Home Health Aide Shortage Leaves Patients Without Care

Older white adult woman sitting on a bed looking out a window.

Thanasis Zovoilis/Getty

Key Takeaways

  • The COVID-19 pandemic and low pay fueled a home health aide shortage, leaving many older adults and disabled people without care.
  • Low wages are partly related to reimbursement rates, as home health aids are reimbursed by the patient or by Medicaid.
  • Over the years, the amount that patients and Medicaid are willing to pay for home health care has not kept pace with wages.

From personal protective equipment (PPE) to low numbers of nursing staff, the pandemic has fueled shortages across all sectors. Home health agencies and the patients that they serve have been hit especially hard.

According to a Consumer Directed Personal Assistance Association of New York State (CDPAANYS) report, 74% of New Yorkers that needed home health aides in 2021 were unable to retain them.

What Home Health Aides Do

Home health aides bathe, dress, groom, and do light housekeeping for people with disabilities, older adults, or chronically ill patients.

Cathy Creevy

Sometimes, we’re the only face that they see.

— Cathy Creevy

As a result of the shortages, many older people and patients with disabilities have been left without this care—or the human interaction that comes with it.

“Sometimes, we’re the only face that they see,” Cathy Creevy, a Philadelphia-based home health aide, told Verywell. “There are no family members at all.”

What's Causing the Shortage?

There are a few factors that are driving the home health aide shortage, but many are long-standing issues in the industry that have been made worse by the pandemic.

Long Hours

The pandemic has exacerbated retention rates among home health aides. According to Creevy, providers are working long hours and are burnt out.

“Before COVID, I started with a 42-hour workweek,” said Creevy. “Which has turned into a 52 hour week since March of 2020.”

Lack of PPE

Home health aides have also been challenged by a lack of access to PPE. As the pandemic has worn on, aides have been constantly faced with shortages for these critical supplies, which they often have to buy themselves.

A 2020 study showed that having a one-week supply of PPE was associated with a lower probability of staff shortages.

Low Pay

Creevy said that low pay is also a contributing factor. Despite having worked in the industry for 21 years, Creevy has only seen a $5.75 difference in pay since they started in 2001.

Edwin Crespo-Thomas

There are home health aides right now being paid about $10 an hour. Who’s going to live off of that?

— Edwin Crespo-Thomas

Creevy said, “I went from $6.25 to $12” per hour. “That’s not much of a big difference considering we have to do a lot of things.”

While minimum wages are being raised to $15 an hour in some states, Pennsylvania’s minimum wage remains stagnant at $7.25.

Edwin Crespo-Thomas, a home health aide in Harrisburg, Pennsylvania, told Verywell that “there are home health aides right now being paid about $10 an hour. Who’s going to live off of that?”

Crespo-Thomas added that “there are reports out there that our food costs went up about 6% and gas and rent has skyrocketed as well. So, $10 an hour to start for home health aides is not helping anyone.”

Philadelphia isn’t alone: home health aides in New York made an average of $15.93 an hour in 2020, falling behind the living wage of $21.77, according to a City University of New York report.

Who Pays for Home Care?

The lower rates are down to reimbursement rates. Home health aides are reimbursed either through private by (if the people they care for can afford it) or by Medicaid.

Fred Johnson, MBA, president and the CEO of Team Select Home Care, told Verywell that “reimbursement rates that Medicaid pays an agency or that a senior is willing to pay for this level of care have not kept pace with the wage pressure and need that these people need to make.”

Johnson added that “people just have more choices now and they’re choosing jobs that offer higher pay, and more stability. People want 40 hours a week, they want benefits, and they want consistency.”

Meanwhile, home health aides can have unstable workloads. “Things seem to be going well, but maybe after three months, that client runs out of money and they can’t afford it anymore,” said Johnson.

That can leave aides going weeks—if not months—without pay.

Helping the Helpers

According to Johnson, improving home health aide retention will take structural change, such as faster and increased reimbursement rates, “so that agencies can pay more to these employees and let those increases flow through to the caregivers.”

Crespo-Thomas added that “what’s happening is they [Medicare and Medicaid are] lowballing home health agencies for these services to the point that home health agencies really can’t keep their doors open or the lights on due to the fact they’re not getting reimbursed properly.”

Some help might be on the way. In March 2021, the Biden Administration proposed a $400 billion plan to expand access to home health care. The plan includes benefits for caregiving jobs, building state infrastructure to support workers, and improving wages.

What This Means For You

The pandemic has heightened the challenges faced by home health aides in the United States, leading to shortages of these healthcare critical workers. As a result, many older adults and people with disabilities cannot get the care they need.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Consumer Directed Personal Assistance Association of New York State. A home care system in crisis: the high cost of low wages

  2. Xu H, Intrator O, Bowblis JR. Shortages of staff in nursing homes during the COVID-19 pandemic: what are the driving factors?. J Am Med Dir Assoc. 2020;21(10):1371-1377. doi:10.1016/j.jamda.2020.08.002

  3. City University of New York. How public health investment in higher pay for home care workers would benefit New York State.

  4. The White House. The American Jobs Plan.

By Kayla Hui, MPH
Kayla Hui, MPH is the health and wellness ecommerce writer at Verywell Health.She earned her master's degree in public health from the Boston University School of Public Health and BA from the University of Wisconsin-Madison.