6 minute read
Critical Shortage of Home Care Workers Threatens Patient Care
The problem: The U.S. population is aging at an unprecedented rate. By 2030, nearly a quarter of the population will be over age 65 and, for the first time, this age group will outnumber children under age 18. The fastest growing segment of the population is the old-old, those age 85 and older. With age comes an increased prevalence of multiple chronic conditions and a need for supportive services to remain at home, where most people want to live. This seismic demographic shift comes at a time when there are fewer family caregivers and a drastic shortage of direct cazre workers who provide hands-on care to older adults and persons with disabilities.
What is a direct care worker and why is their work important? This workforce includes a range of positions from certified nursing aides who are trained for work in institutional settings to unlicensed personal care aides, or PCAs, who work in client’s own homes. PCAs assist clients with tasks such as dressing, bathing, housekeeping, meal preparation and medication management. They are responsible for up to 80 percent of paid, hands-on care provided in private homes, residential settings and adult day care settings. They are in a pivotal position to monitor their clients’ status, recognize and report changes, improve their clients’ quality of life and health outcomes and to avert costly life-changing events such as falls, emergency department visits and hospital stays. Without their support, clients may face a nursing home placement or death and they should therefore be considered as important members of any care team.
How drastic is the PCA shortage? Michigan currently needs 34,000 more home care workers. Further, the average turnover rate is about 82% which destroys continuity of care, keeps the system churned up and is extremely costly. Increased numbers are not enough. We need a stable home care workforce comprised of people who are skilled, care about their clients, and not only want to stay on the job but are given enough resources to do so. Michigan has a lot of good home-based programs but none of them can exist without a qualified workforce. Yet, home care workers continue to be marginalized. The average wage rate for a PCA is about $10 per hour. They receive few, if any benefits. Most do not have guaranteed hours and cannot make it on one income alone. They face a lack of respect with their work referred to as non- or low-skilled or in derogatory terms such as a “glorified butt wiper.” PCAs also face danger as they work in the privacy of personal homes where conditions may be less than ideal. There are no federal PCA competency, professional, ethical or educational requirements.
The good news Just as the causes of the shortage are known, so are a number of solutions. Decades of advocacy work are at long last getting traction, for multiple reasons including the boomers getting older. Efforts to address the shortage are now being aggressively undertaken, such as the work being done by IMPART Alliance, led by Clare Luz, PhD, with the Michigan State University College of Osteopathic Medicine. IMPART, currently funded by the Michigan Health Endowment Fund, aims to help build an infrastructure in Michigan to support the direct care workforce. It is scaling up an evidence-based comprehensive PCA training program, establishing a PCA Professional Association and piloting a PCA technical training program for high school students in partnership with the Grand Ledge School District. Efforts at the state level are now ramping up with Michigan DHHS convening a Direct Care Worker Advisory Committee chaired by Luz and Alexis Travis, PhD, Senior Deputy Director, Aging & Adult Services Agency. Groups such as the Capital Area Health Alliance and partnerships across all settings where healthcare is provided is what will turn this crisis around and make quality of care possible.
WHY CONDITIONS ARE RIGHT FOR A TELEMEDICINE BOOM
By Judy L. Klein, CPHRM, FASHRM, Manager, Risk Management
Few people enjoy going to the doctor’s office. If you’re sick, you’d rather be at home and not around other people who are sick and possibly contagious. You go because you need treatment and maybe a prescription, but if you could get that from home, you probably would. Now, thanks to telemedicine, you can. Although the technology has been around for a while, its use has evolved rapidly and has taken off in 2019. The conditions are right for a telemedicine boom!
The Rise of Telemedicine
Telemedicine, the practice of using technology to deliver healthcare remotely, started as a way to deliver care in rural areas. Since then, both consumers and providers have come to appreciate the benefits. According to Accenture’s 2018 Consumer Survey on Digital Health, 47% of people would prefer to see a doctor virtually than have to wait to see a doctor in person. This is a 2% increase from the previous year.
Providers are also increasingly accepting of telemedicine. According to a survey from American Well, 1 in 5 doctors use telemedicine to care for patients. Among the doctors who are not currently using telehealth, 61% say it’s likely or very likely they’ll start by 2022.
The legal landscape is also paving the way for telemedicine. The Interstate Medical Licensure Compact (IMLC) provides a way for doctors to practice in multiple states – helpful for telemedicine, since virtual visits don’t need to be limited to a single state. Currently, 29 states, the District of Columbia, and the territory of Guam participate in the IMLC. Prior to IMCL, practicing in multiple states was more challenging.
Rising Demand for Convenience
Consumers are demanding more convenient healthcare options. This trend has led to the rise of urgent care centers and retail clinics, and it will also contribute to the expansion of telemedicine.
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