#MacroSW 4/12/18 – Home Care Workers in Home and Community Based Services



Link to Sympur online transcript

Link to PDF transcript

For this week’s chat, we will be talking about the issues facing home care workers who care for older and disabled adults in their homes and communities.

According to the Paraprofessional Health Care Institute (PHI), there are over 2 million home care workers in the US who provide care to older adults and persons with disabilities in community based residential settings.  The demand for home care workers has grown exponentially over the past 10 years and is anticipated to continue to grow, as the population of people over age 65 continues to grow.  Most of these aging adults report a desire to want to age in place at home.

Home care workers in most of the United States are often women (88%), people of color (28% African-American and 21% Hispanic or Latinx), and immigrants (28% born in other countries) (PHI, 2017).  Wages for a home care workers range from $8.46/hr in Mississippi to $14.63 in Alaska and home care workers sometimes struggle with cobbling together enough patients to make ends meet, or with getting consistent hours due to hospitalizations and deaths of their patients.  Home care workers almost never get health benefits, and many work for more than one agency to get enough hours to support themselves and their families.  According to PHI (2017), one quarter of home care workers live below the federal poverty line, and over half receive some form of public assistance.

Here is a link to some information on this important topic from PHI, and a documentary film called Care, which chronicles some of the challenges faced by workers and patients who must navigate home care:





Our host will be Nancy Kusmaul (@nancy_kusmaul).  Nancy Kusmaul, Ph.D, MSW is an Assistant Professor at the University of Maryland, Baltimore County (@UMBC), at the BSW Program of the University of Maryland School of Social Work.  She practiced social work in nursing homes, hospitals, home care, and adult day care.  Her research focuses on long term care services and supports and organizational culture.  She is concerned with the experiences of direct care workers and care recipients. She is a member of the Baltimore County Elder Abuse Coalition and the Maryland Nursing Home Culture Change Coalition.

Robert Espinoza (@espinozanotes) is the Vice President of Policy at PHI, the nation’s leading expert on the direct care workforce, where he oversees its national policy, research, and communications division. In 2017, he designed PHI’s #60CaregiverIssues campaign, which is identifying 60 concrete solutions to the country’s growing workforce shortage in home care. In 2015, Robert was appointed by the Centers for Medicare and Medicaid Services to its Advisory Panel on Outreach and Education, as well as by the National Academies of Sciences, Engineering, and Medicine to the Institute of Medicine’s Forum on Aging, Disability and Independence.

Our #MacroSW Contributor facilitating the chat is Alyssa Lotmore (@AlyssaLotmore). 

Here are the questions we hope to discuss during the chat:

  1. Why are the challenges of home care workers of concern for social workers?
  2. How can improving conditions for home care workers help the people they care for?
  3. How can policies be created that enhance the working conditions for home care workers while still making home care accessible for the people who need it?
  4. How do current immigration policies threaten the stability of the home care workforce?
  5. What can you do to advocate for home care workers?

 About #MacroSW:

#MacroSW is a collaboration of social workers, organizations, social work schools, and individuals working to promote macro social work practice. Macro social work practice focuses on changing larger systems, such as communities and organizations. It encompasses a broad spectrum of actions and ideas, ranging from community organizing and education to legislative advocacy and policy analysis. The chats are held weekly on Twitter every Thursday at 9 p.m. EST (6 p.m. PST). Click here for a list of chat partners. For information about how to participate in the #MacroSW chat, view our FAQs. For chat schedule and chat archives check out: http://macrosw.com.


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