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Prescription for Delaware’s home health care industry: More workers

On Tuesday and Thursday mornings, Honore Kendle goes to the grocery store, runs errands and attends her Bible study group.

In the not-so-distant past, she couldn’t leave her home in Millsboro because she was providing full-time care for her 82-year-old husband Jack, who suffers from Parkinson’s disease.

Now, she gets a break from Theresa Warrington, a certified nursing assistant from Lewes, who bathes her husband, helps him dress and fixes him breakfast.

“I look forward to Theresa’s visits — and so does Jack,” says Mrs. Kendle, 77. “At times, our situation was overwhelming and having her help has made a tremendous improvement in our lives.”

Demand for home care aides is exploding, with jobs projected to increase 41.8 percent in Delaware between 2006-2016, according to the Paraprofessional Healthcare Institute (PHI), a New York-based worker advocacy group. In comparison, jobs in all occupations in the state are expected to grow 10.7 percent.

Filling the ranks of home care workers will be especially challenging in Sussex County, Delaware’s largest, grayest and most rural county. One in five—21.3 percent—residents is 65 or older, compared to the national average of 13 percent, according to the U.S. Census Bureau. The state average is 14.7 percent.

Demand up, labor down

While demand is rising, the labor pool is drying up. The primary source of home care workers —women aged 25-54—is expected to increase by a scant one percent nationwide between 2010-2020, according to PHI statistics.

Senior Honore Kendle talks about the relief her and her husband Jack receive from an in-home caregiver.

Senior Honore Kendle talks about the relief her and her husband Jack receive from an in-home caregiver.



In Delaware, even fewer workers will be available, PHI projects. The population of women in that age group is expected to shrink by one percent during that period.

Already, the First State is near the bottom in meeting demand for home care workers, according to a Long-Term Care Scorecard compiled by AARP, the Commonwealth Fund and the SCAN Foundation, nonprofit advocacy groups. Delaware ranks 47th in the number of personal care aides per capita.

“That is a very stark demographic,” said Dorie Seavey, PHI’s director of policy research. “Delaware needs to do more to support workers who care for people in their homes rather than in nursing homes.”

Helping hands

Warrington is employed by Visiting Angels of Milton, owned by David Forman and his wife Annalise, a certified Christian counselor. In only three years, the business is performing in the top 10 percent of Visiting Angels’ 450-plus franchises nationwide.

The company employs 70 certified nurse’s aides who work with more than 120 clients. They perform the sort of non-medical tasks one might expect friends or relatives to manage, if they weren’t already busy working and raising families.

“They do light housework, they drive clients to the doctor’s, they serve as companions,” Forman says. “A few hours a day or even a few hours a week can make the difference between being able to stay in your home or not.”

Visiting Angels charges $17-$25 an hour for personal care. Round-the-clock assistance costs about $1,500 a week. Most people pay out of pocket because Medicare covers home care only during the transition after someone leaves a hospital or rehabilitation center.

The Kendles pay $19 an hour. It requires juggling their budget a bit, an adjustment the couple feels is well worth it.

“It’s the best way to spend our money at this point,” Mrs. Kendle says.

For them, the bottom line is spending the rest of their days in the house they built themselves 30 years ago. They do not want to move to a nursing home.

“God willing, it will never happen as long as I can breathe,” Mrs. Kendle says. “We have families of bluebirds outside our window. We belong here.”

Lots of older Americans feel the same way. By 2020, direct-care occupations will be the largest category of workers in the United States, surpassing retail sales associates and school teachers, says a PHI report.

The federal government defines home health and personal care aides as workers who help people who are elderly, physically disabled, chronically ill, or cognitively impaired and who need assistance with daily activities such as bathing and dressing. They also cook, clean and run errands.

In growth mode

In Delaware, the ranks of workers who focus on health care and social assistance are projected to swell by 13,140 by 2020, according to a report by the state Department of Labor. That is more than two and a half times the 5,510 new jobs expected in construction, the second-highest occupational sector.

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Franchises: At home with health care

As demand for personal home aides grows, so do businesses that provide helping hands for people who are sick or elderly, a blend of traditional independent operators and booming franchises. The rare exception is worker-owned home care companies, which account for only two of the thousands of private duty providers nationwide.

So, where will the workers come from? Home Instead, a franchise network that employs 65,000 home care aides nationwide, is looking to immigrants to help make up the shortfall. Currently, one-fourth of the company’s aides are documented foreign workers.

Forman has hired a few aides from Ukraine and the Caribbean but he doesn’t believe foreign-born workers will make a significant impact on the labor market in lower Delaware.

He says it is challenging to hire and retain quality workers in Sussex County because of its unique geographic mix. While most clients live in affluent coastal resort communities, the majority of caregivers reside in rural, more affordable areas. The largest county east of the Mississippi in the United States, Sussex encompasses 1,196 square miles, nearly half the state, with little access to public transportation.

“The price of gas is huge when you are making $10 an hour,” Forman says. “If you live in Seaford or Greenwood you aren’t going to be able to take care of someone who lives in Fenwick.”

Visiting Angels finds workers in various ways, most by word of mouth. A few aides turned to home care after working in nursing homes because they prefer to work with clients one-on-one. Some lost jobs in the recession. Others simply enjoy helping people.

Trained as a registered nurse, Warrington took time off to raise her children. Her license had expired by the time she decided to go back to work, so she gave home care a try.

She works with the Kendles and one other family and enjoys the flexibility of a part-time job.

“Taking care of someone is the most rewarding job I can think of,” she says. “Mr. Kendle reminds me of my own father and I treat him like that.”

Low wages, high churn

Still, turnover is high. Forman says the average length of service is six months to a year. That’s true throughout the industry, says Deane Beebe, PHI spokeswoman.

“The job is hard, the pay is poor and the rate of injury is high,” she says. “There are personal care aides who love the work but go to Starbucks because it offers health benefits.”

Forman says agency operators are hard-pressed to keep care affordable for clients. Turnover is expensive for employers, who are faced with ongoing costs for training, background checks, home evaluations and other administrative expenses.

“There is no way we can pay health insurance because we would have to pass along those costs,” he says.

PHI is pressing to overturn laws that exempt companions from overtime pay and minimum wage requirements, an issue that impacts aides who remain in homes overnight. Currently, 21 states mandate overtime and minimum wage for home care workers, including New Jersey, Pennsylvania and Maryland. Delaware does not.

Seavey notes that many aides are able to find only part-time jobs and most do not have paid time off. In 2012, a PHI analysis determined the average annual earnings of a home care worker were $16,600 a year. In Delaware, the average wage was $10.42 an hour, compared to the overall hourly wage of $17.40 an hour.

So, how do workers make ends meet? Often, the taxpayers help out. In Delaware, 41 percent of aides receive some form of public assistance, such as food stamps or Medicaid.

“Essentially, the wages are backfilled with public subsidies,” Seavey says.

She predicts that without government help or programs that enhance pay and prestige for home care workers, a long-term solution will remain elusive. Without enough aides, expect more ill and elderly people to turn to nursing homes for care.

“We will return to what we had before the recession, tremendous shortages of home care workers,” she says. “When someone can’t find care in the community, many people will have no choice but to go into an extended care facility.”