With members of the baby boomer generation aging into their retirement years, the senior care industry has long been anticipating a shortage of caregivers as the need for more employees to meet this growing demand increases.
But with the COVID-19 pandemic driving some health care workers away from the field, this trend has accelerated, and facilities throughout the country are struggling to hire staff.
The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) report a steady decrease in workforce levels at nursing homes nationwide, with a net loss of 220,000 jobs between March 2020 and October 2021. In the assisted living sector, there was a net loss of 38,000 jobs during that time frame.
The scarcity of professional caregivers is being seen locally in skilled nursing and at assisted living facilities, as companies compete against one another to hire new staff.
“There’s always been a looming caregiver shortage on the horizon and the pandemic accelerated it, and so we have a lot more openings than we did prior to the pandemic,” said Cory Fish, director of human resources at St. Paul’s Senior Services.
St. Paul’s runs several senior care facilities in San Diego County for every level of care, from independent living and adult day care programs to memory care, assisted living and skilled nursing.
As more caregiving jobs remain open in the region, the price is continuing to increase for those who need the help.
County resident Mike has, at times, struggled to find in-home caregivers to help support his 71-year-old wife, who was diagnosed with dementia six years ago. (Mike asked that his last name not be included to protect their privacy, and out of worry that hiring new caregivers could become more difficult.)
Over the course of the pandemic, Mike said he has seen the cost of caregivers of the agency from which he employs them increase by about 35 percent up to about $34 an hour. To employ four caregivers in his home for 120 hours per week, he now pays more than $16,000 a month for her care.
Only some of that is covered by long-term care insurance, but eventually that money will run out and it’ll be all out-of-pocket.
A lot of that money goes to the agency, not the caregivers doing the work, but further increases are expected to be unsustainable for most families.
“I won’t say (caregivers are paid) minimum wage, but they’re probably not as appreciated financially as maybe they should be,” Mike said. “But it’s a double-edged sword, because people that need the help can’t afford exorbitant costs either.”
In some cases, finding a caregiver has proved to be an impossible task.
Although she would ideally like a caregiver in her home two to three days a week, San Diego resident Sabrina Chan said she has been unable to find one who consistently shows up for shifts or lasts long term.
Chan has had her plate full for the past few years as she simultaneously cares for her mother with dementia and 4-year-old twins, so she has been unable to return to her career as a research scientist.
She started looking to hire a caregiver in June 2020 as her mother’s symptoms worsened, and found someone through an agency after a few months.
But since the beginning of this year, it has been more difficult, and for more than three months, Chan hasn’t been able to hire any caregivers. These days, she spends about half her waking hours caring for her mom and has seen a decline in her own health because of the stress.
“It’s quite burdensome because I cannot give the attention to my kids as much as I would like,” Chan said. “And I cannot give the attention to myself as much as I would like because, for me, I put my mother and my kids before myself.”
She has put her search for a caregiver on the backburner for the time being, but Chan worries that once she does find one again, the person will be very new in the role and inexperienced with caring for late-stage dementia clients.
“Sometimes when (agencies) send a caregiver, it’s only the second time they’ve ever done this,” Chan said. “They may not be able to handle some of the behavioral issues for someone with dementia.”
Where care jobs are recovering
Although some sectors of caregiving like nursing homes and assisted living facilities are struggling to hire more caregivers, some in-home health jobs have largely recovered, compared with their prepandemic numbers.
The AHCA and NCAL report that despite the jobs lost over the course of the pandemic, the sector has nearly recovered to prepandemic numbers, with a 1.2 percent net job loss overall.
Leslie Bojorquez, franchise owner of care agency Home Instead La Mesa in La Mesa, California, said hiring and retention has become relatively stable now. The company is mostly able to keep up with demand for client care hours, although they are always hiring and have to accept new clients slowly.
“Home care is an essential service — our clients have been able to stay home during this pandemic,” Bojorquez said. “It’s been a godsend for them, but it means that we may have to start out a little slower with the amount of hours.”
With a smaller job deficit for in-home care, some professional caregivers have struggled to get full-time work as the industry has recovered. That includes Gladys Durham, who has worked as an in-home professional caregiver for 20 years.
Every day is different for Durham, who some days sees multiple clients, while on others she will visit only one. Depending on her client’s mobility and cognition levels, she may provide anything from simple companionship and meal preparation, to helping them with showering, toileting and housecleaning.
When the pandemic began, Durham saw an increase in demand as families tried to keep their loved ones at home to prevent them from becoming infected with the novel coronavirus.
“A lot of people didn’t feel comfortable having their family member going into a medical establishment, such as a hospital or nursing care facility,” Durham said.
The 40- to 50-hour workweeks she faced during the first year of the pandemic have since dropped down to 20 to 30 hours per week through the agency she works for, Accredited Home Care.
“I’ve done a lot of stuff over the years, but I’ve never been in a dry patch — there’s always work for caregivers,” Durham said, adding “there’s so many agencies in San Diego, and they’re always looking for help.”
That doesn’t bode well for the 58-year-old San Diego resident, who is working toward retiring in the next decade. While she could apply for a position elsewhere, she said many other home health care agencies don’t offer benefits, so she’s sticking to her current job to continue building her 401(k) retirement package.
What’s next for care careers
Regardless of the current instability of the senior care industry, the nation faces a dim future when it comes to addressing the needs of older adults.
About a half-million people age 65 or older live in San Diego County, and that number is expected to double by 2030, according to county estimates. With that will be an increased push for all sectors of the silver economy, including professional caregivers.
“We are just so far behind the eight ball in terms of being able to meet that need,” said Supervisor Terra Lawson-Remer, who has made increasing the “care economy” one of her goals.
Lawson-Remer introduced an agenda item in a Board of Supervisors meeting last month to assess increasing local investment in the care industry, and improving caregiving through programs like In-Home Supportive Services, a county initiative that helps seniors age in place.
“Part of the issue is, we haven’t really done the investment in making this into a career and a job that actually is a job people can live on,” Lawson-Remer said in an interview this month.
While that assessment is in its early stage, Lawson-Remer foresees the county taking steps to increase pay and benefits for caregivers, and help people progressively train from roles as caregivers into higher paying jobs like nursing.
Along with caregivers, nurses, teachers and social workers, she added that many roles within the care economy will need more support as the county’s population continues to grow.
“There’s a lot of structural reasons that those jobs haven’t paid well enough, they haven’t provided good job security — they provide social benefits that in general nobody has been willing to pay for,” Lawson-Remer said. “It’s not just caregivers. It’s a broad challenge of fundamentally undervaluing work that historically was often women’s labor.”
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