Home Care May Hurt Vulnerable Family Caregivers and Home Care Workers
It is time to recognize that a system powered by free or low-cost labor is doomed to failure
Like many seniors, Beverly, an 86-year-old with significant cognitive impairment can no longer live independently. Her family recently learned that Amazon and several leading healthcare enterprises have a solution. Together, these organizations have created the Moving Health Home Coalition to help people like Beverly.
What made the Moving Health Home concept attractive to this group of economic powerhouses? Undoubtedly, there is some altruistic motivation to rescue seniors from an inefficient medical care system. But there is also a lot of money involved and Moving Health Home may profit by unintentionally exploiting two vulnerable groups who are critical to home care — the 2.3 million underpaid home care workers and 53 million overwhelmed family caregivers. These caregivers, who are disproportionately female and minority, provide essential personal assistance and health care support at home to older adults and people with disabilities, but remain largely invisible [in assessments of what it will take to adequately care] for people like Beverly.
Failing to support home care workers and family caregivers puts seniors at risk because they cannot depend on reliable assistance. The annual turnover rate of home care workers has reached approximately 64%. These workers are at high risk for physical injury and chronic pain and endure tremendous stress. Similarly, family caregivers who face significant caregiving burden experience high rates of mental health issues and stress-related diseases. During COVID-19, caregiving at home has been further strained: almost 30% of unpaid caregivers report increased substance use and having had suicidal ideation, and almost 45% of family caregivers currently experience symptoms of depression.
More home care may translate into more stress, burden, and health risks for caregivers. Moving Health Home builds on the concept of “hospital at home” by setting up hospital-grade care in a home environment. When home hospitals are in place, guess who provides most of the emotional, daily living, and care needs? The likely answer is low pay or no pay caregivers and home care workers.
It is time to recognize that a system powered by free or low-cost labor is doomed to failure. Without more thoughtful design, we will unintentionally harm both the caregivers and the people they serve. There are better options. Here are three actions home care payers and agencies should consider:
Increase Payments
Home care workers are paid poorly, earning on average only $12 per hour. Securing a higher minimum wage would be a starting point to fairly compensate them. In fact, to attract new talent, many home care agencies have started to offer higher pay rates and upgraded benefit packages. Although increasing caregiver wages sounds like a budget buster, reasonable pay may actually reduce the cost of caregiving. For example, high turnover rates are expensive as the cost of replacement hire can range from $2000 to $7000 per direct care worker. Further, inadequate or inattentive care incurs substantial costs. For example, unmet care needs can lead to a 20% increase in ED visits and 30% higher rates of hospital readmission. In contrast, more secure home care, such as having an available family caregiver involved, saves an average of nearly $1,600 per patient by reducing both ER visits and inpatient admissions. Moving Health Home will undoubtedly save these large organizations money and a portion of these savings should be shared with the workers who are on the front lines.
Deliver support for both the patients and caregivers
Home care delivery needs to switch from a solely patient-centered model to one that addresses the joint needs of the patient-caregiver dyad. When caregivers are fatigued and depressed patient and caregiver health is poorer and health-related costs are higher. At a minimum, both home care workers and family caregivers would benefit from consistent, timely care training and emotional support. Many training and support programs for home care workers and family caregivers not only significantly improve patient and caregiver health outcomes but also reduce patient and caregiver healthcare utilization. To ensure care for caregivers, these elements should be integrated into any home care service delivery model.
Track meaningful outcomes for caregivers and workers
Both public and private health plans do not systematically collect health and cost data for patients’ caregivers. To evaluate the “true impact” and “true costs” of new home care models, health care payers need to track the wellbeing and health care utilization of both family caregivers and home care workers. Payers may demand clear and measurable evidence of caregiver support and take this into consideration when purchasing homecare services. As a result, home care companies may be increasingly motivated to push for better caregiving conditions for caregivers and workers.
A century ago, Beverly could have expected home care provided by family and community. We are now at another inflection point for home care. This time, as we rethink the “where” of care delivery, Moving Health Home can do justice to family caregivers and home care workers by advocating for their physical, emotional, and financial well-being.
Authors:
Venus Wong is a consultant at Stanford University’s Clinical Excellence Research Center and a psychologist.
Sarah K. Rosenbaum is a psychiatrist at Stanford University.
Robert M. Kaplan is a faculty member at Stanford University’s Clinical Excellence Research Center, a former Associate Director of the National Institutes of Health, and a former Chief Science Officer for the U.S. Agency for Health care Research and Quality.
