High turnover affects home health care quality

WASHINGTON -- As ailing Baby Boomers choose to stay home rather than seek full-time care in a hospital or nursing home, the industry charged with caring for them faces staffing shortages and a high turnover rate.

From state to state, that annual turnover rate can vary from 60% to 100%, according to research from the Institute for the Future of Aging Services.

Experts argue that encouraging people to enter the health care field — and stay in it — might be best addressed by offering a living wage, better benefits and overtime pay. But home health care business proponents say paying those wages would mean that seniors would have to pay more for their care.

The fight comes as the Labor Department released new rules in December requiring home health care businesses to pay their employees minimum wage and overtime. The federal minimum wage is $7.25 an hour.

High turnover is directly related to low wages, said Catherine Ruckelshaus of the National Employment Law Project. The turnover affects seniors, who face a multitude of caregivers, rather than the same person; employers, who must pay to constantly retrain employees; and employees who aren't able to advance in their careers, she said. Though 21 states have regulated the industry and insisted on minimum-wage protection, some employees do still make less than $7.25 an hour.

"They're making $16,000 a year," Ruckelshaus said. "No one can live on that. I think we forget the broader picture here."

Requiring employers to pay time-and-a-half for overtime could mean that some seniors will have to have more than one caretaker because they require more than 40 hours of care a week, said Gale Bohling, director of government relations for the National Private Duty Association.

Also, Bohling said, caretakers who now spend more than 40 hours a week at a person's home without receiving overtime will not be able to assist people they consider family.

"They're kind of like superstars," he said. "For them, this really isn't a job; it's a lifestyle."

Many caretakers surveyed say they don't work full time although they would like to. That's because they probably don't get along with the families they've worked with, Bohling said, which is why they can't get full-time work.

"They don't know that because the family's not going to say, 'We don't want you,' " he said.

About 60% of employees work fewer than 40 hours a week, Bohling said, and most companies pay "significantly more" than the minimum wage.

Turnover comes because people have to drive long distances to people's homes, not because of low wages, few benefits and long hours, Bohling said.

Since 2000, there has been a 23% increase in home health care employment, while salaries have remained the same, about $21,000 a year, according to a study conducted by Michael Hicks of the Center for Business and Economic Research at Ball State University.

"That stuck out," said Hicks, who conducted the study for the Indiana Association for Home & Hospice Care.

A study by the Carsey Institute at the University of New Hampshire found that the median hourly wage for home health care workers in New Hampshire was $10 an hour; 70% had no paid leave, and only one in five had health insurance through their employers.

They also found that low wages and few benefits were the main reasons the industry could not hire enough people to support industry growth, said Kristin Smith, a University of New Hampshire family demographer who conducted the study. Twenty-one states already have overtime and minimum-wage requirements, Smith said, and that has not affected care.

"There's certainly research that shows higher wages are associated with higher quality of care and lower levels of turnover," Smith said.