Good economy worsens elder-care shortage

Better-paying positions attracting women who usually fill such jobs

January 03, 2000|By NEW YORK TIMES NEWS SERVICE

PHILADELPHIA -- The booming economy is worsening a severe shortage of the low-wage workers who care for the nation's growing number of frail elderly people, health care experts say.

The shortage of home health care nurses, aides and nursing home assistants has grown in the past two years as better-paying jobs with better conditions have opened up for the women who have traditionally filled those positions, which have low wages and few benefits.

To a lesser extent, many in the industry say, cuts in Medicare have made the strenuous jobs even more demanding as agencies have made up for reduced income by requiring workers to deliver more care in less time.

Almost every state is grappling with the shortage, according to a national survey conducted last year by North Carolina. New Jersey recently put the recruitment of home health care workers at the top of its list of priorities for elderly care, and states including Florida, Pennsylvania and Maryland have established task forces to study the issue.

A task force has also been formed in Connecticut by the Association for Home Care, a trade organization, with the state participating. In New York City, with its large pool of immigrant workers, the shortage is less severe. But the rest of the state mirrors the country, and the state's home care association is looking for ways to find more workers.

Even the experts cannot find help. Mary Mongan, a registered nurse who is vice chairman of the New Hampshire State Council on Aging and a former state health commissioner, knows how to negotiate the health services world as well as anyone. But when doctors told her 83-year-old sister-in-law three years ago that she had cancer and the sister-in-law wanted to stay at home in Manchester, N.H., Mongan could not find home health care aides who could provide 24-hour help.

Her sister-in-law was forced to move to Maryland to live with her daughter, Mongan said. "We couldn't put together enough dependable help," she said. "They didn't have the manpower."

The shortage involves the aides, most of them women from their mid-20s to mid-40s, who do the basic, unpleasant and often dangerous work -- bathing, changing diapers, cleaning bedsores, feeding, lifting and transferring people in and out of bed -- for the fastest-growing population in the country, the very old. And these days, more and more of those workers find they can earn about the same wages at McDonald's or Target.

With some home health care aides financed by Medicare, the federal health insurance for the elderly, others by Medicaid, the federal insurance for the poor, and even more through private payments, it is difficult to estimate the numbers of aides.

The Bureau of Labor Statistics put the number of aides financed by Medicare and Medicaid at 697,000 in 1996, a number that includes paid homemakers.

Tens of thousands of additional home health care workers will be needed in the next few years, experts say, with the number of jobs to be filled expected to increase by 76 percent between 1996 and 2006.

North Carolina will need about 21,000 more nursing aides and other aides -- in nursing homes as well as in the community -- over the next five to six years, according to the state's report.

"In a bad economy, when you can't get any other job, and you have a sixth-grade education, being a home health aide is an attractive job," said Carol Keintz, executive director of the Home Health Assembly of New Jersey, a nonprofit trade association. "In a good economy, when Dunkin' Donuts doesn't care if you've got a sixth-grade education, it's tough to find people."

In addition, Keintz said, fast-food restaurants and retail stores like Target offer steady, full-time work, often with benefits.

Home care, with clients whose needs constantly change and with Medicare limiting the number of visits, tends to be part time and unpredictable.

"Agencies can't say, `We can promise you a job every day, '" Keintz said.

"Suddenly, five of their patients die or go to the hospital, and they say to the worker, `Don't come in today.' "

Finding workers is particularly difficult in states such as Florida, where the tourism industry offers an abundance of relatively unskilled jobs.

"We're having a terrific problem finding home health care aides," said Gene Tischer, executive director of Associated Home Health Industries of Florida, a nonprofit trade association.

"That same level of worker is attracted to restaurants and hotels. It's highly competitive," Tischer said. "It's easier work to go to Arby's than to go into [a] house and give [someone's] dad a bath."

Pub Date: 1/03/00

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