually work for several agencies at the same time in order to cobble together a work week that makes sense for them financially and life-logistically. This is hardly what one would call a secure work environment – despite efforts of agency owners to do just that. The new reality is caregivers want to work 5 days a week, 12 hours a day. By definition, this requires two employers or an agency to incur – and pass on – the high cost of overtime.
Additionally, caregivers often pivot where and whom to work for based on quarters and dollars. I am constantly watching wage and pay scales in my market and am keenly tuned to incentivizing my caregivers based on their experience, commitment, flexibility, and other hard and soft skills they bring to my organization. What Osterman points out in his book, as have others in the industry, is that caregivers now understand they are in short supply. This fact is changing the wage dynamic and has implications on the workplace culture.
Private duty care is also a fickle environment that depends as much upon personal chemistry as it does caregiver skills and expertise. A squabble or disagreement with an extended family member can result in a change of an exceptional caregiver. In a larger, structured environment, that same caregiver would simply be transferred to another patient, resident, or floor. This may be totally arbitrary and unfair, but it is the reality of the job.
As my industry has responsibilities to both clients AND caregivers, agencies have had to recalibrate their business in significant ways. At Senior Helpers Boston and South Shore, we now recruit caregivers in three ways: General Availability to which we assign clients; Case Specific to meet explicit client needs, and To∙A Schedule, to cover the shorter-shift needs of clients with limited needs or means. Our hope is to provide caregivers the opportunity to grow in the job and earn more through a quarterly reward program designed to increase their ongoing earnings and recognize excellence.
We also do this because, unlike caregivers in any other setting, Home Care Agencies are also asking more OF them.
I began this article by suggesting that caregivers in private duty home care are unique. They are unique because we ask them every day to make important, independent, judgement calls when they are on the job. Unlike a mega-supervised setting, like a hospital, rehab, or assisted living facility, our caregivers fly solo in our clients’ homes. While there, they must be prepared and confident to make on-the-spot decisions involving scores of little or big issues. Supervising nurses and case managers are always available for phone and in-person support, but clients still depend on them to make the right decisions. This is also why reputable agencies look for mature, seasoned, and “life-experienced” caregivers, and demand that each be Home Health Aid or Certified Nursing-Assistant trained.
A major shift as noted in the Reuters article has been in the sheer acceleration of demand for care in the home. Important decisions are more frequently being made in crisis mode, when a major medical event has happened and a family is in chaos. As an agency, we must have a rapid response to staffing these emergencies with strong caregivers, while we are also developing the critical, customized care plans. Our response is to create a stable of caregivers ready to deploy for these events, which we call “startups”. This has disrupted our former business model and presented a new set of challenges. We are now hiring caregivers as staff aides. This will require changing expectations from both clients and caregivers as cases start up with these aides then transition to permanent staffing assignments.
At the heart of private-duty home care is the client, whose demands and expectations are also evolving in this environment. Two client issues will always drive success: great care and safety. As caregivers flex their agendas, agencies will not always be able to staff unconventional shifts – even with the investment in full time aides. Agencies must honestly decline some of these cases when we cannot compromise on start, stop, and minimum hours-per-shift with our clients. Caregivers have kids, car pools, schools, and outside responsibilities themselves. They, too, are juggling, scrambling, and scheduling. We respect their busy lives and must balance them along with the wishes of clients.
We pride ourselves on matching up caregivers with seniors and the wishes of extended families. Great match-ups require more than sending a skilled CNA or HHA to perform a job –an understanding of human nature, experience in the business, and the quality of being an excellent listener. This does not take place overnight and cases may need a week or two to stabilize. In this new home-care environment, transparency, honesty, and flexibility are required from everyone in the mix.
As fresh dynamics take shape in my industry, forces around it are helping to change attitudes. PHI International, Working Nation, and 60CareGiverIssues.org are collaborating in a multi-year, multi-media effort to thrust caregiving in a whole new light, presenting home care as a game-changing opportunity for women and men looking to make a difference. We need them to be the best they can be because they are doing incredibly important work.
At Senior Helpers Boston and South Shore, we anticipated the change in market dynamics and we are (mostly) prepared for it. Our readiness in staffing reflects where our clients are coming from and the shifting landscape of caregivers. Our philosophy of care and intensive caregiver training speak to our continuing commitment to safe aging in place at home.
The caregiver shortage might be hitting home, but by each of us understanding what is at stake, we have a better chance that great care will be there for all seniors in need.
About Mark Friedman
Mark Friedman is the Owner of Senior Helpers Boston and South Shore and a regular contributor to South Shore Senior News. Passionate about seniors and healthcare, the goal of his agency is to set a new standard in home care in Massachusetts: first by delivering an exceptional home-care experience in a combination of highly trained and high-touch caregivers; and secondly by becoming a significant connection for elders to resources and services in the 75 communities his company serves.