In late 2022, an analysis by the Public Health Institute’s Workforce Data Center pointed to a national shortage in caregivers and ranked each state by what the expected growth in job openings for care aides would be through 2028. Colorado was projected to see a 30 to 40% increase in such positions needing to be filled, matching approximately a dozen other states anticipating similar hikes in demand. Only three states had projections that were higher than 40%.
AARP in late 2022 reported that in-home caregivers remain “in high demand” nationally. The organization noted there were currently almost 2.3 million such aides in the U.S., and projected that the positions of home health and personal care aides would grow faster than any other occupation for the next 10 years, with more than 700,000 openings for such workers each year. One reason may be that, as the New York Times has reported, the number of people choosing to live in nursing homes or assisted living facilities make up less than 5 percent of the population age 65 and older. Older adults consistently favor by wide margins to live in place as long as possible, which increases demand for personal in-home care aides.
The Centers for Disease Control and Prevention reported in early 2021 that 34.1 percent of Americans 18 and older are either caring for an adult or juggling the care of both adults and children. A Pew Research Center survey found about 25 percent are doing both — comprising what has come to be known as the “sandwich generation” — adults caring for both older family members and young children at once. AARP found that the number of people caring for an aging friend or family member has risen more than tenfold since 1989. With fewer paid health care workers available, the burden on families will only increase.
The issue is acutely relevant for Colorado, which is now reportedly the state with the second fastest population growth in residents age 65 and older. This population cohort is projected to grow by nearly 50% by the year 2030. But while these caregiver demand numbers grow, the supply of caregivers to meet the demand shrinks. This shrinkage had begun prior to the COVID pandemic, but then was noticeably exacerbated by it.
The looming question is: How will this health care worker shortage be remedied?
Fewer workers for care facilities too in Colorado
Nursing homes and assisted care facilities are also affected by the worker shortage. An in-depth report in the Denver Post in 2022 stated the pandemic had “pushed staffing at Colorado’s nursing homes from tight to a near-crisis.” The report noted that statewide there were nearly 30,000 COVID infections in nursing homes during the pandemic’s most critical period and more than 1,900 deaths among residents and staff. “More than 2,000 people working in Colorado nursing homes left the industry,” the Post stated, “forcing some homes to stop accepting new residents and straining care for those already living in them.”
The Post cited U.S. Bureau of Labor Statistics data that showed March 2020 employment in Colorado long-term care homes peaked at about 44,000, and more recently has fallen to less than 42,000. During the omicron surge Colorado sent some 260 members of the National Guard to help in understaffed facilities. In addition, the Post noted, “Of the 183 Colorado nursing homes with data on Medicare’s Care Compare website, 123 saw at least half of their staff turn over in the last year.” This turn-over rate was comparable to the rate nationwide, leading many facilities to limit admissions.
The report quoted the CEO of Good Samaritan Society, which operates nursing homes in Colorado and 21 other states, as saying their facilities had 2,500 job openings across the organization that they were recruiting to fill. The shortage at least temporarily led Good Samaritan to suspend new admissions in Fort Collins and close its Greeley campus. The head of a Colorado nursing home trade group estimated that statewide occupancy was about 70% in the first quarter of 2023, down from a more typical 80%, but there was not enough staff to open additional beds.
Number and quality of staff are crucial for Caregivers in Colorado
As a further challenge in the overall picture, there is also considerable controversy over whether long-term care facilities are hiring enough staff to safely and effectively look after residents. Nationally there are proposals being made to require the Centers for Medicare and Medicaid Services to set minimum staffing levels for nursing homes. (The current federal standard is that homes should have a nurse available for at least eight hours each day, and enough staff to provide about two hours of care to each resident.) Some also advocate for the states to receive additional funding to beef up inspections of facilities, one reason being that too many are operating without adequate staff. The Good Samaritan CEO has said such mandates could be “a death sentence for many of our nursing homes.”
Meanwhile Jayla Sanchez-Warren, director of the Area Agency on Aging serving the Denver region, says efforts to require higher staff-to-patient rations have been consistently and successfully opposed by the nursing home industry. One reason, of course, is added cost and concerns about what Medicaid might or might not pay. And yet, says Sanchez-Warren, staffing is “absolutely fundamental. It’s the most important thing in a nursing home.” Inspectors of Colorado nursing homes have frequently cited low staffing as a cause of failures in care. There have also been reports that, due to personnel shortages, direct-care staff members are sometimes temporarily pulled away to perform lower-level tasks such as getting meals to residents.
Additional challenging factors to the number of Care Givers
Several spokespersons in long-term care also call attention to another challenge: The fact that hospitals are stepping up recruiting efforts for caregivers and boosting salaries, using financial resources that long-term care facilities and home care agencies most often cannot match. Low Medicaid reimbursements that are meant to cover care costs for large numbers of recipients feed into this imbalance. The Good Samaritan CEO stated that due to extra labor costs in hiring temporary staff when they could be found, his network’s average cost of care for each resident jumped by roughly $70 per day.
Last but not least of the factors in play, the challenge has only grown larger and more urgent because people are living in their homes longer than they used to. That means both a greater need for in-home care aides and the fact that when nursing homes do enter the picture for some families, those going into the homes are older and sicker than they were years ago.
The health care complex as a whole is affected
The overall situation has ripple effects. For instance, if nursing homes don’t have beds for patients who need follow-up care before returning home, those patients can remain stuck in the hospital, which might already be short-staffed. Home health care agencies have reported similar staffing shortages, so that form of help also might not be available to a patient ready to be discharged from the hospital.
Bill Dombi, president of the National Association for Home Care & Hospice, has been quoted in the online resource MedPage Today as saying “Everybody [in home care and hospice] is reporting that they are turning away patients because they don’t have adequate staff. That puts an added level of responsibility on [hospital] staff, who are already double shifting. Nursing homes have limited admissions for the same reasons as home care.” He said home care agencies have reported a range of staffing shortages from 5% to 20%. This is compounded by the fact that fewer people are joining the home care field following the COVID pandemic.
Pay and working conditions are key issues for Caregiver
It is widely agreed that improving the pay and overall working conditions for caregivers is one key to solving the workforce shortage. The nonprofit Paraprofessional Healthcare Institute estimates that nearly 90% of the 2.3 million home care workers in the U.S. are women, and 62% are people of color. Despite serving as an integral part of the health care system, these particular care workers often lack health insurance of their own, and often don’t have guaranteed sick leave or paid time off.
A trade group report estimated that hourly wages for caregiving staff rose by about 8% in 2021, with larger increases for certified nursing assistants, who are some of the lowest-paid employees. Job listings in the Denver area in early 2023 showed rates were still relatively low, though, often falling below $20 per hour. As Sanchez-Warren of the Denver Area Agency on Aging noted, people can earn that much in jobs that are much less physically and emotionally taxing.
Bill of Rights for Colorado home care workers
Colorado Newsline reported in September of 2022 that organizers of a group representing home health care workers in Colorado had gotten more than 50 lawmakers and legislative candidates to sign on to support increased protections and benefits for workers in the caregiving industry by way of a Home Care Workers Bill of Rights. This would include higher wages and benefits, protections against wage theft and harassment, and more decision-making power for workers. The advocacy group, Colorado Care Workers Unite (CCWU), said such a measure could benefit an estimated 60,000 care workers in Colorado. Advocates also noted that the Colorado Health Institute projects that more than 70% of Coloradans will receive home care at some point in their lives, and these workers “deserve to be treated with the same love, the same compassion, the same dignity that they show every one of us.”
CCWU states that its goals are to win decision-making power for caregivers, a livable wage, more training, improved opportunities, and a safe work environment. CCWU helped win a budget provision in 2021 requiring state-funded home care workers to be paid a $15 an hour minimum wage. This took effect in 2022 and covered those working in various capacities in Health First Colorado, the state’s Medicaid program. Among the caregiving areas covered are Adult Day Services, Alternative Care Facility, Consumer Directed Attendant Support Services (CDASS), Group Residential Support Services, In-Home Support Services (IHSS), Personal Care, Respite Care, and more. The state directive said workers could be paid more than the base minimum wage but not less. CCWU hailed this as a good step forward but said more needs to be done to support caregivers statewide.
What Coloradans can do about the Caregiver Shortage?
With the caregiver workforce shortage unlikely to be significantly improved in the short term, those needing and looking for long-term care would be wise to evaluate as thoroughly as possible the quality and track record of potential care providers. Remember you can always contact your local ombudsman, who will be able to assist you in finding a provider that best fits your or your loved one’s needs or help you with any long-term care issues, such as addressing concerns about quality of care in a particular facility. See https://www.coombudsman.org/. Ombudsmen are there to help ensure the health, safety, welfare, and rights of residents living in long-term care facilities.
Another resource that may be of help is the Consumer Direct Care Network (CDCN), which has a presence in several states, including Colorado. Their stated mission is to provide quality care and support to families and people of all ages, including older adults, children, and individuals with physical, intellectual, or developmental disabilities, “so they can remain safe, healthy, and independent in their homes and communities.” The Care Network offers relevant training for caregivers or provides services directly in areas such as Financial Management, Self-Directed Personal Care, In-Home Caregiving, Respite Care, Chore Services, Veteran Care Services, Private Duty Nursing, and more. You can find more information on self-directed care at the CDNC website mentioned above and in our AgeWise Colorado article on the subject at https://agewisecolorado.org/blog/consumer-directed-care-assistance-for-colorado-seniors-and-caregivers/.