The need for in-home care rises as baby boomers age


Published: 3/23/2013

Every morning for the last seven years, Fanie Occeas has been preparing Prescola Beneby a hearty weekday breakfast — grits and sardines or sausage and eggs. Every morning, too, Occeas bathes the 87-year-old, tidies up her Arcola Lakes house and settles her in a wheelchair.

Their banter is easy, their movements together familiar and sure. “She’s like a daughter to me,” says Beneby.

Adds Occeas, “I’ve learned a lot from her.”

Occeas is a certified nursing assistant who looks in on Beneby and three other homebound seniors during her rounds for her employer, United HomeCare. Beneby is a mother of six, bedridden because of rheumatoid arthritis. The two are part of a trend that experts say will become very common as the nation’s population ages and more seniors choose to stay at home instead of moving to nursing facilities.

The number of people age 65 and older will double to 81 million in the next 30 years and the demand for nonmedical home-based help — for daily activities such as dressing, bathing and meal preparation — is expected to soar. In the past four years alone, there has been a 40 percent growth in U.S. senior care agencies, according to, a company that connects seniors and professional caregivers with care options. More than 4,000 caregivers are hired monthly.

In a company index of the elder-care job market, Miami ranks 18th among the top 20 metro areas for home healthcare employment, followed by Orlando and the Tampa/Sarasota area. According to the Bureau of Labor Statistics, employment of personal care aides is expected to grow by 70 percent in this decade and home health aides by 69 percent, making them the first and second fastest-growing occupations.

“We have agencies telling us, ‘We need this kind of worker, we need that kind,’” says Julie Northcutt, founder and CEO. “Even in this economy, we’ve had a huge demand. Agencies are growing as fast as they can.”

Finding and training workers for these jobs will become increasingly important as the baby boomer generation, 78 million strong, ages. Various studies also have found that at-home care is actually more effective — and less expensive — than similar care in a nursing home or hospital.

But will there be enough workers to fill the need?

“There’s no question in my mind that we have totally, totally, underestimated what we will need in terms of medical professionals to service us,” says Nancy Stein, founder of Seniority Matters, a network of pre-screened resources for South Florida seniors. “We’re in for a rude awakening.”

Stein says she gets many calls from boomers trying to plan for their parents’ care and “they don’t have a clue what to do. We really need to start thinking of what’s important to us, where we want to live, what we can afford as we age. It’s so important to plan ahead.”

She says she hopes boomers’ experiences with their parents will prompt them to do just that.

Jacqueline Torre, a human resource executive for United HomeCare, hires between two and five home health aides a week to add to its current 650-member roster. It hosts an open application period every Wednesday and provides free in-service training every year. Still, it has a waiting list that tops 1,000 prospective clients.

The demand is particularly high in Miami, where Hispanics prefer at-home care. “Our culture prefers to keep the family member at home, no matter what,” Torre says. ”The first pick is always a home health aide instead of sending them to a place.”

The need for direct-care workers — which includes home health aides, nursing assistants and personal care assistants — is actually not new. Senior advocates have been sounding the alarm for years, but now the looming shortage is expected to worsen faster because the new federal health law tries to reduce hospital readmissions and expands programs that encourage Medicaid recipients to receive in-home care.

But attracting workers to occupations that pay slightly more than minimum wage and offer few benefits is difficult. Though direct-care workers provide about 70 to 80 percent of the paid hands-on care and personal assistance received by the elderly or the disabled, a 37-year-old “companionship exemption” to the Fair Labor Standards Act excludes them from guaranteed minimum wage and overtime protection. That exemption was supposed to cover jobs like babysitting, but because of a quirk in the law, home health aides ended up falling under that provision.

A handful of states do have some kind of wage and overtime protection, but Florida is not in the group. In addition, home care workers expect a revision of the federal minimum wage and overtime requirements this spring, after President Obama announced a proposal in December 2011 that would narrow the definition of the companionship exemption.

Even then, some say that change won’t be enough to encourage more people to enter the direct-care workforce. According to the Paraprofessional Healthcare Institute (PHI), a New York City nonprofit organization that keeps tabs on the industry, the national median hourly wage in 2011 for personal care aides was $9.49 and for home health aides, $9.91, substantially lower than the median of $16.57  for all U.S. workers. (The minimum wage was $7.25 an hour.)

That disparity exists in Florida, too. The median hourly wage in the state was $9.39 for personal care aides, $10.13 for home health aides and $11.19 for nursing aides. In comparison, the median hourly wage for all occupations was $14.79. What’s more, fewer than half of direct-care workers have employer-based health coverage.

“We need to seriously look at wages and provide appropriate training and benefits and opportunities for advancement if we want this to be an occupation that people enter and stay with,” says Steve Edelstein, PHI national policy director.

Occeas, who has been employed as a direct-care worker for more than 11 years, is an anomaly. Many of her colleagues last but a few months on the job, moving to better paying positions that can guarantee hours and healthcare benefits. She says she has stayed in the profession because she loves caring for the elderly.

“I don’t know what’s going to happen in the future,” she says. “We need a new generation of workers to replace people like me and where will they come from?”

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