How paying home health caregivers more could save health systems money

About Susan Heavey

Susan Heavey, (@susanheavey) a Washington, D.C.-based journalist, is AHCJ’s topic leader on social determinants of health and curates related material at She welcomes questions and suggestions on resources and tip sheets at

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Is it worth it to provide more skilled – and higher paying – home health care?

That is the question that New York Times’ economic columnist Eduardo Porter tackled in a recent piece examining whether staffing the nation’s long-term care system with better-trained and higher-paid aides could give them more responsibilities and better address health care gaps.

His piece, “Home Health Care: Shouldn’t It Be Work Worth Doing?,” highlights a forthcoming work by Paul Osterman, an author and professor at the Massachusetts Institute of Technology’s Sloan School of Management. Osterman’s research explores why the home health profession hangs near the bottom rung of society, despite it being a fast-growing and needed occupation as our population ages.

Porter also looked at how such aides could serve as a bridge between patients and more expensive doctor and hospital visits, helping to reduce health disparities and decrease gaps in care. He writes:

“Home health aides trained to do more – to spot patients’ health problems, to keep track of their pills and doctors’ appointments and to offer advice on healthy living – could wring billions of dollars in savings from the health care system.

Better-trained aides could help patients manage chronic conditions like obesity and diabetes. They could also help manage the transition out of a hospital, ensuring that patients took their medication and followed up with the doctor, to prevent them from having a relapse or ending up in a nursing home.

One assessment of the academic literature concluded that there are $250 billion in savings to be had from better managing chronic conditions and reducing hospital and emergency room admissions and readmissions.

And there are other jobs for personal care aides to do. For instance, community health workers doing home visits can help bridge the gap between patients and doctors – improving rates of immunization, helping manage conditions like high blood pressure and otherwise encouraging healthy behaviors.”

The NYT article is among several recent pieces by journalists on the ramifications of keeping home health care such a low-paying profession.

Kaiser Health News’s Shefali Luthra recently shared how she was prompted by a press release to report on how low-wage home health aides were struggling to afford health care for themselves. (Check out her “How I Did It” essay for AHCJ.)

Porter also examined that issue, writing: “Yet despite their critical importance to the well-being of tens of millions of aging Americans, one-fourth of these aides live in poverty. The jobs are so unappealing that it is hard to keep workers in them: four in 10 leave the occupation entirely within a year. Many prefer the fast-food business.”

The growing population of older people needing help is another important issue. “By 2040, there will be more than 50 million disabled people in the United States needing some form of long-term care, 12 million more than today. Most will be cared for by family members, but the demand for care workers will explode,” he noted.

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