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8/29/2017 7:32 am  #1

Shouldn’t It Be Work Worth Doing?

Home Health Care: Shouldn’t It Be Work Worth Doing?

Do you know who is going to care for you when you are old and frail? By current standards, it’s likely to be a middle-aged immigrant woman, with maybe a high school education and little if any training, making $20,000 a year.

And that’s if you are lucky. If you live in rural America, you may already have a hard time finding somebody to look after you. Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management calculates that if nothing is done to draw more workers into the field, there will be a shortage of at least 350,000 paid care providers by 2040.

This, I’m sure you’ll agree, makes little sense.

How to provide long-term care for a fast-aging population poses one of the more convoluted challenges of the American labor market. Care providers — home health aides, personal care attendants and certified nursing assistants, in the government’s classification — are expected to be among the nation’s fastest-growing occupations. The Department of Labor’s economists expect about a million more will be added from 2014 to 2024.

And yet despite their critical importance to the well-being of tens of millions of aging Americans, one-fourth of these aides live in poverty. The jobs are so unappealing that it is hard to keep workers in them: four in 10 leave the occupation entirely within a year. Many prefer the fast-food business.

“Home care is absolutely the bottom rung on the ladder, but home-care workers are the people that spend the most time with the client,” said Adria Powell, who runs Cooperative Home Care Associates, a worker-owned long-term-care agency in New York.

As President Trump promises to recover the jobs of an ancestral age populated by well-paid coal miners, steelworkers and assemblers of air-conditioners, he is missing one of the most critical challenges of the American work force: transforming long-term care into a higher-quality, better-paid job that could support the middle class of the future.

It can be done. In his new book, “Who Will Care For Us?,” to be published next month by the Russell Sage Foundation, Professor Osterman suggests that improving these jobs could actually improve the quality and efficiency of the entire health care system. “It could save the system money,” he told me.

There are a few reasons long-term care is such a bad job. “Most people see it as glorified babysitting,” said Robert Espinoza, vice president for policy at PHI, an advocacy group for personal care workers that also develops advanced training curriculums to improve the quality of the work force.

The fact that most workers are immigrant women does not help the occupation’s status. Occupational rules that reserve even simple tasks for nurses, like delivering an insulin shot or even putting drops into a patient’s eye, also act as a barrier against providing care workers with better training.

But perhaps the most important barrier is the government’s budget: Medicaid — funded by federal and state governments — picks up more than half the tab for the $300 billion or so spent every year on long-term care.

States spend about $200 billion of their own funds on Medicaid. It is the second-biggest item on their budget, after education. To raise reimbursement rates for long-term care agencies, they would have to find the money elsewhere.

Still, Professor Osterman points out that shortchanging long-term care is shortsighted. Home health aides trained to do more — to spot patients’ health problems, to keep track of their pills and doctors’ appointments and to offer advice on healthy living — could wring billions of dollars in savings from the health care system.

Better-trained aides could help patients manage chronic conditions like obesity and diabetes. They could also help manage the transition out of a hospital, ensuring that patients took their medication and followed up with the doctor, to prevent them from having a relapse or ending up in a nursing home.

We live in a time in which decent and otherwise sensible people are surrendering too easily to the hectoring of morons or extremists. 

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