Home care crisis drives innovation for aging in place

Home care is one of the nation’s fastest-growing occupations.

In 2024, 3.2 million home health and personal care aides were on the job — up from 1.4 million in 2014, according to PHI, a research and advocacy group.

The U.S. Bureau of Labor Statistics projects a need for 740,000 additional aides over the next decade, the KFF report shows.

Consumers pay a median of $34 per hour for home health aides, while median wages for aides remain under $17, with limited access to benefits.

Many workers — largely women and one-third immigrants — live in low-income households and rely on public assistance. Turnover approaches 80% annually, according to the ICA Group.

Worker-owned co-ops show promise

Some innovations are improving conditions for workers and patients alike

Home care cooperatives — businesses owned by the aides themselves — have demonstrated lower turnover and higher pay.

Cooperative Home Care Associates in the Bronx, New York, launched in 1985 and now employs 1,600 aides. The ICA Group counts 26 such co-ops nationwide.

“These co-ops are getting exceptional results,” said Geoffrey Gusoff, a UCLA health services researcher. “They have half the turnover of traditional agencies, they hold onto clients twice as long and they’re paying $2 more an hour.”

He described responses from co-op members as overwhelmingly positive when asked about their working conditions.

“But the biggest single response was, ‘I have more say’ over working conditions, patient care, and the administration of the co-op itself,” Gusoff said. “Workers say they feel more respected.”

Digital registries, specialized training

Registries connecting aides directly with clients are also gaining traction.

Carina, which serves patients in Oregon and Washington, supports 40,000 providers and 25,000 clients.

“People are seeking a fit in who’s coming into their homes,” Carina CEO Nidhi Mirani told KFF. “Individual providers can choose their clients. It’s a two-way street.”

Training programs further improve outcomes.

A team led by Madeline Sterling — a primary care doctor and the director of Cornell University’s Initiative on Home Care Work — tested a 90-minute virtual module on heart failure for 102 aides at VNS Health.

“Leg swelling. Shortness of breath. They’re the first signs that the disease is not being controlled,” she said.

Aides using a mobile health app made fewer 911 calls, and their patients had fewer emergency room visits, according to KFF.