Workplace Culture

A Call for Standards as At-Home Senior Care Workforce Rapidly Expands

By Rebecca Vesely

Feb. 27, 2013

Employment opportunities for in-home caregivers are rapidly expanding as baby boomers age, but federal officials say standards and professional qualifications have yet to catch up to demand.

Each month, more than 4,000 caregivers and certified nursing assistants are hired by in-home care agencies, which have grown by 40 percent in the past five years, according to, a Chicago-based senior care clearinghouse.

“There is a huge demand in senior care, along with great pay opportunities, and a variety of jobs available,” says Julie Northcutt, founder and CEO. “The industry is growing so quickly. Often these jobs can’t be filled due to a lack of applicants.”

The sector is developing at breakneck speed, and regulators are working to professionalize the field. In late 2011, the U.S. Labor Department issued a rule extending minimum wage and overtime protections to the nearly 2 million in-home caregivers nationwide. Just 15 states have minimum wage and overtime laws for in-home caregivers, the department said.

More protections are needed for patients and payers, too, according to a recent report. Federal agencies need to provide more oversight to fight fraud in the home caregiver system, according to a November 2012 report from the U.S. Department of Health and Human Services Office of the Inspector General.

The national average rate for in-home caregivers is about $10 per hour, or $120 per day, according to data compiled by

But a December report by the Paraprofessional Healthcare Institute found that wages for personal care workers actually declined in 16 states in 2011. In 33 states, average hourly wages of these workers fell below 200 percent of the federal poverty level, or $10.47 per hour.

“It will be very difficult for our country to meet the rapidly growing demand for personal assistance workers without improving these wages,” says Dorie Seavey, director of policy research at the Paraprofessional Healthcare Institute.

Some 6 million seniors employ in-home caregivers for daily assistance to live at home, and that number is expected to double by 2030, according to the Labor Department.

The job outlook for the sector is among the rosiest in all fields. Opportunities are expected to increase 70 percent from 2010 to 2020, and home health aides and personal-care aides are among the top five occupations projected to see the largest increase over the next decade, the Labor Department said.

Meantime, there are nearly 11,000 senior-care agencies nationwide, and 1,000 new agencies opened in 2012 alone, according to

But in-home caregivers often struggle to survive. More than 90 percent are women, nearly half are minorities, and 40 percent rely on public benefits such as Medicaid and food stamps, according to the Labor Department. The average median pay in 2010 was $20,170 annually, the department said.

Medicare and Medicaid are the largest payers for home health care services, according to the National Association for Homecare & Hospice.

More oversight is needed to fight fraud in the home caregiver system, according to a November 2012 report from the Office of the Inspector General.

The report said the Centers for Medicare & Medicaid Services is not doing enough to monitor personal-care service programs. In 2011, Medicaid costs for personal-care services totaled about $12.7 billion, a 35 percent increase since 2005. Under the program, beneficiaries can either hire individual caregivers themselves or go through an agency.

The Inspector General report said some states don’t mandate criminal background checks and licensing for home health workers and recommended federal standards to protect workers and patients. The recommendations included clear claims documentation, supervision of caregivers and beneficiary assessments.

Val Halamandaris, president of the National Association for Home Care & Hospice, says the group supports national standards for “worker competencies, qualifications and background screenings.”

Rebecca Vesely is a writer based in San Francisco. Comment below or email

Rebecca Vesely is a writer based in San Francisco.

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