The U.S. needs more home care workers. Is this the solution?

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America's home care shortage is critical, and growing. The industry's shortage seems to be driven by low wages, few benefits and a lack of respect for workers, 90 percent of whom are women. Would giving them more responsibilities and more training help workers earn more? In the second part of our reporting, economics correspondent Paul Solman takes a closer look at whether there is a solution.

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• William Brangham:
  
  Many of us say we want to stay at home as we grow into old age.
  
  But as economics correspondent Paul Solman recently reported, the country is facing a shortage of home care workers, the very people who can make staying at home possible.
  
  Tonight, Paul looks at efforts to address that shortage. It's part of our weekly series, Making Sense.
  
  
• Paul Solman:
  America's home care shortage is critical and growing.
  
  
• Woman:
  All right, Tom, come sit down for breakfast.
  
  
• Paul Solman:
  Right now, 90 percent are women, who help older adults and people with disabilities get through the daily tasks of living at home.
  The key drivers of the shortage, according to gerontologist Clare Luz.
  
  
• Clare Luz:
  Low wages.
  
  
• Paul Solman:
  Right.
  
  
• Clare Luz:
  Virtually no benefits, lack of guaranteed hours and lack of respect. Those are the big-ticket items.
  
  
• Paul Solman:
  The pay? A national average of $10.49 an hour. And that's not nearly enough to make up the shortage, says MIT management professor Paul Osterman.
  
  
• Paul Osterman:
  We have to find ways to make these jobs for these home aides better jobs, so more people are willing to do the work.
  
  
• Paul Solman:
  On the demand side, the reason is obvious and pressing, the number of elderly and disabled in need of assistance is expected to double in the next 25 years.
  
  
• Paul Osterman:
  It's going to put tremendous pressure on unpaid family members to step in, but they're not going to be there in the numbers that we need.
  
  
• Paul Solman:
  There aren't enough Hellen (ph) Kwants, that is. She's been caring for the elderly since she arrived from Colombia at age 22.
  
  You're now how old?
  
  
• Hellen Kwant:
  Eighty-seven.
  
  
• Paul Solman:
  And you're still doing it? How old is the person you're taking care of?
  
  
• Hellen Kwant:
  Eighty-seven.
  
  (LAUGHTER)
  
• Paul Solman:
  Hellen's daughter, Martha,` is also a home care worker.
  
  
• Martha Kwant:
  My mom raised us to care for our elderly neighbors, so since we were knee-high to boll weevils, we were taking food and helping do this.
  
  
• Hellen Kwant:
  Yes, we adopted like a grandma.
  
  
• Paul Solman:
  But Martha wonders if the rest of her fellow Americans are equipped to take in aging relatives.
  
  
• Martha Kwant:
  As a society, we're not so good about having the patience, as other cultures do, to have family move in, or to have that person move in with family and soften the approach to that ledge and the fall. That's not something most Americans are prepared to do.
  
  
• Paul Solman:
  So, what to do?
  
  In his book "Who Will Care For Us?" Osterman argues home care workers should be given more responsibilities, like managing chronic conditions, and especially more training.
  
  
• Paul Osterman:
  If they could do more they would be more productive. That would justify better compensation for them, which would mean that more people would enter into the market, and we will be able to avoid the shortages we will inevitably face as the baby boom ages.
  
  
• Woman:
  I'm tearing that off. I'm not touching my hand.
  
  
• Paul Solman:
  At a recent session in Grand Ledge, Michigan, called Building Training, Building Quality, or BTBQ, experienced home care workers were learning how to train new employees.
  
  BTBQ curriculum provides baseline training for home care workers. The goal is to attract and retain more people, because last year the industry had a median turnover rate of 67 percent.
  
  
• Alyssa Lawrence:
  We're constantly looking for other ways to retain our staff.
  
  
• Paul Solman:
  Participant Alyssa Lawrence thinks more training could lead to higher job satisfaction among her employees.
  
  
• Alyssa Lawrence:
  We're trying to break that stigma of you're just a home health aide, so this way we're looking at trying to better educate them, better train them and hopefully retain our staff a lot better.
  
  
• Paul Solman:
  But here's the problem, more training in no way guarantees higher pay.
  
  
• Wendy Martin:
  I was gobsmacked on how little they pay for this.
  
  
• Paul Solman:
  After Wendy Martin (ph) lost her automotive job, she decided to run a home care agency with her mom.
  
  If your work force is better qualified because they have gotten the training that you're learning how to give, are they going to earn more money?
  
  
• Wendy Martin:
  Probably not.
  
  
• Paul Solman:
  The reason for that is, most long-term home care is paid for through Medicaid.
  
  
• Paul Osterman:
  The financing system is a tremendous challenge. Medicaid has to compete with education and public safety for resources. Medicaid today caps what you can do for these aides in terms of compensation.
  
  
• Paul Solman:
  But, he says, if home care workers were better-trained and higher-paid, Medicaid and insurance companies would actually benefit economically, because patients would avoid more expensive medical care.
  
  
• Paul Osterman:
  Fewer emergency room visits, fewer readmissions into hospitals. Secondly, they will save money because they could shift some work from higher paid folks, largely nurses, to these aides. And they will save money because they will avoid unneeded nursing home entrances.
  
  
• Paul Solman:
  Clare Luz says the Michigan training program has already provided evidence of cost-saving.
  
  
• Clare Luz:
  We were able to demonstrate empirically an association between this comprehensive training program and expensive client outcomes, like falls and emergency room visits.
  
  Just from an economic standpoint, a business standpoint, it's foolish not to be looking at this work force.
  
  
• Henrietta Ivey:
  Your hair is very, very curly and pretty.
  
  
• Paul Solman:
  Henrietta Ivey has many years of experience, but she says when workers like her care for clients dependent on government reimbursements in her native Detroit, the pay is still a measly $9.50 an hour.
  
  
• Henrietta Ivey:
  They tell you, get skilled, get trained. And we do get skilled and get trained, but that money has not changed. It hasn't.
  
  
• Paul Solman:
  After talking to her for a while, I wondered, could Ivey cater to private clients who could afford to pay more out-of-pocket to a loving, seasoned pro like her?
  
  Maybe it's that there is a big entrepreneurial opportunity.
  
  
• Henrietta Ivey:
  You have got a good point there, but say, for example, me and a group of home care workers say, you know what, let's just start a home care agency.
  
  
• Paul Solman:
  Right.
  
  
• Henrietta Ivey:
  If we don't have money saved, which we don't, because we don't make any money to save anything to think on that level, those are our barriers. When you don't have that money for your basic needs, those types of ideas are just ideas for us.
  
  We work, we sweat!
  
  
• Paul Solman:
  So Ivey has become an activist with the Service Employees International Union to press for higher wages.
  
  
• Henrietta Ivey:
  Somewhere, somebody is going to snap and say, you know what? We see the problem here now. It ain't that people don't want to work. It's not that people are not smart enough. We're not paying them enough.
  
  That's what I like to hear, that sizzle.
  
  
• Paul Solman:
  And, says Paul Osterman, if we want there to be more home care workers like Henrietta Ivey around when we need their services, we will have to advocate for them too.
  
  
• Paul Osterman:
  We're going to need help, and we're going to wonder where it is and why it's not forthcoming. And then we will complain. And there will hopefully be a politician who will see it in his or her interest to make this their issue.
  
  
• Paul Solman:
  For the "PBS NewsHour," this is economics correspondent Paul Solman reporting from Michigan.
  
  
• Henrietta Ivey:
  You're welcome.
  
  

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The U.S. needs more home care workers. Is this the solution?