Study- Half of All States Approaching a ‘Caregiving Emergency.’

Home care worker shortages and rising care costs in America have pushed nearly half of states to the brink of a “of an unpaid family caregiving emergency,” according to a new study by Columbia University Mailman School of Public Health. “America’s Unseen Workforce: The State of Family Caregiving” is the latest installment in a caregiver research series sponsored by Otsuka America Pharmaceutical, Inc. (Otsuka). Unlike most studies that concern the availability of paid professional caregivers, the new study focuses on unpaid family caregiving.

The good news: Ohio and Missouri are among the list of 20 states categorized as "Safe for Now;" the others are Alaska, Colorado, Connecticut, Delaware, Illinois, Indiana, Kansas, Maine, Massachusetts, Montana, New Jersey, New York, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wyoming. The study warns, however, that active monitoring is necessary in these states to ensure that family caregivers remain in control; economic and demograghic pressures are stressing these family caregivers. More, even in states where critical shortages don't yet exist, and family caregivers are generally supported, caregiving is especially challenging in more rural communities.

The challenges are felt most acutely in Alabama, Arkansas, Florida, Georgia, Louisiana, Nevada, South Carolina and Tennessee. In these states, pervasive workforce shortages and large rural populations make it extremely hard for home-based care providers to deliver services, placing an outsized caregiving burden on seniors’ family and friends. Georgia, for example, has one of the largest home care aide shortages in the US and is designated as “critical” in the report.

Nationwide, unpaid caregivers contribute approximately $375 billion in labor each year, the report found. The report also highlighted the high and growing burden of dementia caregiving. Dementia is associated with approximately 40% of the total value of unpaid caregiving in the US, according to the report. This is equivalent to roughly $150 billion annually in unpaid dementia-related care costs.

Given these significant burdens — as well as the federal government’s focus on cost-cutting — the researchers called on state and local policymakers to implement solutions that benefit unpaid family caregivers. John McHugh, PhD, lead researcher for the report, said in a statement:

“At a local level, it is repeatedly the family caregiver who shoulders the immense pressures generated by healthcare shortages and rising dementia cases.Without strategic, state-level initiatives, the strain on our healthcare system and economy will only intensify. It is important for policymakers to recognize the value of family caregivers and consider the long-term savings that can be achieved by acting now.”

Debra Barrett, vice president, corporate affairs at Otsuka added:

“Although caregivers don’t have a choice but to continue their vital work, it is essential that policymakers understand the difficult choices being made by families across their state and assist in supporting the valuable contributions of unpaid caregivers. Progress is being made, but achieving comprehensive change requires strong support and collaboration from both federal and state governments. At Otsuka, our support of this study reflects our broader commitment to advocating for family caregivers everywhere. As we look ahead, we must commit to long-term solutions that uplift and sustain family caregivers, recognizing their critical impact across the country.”

The report findings underscore the need to advocate for more support and resources for unpaid family caregivers:

• In an era of reduced government spending, it’s crucial to establish a consistent and reliable standard of support for unpaid family caregivers at the state level.

• States must advocate for funding to support programs that provide financial assistance, training, and respite care for unpaid family caregivers to meet the growing demand and avoid putting more strain on their local healthcare systems.

• States with a higher rate of dementia care must urgently implement new solutions for unpaid family caregivers to bridge the workforce gap. 

• To get ahead of the rising demand for managing complex, chronic conditions like dementia — traditionally managed by healthcare professionals — training and certification programs for family caregivers are essential.

• States with higher rural populations must implement targeted strategies to support the unpaid caregiving workforce. 

• Where there is a shortage of healthcare workers, states can support family caregivers financially in recognition of their contribution to the healthcare system.Investing in the long-term care workforce at the federal level is crucial. This involves better training, higher wages, and finding long-term solutions for staffing challenges for both institutional and community-based care.

Just the fact that there is a focus on home health caregivers is important- these cargivers are vital in an aging in place plan. Tax, and regulatory reform could better incentivize and support family caregiving.

Otsuka is the lead, founding sponsor of Caregiving, a two-hour documentary for PBS portraying paid and unpaid caregivers navigating the challenges and joys of "this deeply meaningful work." Intertwining intimate personal stories with the untold history of caregiving, the documentary reveals the state and the stakes of care in America today. The project, created with executive producer Bradley Cooper, premieres June 24 on PBS and is available to stream on May 27 on PBS.org and the PBS App. It is the next feature film of the WETA award-winning Well Beings campaign, which addresses critical health needs in America. To learn more about Otsuka’s caregiver commitment visit: otsuka-us.com/caregiver.

Home Health Care Worker Shortage Risks Lives- Impacts Aging in Place Planning

Aging in Place Planning should consider and account for all risks, including availability/unavailability of paid health care workers. The Michigan home health care worker shortage is discussed in an article here, and in a newscast video here.  

The reports suggest that Michigan home health care workers are paid only nine dollars per hour, and often call off.  Of course, there is a vast array of choices in health care agencies (public, private, for profit, and non-profit), and every agency deals with worker retention and availability differently.  

Our office is aware of only one private agency that will certify availability of an aide 24 hours a day; their workers agree that they cannot and will not leave until they are relieved, and the company assures availability by always having supervisory staff and periodic staff available to fill needs. 

Regardless, the challenge of caregiver availability is one that must be considered in making aging in place decisions.  Availability of temporary or respite services, workers, or sometimes, charitable hospice services, may provide relief when worker a home care worker shortage exists. Outside custodial care, respite care, or adult day care may relieve risk upon lack of availability, but transport and cost must be considered.       

There is a Shortage of Health Care Professionals Capable of Serving the Elderly Population

There is a troubling shortage of health care professionals specializing in treating and caring for the elderly, according to an article published in Kaiser Health News. This shortage includes geriatricians, physicians who specialize in the treatment of adults age 65 and older, as well as nurses, physical therapists and psychologists who know how to care for this population.

The American Geriatrics Society estimates that the nation will need approximately 30,000 geriatricians by 2030 to serve the 30 percent of older Americans with the most complicated medical problems, according to an article in Health News from NPR. There are, however, only about 7,000 geriatricians currently practicing. To meet the projected need, the society estimates medical schools would have to train at least 1,500 geriatricians annually between now and 2030, or five times as many as last year.

Dr. Todd Goldberg, a geriatrician, recently told Kara Lofton, of West Virginia Public Broadcasting:

“With the growing elderly population across America and West Virginia, obviously we need healthcare providers...The current workforce is inadequately trained and inadequately prepared to deal with what’s been called the silver tsunami — a tidal wave of elderly people — increasing in the population in West Virginia, across America and across the world really.” 

The deficit of properly trained physicians is only expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older.

Dr. Goldberg teaches at the Charleston division of West Virginia University and runs one of the state’s four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field.

For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years.

“This is not just our local program, or in West Virginia,” said Goldberg. “This is a national problem.”

The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled.