Caregiving Organizations... It's Time to STOP Crossing Our Fingers

I spend A LOT of time thinking about caregivers.... Like.... A LOT (you may have noticed). It's no secret that without caregivers, there would be NO caregiving organizations. Yet, changes to the labor market both with respect to caregivers and other "non-skilled" workforces has dramatically increased the difficulty of recruiting and retaining caregivers. You don't need a lot of insight to see this fact. Just talk with a few leaders of care organizations.

I talk with these leaders all the time. New owners, folks who've been in business a couple of years, organizations that have been around for 15+, and the theme I hear is pretty common. "We hire one and lose two." "I can't seem to keep [my caregivers] around for more than a month." "I'm turning away clients because I can't staff the shifts."

There are, of course, lots of theories behind why this is and when it will improve. "Once COVID is over, they will come back." "[Caregivers] don't want to come back to work because they are scared of getting sick."

Now, to be sure, these reasons are probably short term factors in this caregiver shortage. But when COVID is over or transitions to an endemic, managed disease… Do we really think that things are going to go back to normal for our clients, our organizations, or our caregivers? I'm going to perfectly honest. I don't. And it's not just my opinion.

Here are the numbers that back it up: According to the US census, by 2030, all 73 million Boomers will be over the age of 65. The oldest boomers will be 84 years old[1]. Contrast this number with the 4.5 million professional caregivers estimated to be employed as of November 2020[2]. This ratio of 16.2 Boomers for every 1 paid caregiver looms as a serious issue on the horizon. Even if we doubled the number of paid caregivers between now and 2030, it would still represent a ratio of a little over 8:1. Such a doubling would be a serious feat, and will require some real changes to the caregiving industry.

Want more of a reality check? Consider these sobering examples of the significant challenges in place to simply MAINTAIN the caregivers we have:

In Texas, a 2015 report found that the average rate of caregiver turnover in assisted living was 97%[3].Notice I put the year of the report. This number is NOT pandemic related. Average turnover in a home care setting is 65.2, nationally[4]. According to a study by UCSF, there were significantly more people LEAVING the care industry than joining it between 2003 and 2013[5]

If these number make you sweat a little, you’re not alone. How can we possibly increase the number of caregivers available…. When we can’t even keep the caregivers we have? When we are actually LOSING ground?

There are some other troubling numbers looming on the horizon (I know, I’m a total ball of sunshine). The ratio of available family caregivers to people needing care is expected to fall from 6.1:1 to 4.1:1 in the next 10 years. By the time we reach 2050, that number will fall to 2.9:1[6]. If that seems a long way off now, consider your own age by that time. I’ll be in my late 60s. If you’re in your late 30s, 40’s, 50’s, or even 60’s now, this number won’t just be a statistic. It will directly affect how you DO or DO NOT get the care you need, and WHERE you can get it.

Want to age in your own home? At a certain point, that will likely require some level of assistance, which will have to be provided on a 1:1 basis. In a 2021 survey, 90% of those over the age of 50 report that they plan to age in place[7]. Where will these caregivers come from?

Just for kicks, add in the fact that people are living with more complex injuries and medical conditions (meaning: the caregivers we have will need to know a lot more to care for people safely).

So, we have a three-fold problem here. First, the number of people needing care is going to go up. Second, the availability of people able to provide care is going down*. And third, we should expect people who need care to have increasingly complex care needs.

However you want to shake it, the upshot of this data is undeniable: we need more caregivers, and we need them to be well trained.

So what are we supposed to do? Cross our fingers and wait?

I don't know about you, but I'm not a cross my fingers and wait kind of person. Instead, the time has come to seize this as an opportunity for new solutions. An opportunity to thrive by trying something new, instead of clinging to old assumptions, strategies, and practices that make us feel comfortable.

In the words of Ted Lasso, “Takin' on a challenge is a lot like riding a horse. If you're comfortable while you're doin' it, you're probably doin' it wrong.”

This is a challenging situation, to be sure. It's time to meet it by committing to new standards of excellence, efficiency, and ingenuity.

Author, Emilia Bourland, OTR, ECHM is the founder of Higher Standards Caregiver Training, where the mission is “to improve lives and businesses by revolutionizing caregiver training.” You can contact her directly at Emilia.bourland@aipctherapy.com.

“Jointhe Training Revolution.”

*For family caregivers, this decrease in ratio is inevitable for current generations. We can’t go back in time and have more babies! For paid caregivers, a reversal of this trend is going to take some very honest introspection and some very heavy lifting.

[1] Bureau, Census. “By 2030, All Baby Boomers Will Be Age 65 or Older.” Census.Gov, https://census.gov /, 24 Aug. 2021, https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html. Accessed 10/4/2021

[2] “Caregivers in America - AHIP.” AHIP, 20 Nov. 2020, https://www.ahip.org/caregivers-in-america/. Accessed 10/4/2021

[3] “Staff Turnover: Texas Nursing Homes at Tipping Point - THCA.” THCA, https://txhca.org/tipping-point-staff-turnover/. Accessed 10/4/2021

[4] “Caregiver Turnover Rate Is 65.2% According to 2021 Home Care Benchmarking Study - Home Care Association of America.” Home Care Association of America, https://www.hcaoa.org/newsletters/caregiver-turnover-rate-is-652-2021-home-care-benchmarking-study. Accessed 10/21/2021

[5] Frogner, B. and Spetz, J. (2015). Entry and Exit of Workers in Long-Term Care. San Francisco, CA: UCSF Health Workforce Research Center on Long-Term Care.

[6] D. Redfoot, L. Feinberg, A. Houser. The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers (Washington D.C.: AARP Public Policy Institute, August 2013). www.aarp.org/research/ppi

[7] Health, Capital Caring. “NEARLY 90% OF AMERICANS AGE 50 AND OLDER WANT TO “AGE IN.” GlobeNewswire News Room, Capital Caring Health, 5AD, https://www.globenewswire.com/news-release/2021/05/10/2226492/0/en/NEARLY-90-OF-AMERICANS-AGE-50-AND-OLDER-WANT-TO-AGE-IN-PLACE.html. Accessed 10/4/21 

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