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An unprecedented shortage of staff has hit home-care agencies hard —with job applicants ghosting employers for bigger unemployment checks

  • Home-care agencies say they’re having unprecedented staffing issues amid a nationwide hiring crisis.
  • Job applicants are ghosting interviewers, sometimes because of bigger unemployment checks.
  • The industry’s staffing issues have worsened this year, leading to delayed care for older people.
  • See more stories on Insider’s business page.

For home-care agencies, the national labor “shortage” has led to a burgeoning industrywide staffing crisis.

The fragmented home-care industry, despite offering employment in a job sector that’s poised to grow more than any other sector by 2029, is desperate to find caregivers for older people and those with disabilities. It’s work that pays near the minimum wage and can be emotionally and physically taxing.

This is happening at a time when there’s a tight labor market that’s accompanied the gradual state-by-state reopening throughout the US. Restaurants, including major chains like Subway and Dunkin’, are struggling to hire enough employees to return to pre-pandemic business hours. The most recent jobs report in April showed the US added just 226,000 jobs, far below the 1 million economists had predicted.

Although anecdotal evidence from employers indicates some can’t find the workers to meet rising consumer demand, not everyone agrees on what to call what’s happening to the US labor market. One Washington Post headline stated its interpretation outright: “It’s not a ‘labor shortage.’ It’s a great reassessment of work in America.”

Seven home-care-industry professionals told Insider that applicants were ghosting interviewers and not showing up to new-hire orientations in numbers higher than they said they’d ever seen. While the franchise-dominated industry has historically been prone to high turnover, the recent staffing issues are leading to delays for patients, some of whom are in dire need of care.

Some franchise operators said their home-care job applicants were explicitly pointing to better income from unemployment benefits when turning down job offers. A lack of childcare and better-paying, less-grueling jobs elsewhere have also made it hard for home-care companies to fill vacant caregiving roles.

Jennifer Tucker, the chief operating officer of Homewatch Caregivers, which has over 200 home-care franchises in 33 states, said the staffing crisis was “the biggest thing happening in home care.” Homewatch’s competitors are experiencing the same issue, she said.

“We’re talking about a workforce where we’re competing with Chipotle and Amazon,” Tucker said, invoking the restaurant and retail giants’ recent decision to raise wages. “They’re not necessarily entry level, but they tend to be a bit lower-skilled. They might hop around.”

Home-care operators say bigger unemployment checks and other job opportunities are contributing to their staffing issues 

Nationwide, demand for home care has risen as clients, typically older Americans, or their families feel more comfortable seeking out in-person care amid widespread vaccination and declining coronavirus cases. 

But franchise operators hoping to hire more caregivers to staff these cases are finding that applicants from job-posting sites like Indeed are not showing up for interviews.

Kirk Fisher, who runs a Homewatch franchise in Williamsport, Pennsylvania, for the past six years, said staffing was harder than it’d ever been. 

“We get eight people per week scheduled to interview. We generally have two show up, and we generally have one of them show up for orientation,” Fisher said. “Previously we could hire three people per week without much difficulty at all.”

The day he spoke with Insider, an applicant told him they made more on unemployment than they would make working for Homewatch, Fisher added. 

Other applicants in his area are also asking for more hourly pay than he said he could offer. Fisher pays his employees $11 to $12 an hour, he said, but some applicants are asking for up to $18 an hour.

Fisher said he couldn’t afford to offer his workers a pay bump similar to ones offered at fast-food stores like Chipotle and McDonald’s. Between what clients can afford to pay out of pocket and Pennsylvania’s Medicaid reimbursement, which covers the nonmedical home care Homewatch provides, increasing pay by $2 an hour is out of the question, he added.

elderly person health aide

A home health aide in January 2010.

Joe Raedle/Getty Images


“We have to maintain a certain margin so we can provide the benefits,” he said, referring to the minimum essential health-insurance coverage he provides to employees.

Rebecca Smith, an Always Best Care franchise operator in Northern California, has had similar issues recruiting home-care workers.

“We’ll reach out to 15 to 30 applicants a week, but we’ll only have maybe 10 show up for an interview, and maybe three that actually want to get hired,” Smith said. “They just ghost us.”

Smith said government stimulus checks definitely affected her applicant numbers. Smith said she even ran an analysis of her Indeed applicants over time and found that every time direct cash assistance went out, she saw a dip in the number of applications to her open caregiver roles.

“You can completely see when funding gets issued. There’s a complete drop in people even looking for jobs,” she said. 

Dan Sweiger, a California BrightStar franchisee, said caregivers in his San Diego-area job market know they’re in a better bargaining position than before the pandemic.

While home-care workers elsewhere are unionizing and demanding a $15 minimum wage nationwide, Sweiger already offers his employees at least $16 an hour, a competitive wage where he operates. 

“They’re negotiating for more pay, and ours is creeping up,” Sweiger said of his employees. “At some point, you’ve got to pass it onto the customer, and we try really hard not to do that.”

Home-care workers say their pay isn’t enough to make ends meet

Nursing home workers protest in Brooklyn, according to the Healthcare Workers Union.

NYC nursing-home workers protest lack of PPE, hazard pay, and respect from employers on May 21, 2020.

Stephanie Keith/Getty Images


The tight labor market comes at a time when the Biden administration has indicated it would support the decades-long effort by groups to unionize the industry, allocating $400 million as part of a sweeping infrastructure plan. 

But for now, home-care workers told Insider their pay wasn’t enough to make ends meet.

Carlena, a nonunion home health aide in the Midwest, said the $11 to $12 an hour she makes with a major home-care franchise wouldn’t be enough to make ends meet without child support provided by her ex-husband. Carlena requested that her last name and home-care agency not be used to protect her privacy. They are known to Insider.

“If I didn’t get child support, no, absolutely not,” she said when asked if she was making ends meet. In addition to her home-health-aide work, she also makes $10.50 an hour working as a caregiver in a residential nursing facility.

Carlena said her agency was feeling the shortage of workers and trying new ways to recruit additional staff. 

“They just started an incentive program because we are desperate for more workers,” she said. While her agency has yet to raise pay, it now offers a $500 bonus dispensed over three months for any successful referrals.

LaTonya Jones-Costa, a home-care worker in Georgia for over two decades, said she could barely make ends meet between her two home-care jobs, each of which pay under $15 an hour. She is in the process of organizing an Atlanta-area caregivers union with the Service Employees International Union.

“This country has been held up by Black and brown women doing the work that we do,” Jones-Costa said. Without home care, people with ailing parents or loved ones with disabilities would be forced to stay home, in turn curtailing their ability to make money for their families.

As an organizer and longtime caregiver, Jones-Costa is keenly aware of the importance of the work she does, as well as how little she is paid for it. 

“If every home-care worker was to leave the field to go to a higher-paying job, where would that leave the country?” she said.

‘We’ve got vulnerable people that can’t get the care they need’

The staff shortage directly impacts the elderly, terminally ill, and those with severe disabilities who look to home-care agencies.

In rural Pennsylvania, the Homewatch franchisee Fisher said he’s had to turn away cases. Many of his clients, who pay out of pocket or through state Medicaid, come through groups that coordinate patient services, but he doesn’t always have the staff to take cases.

“They actually put five potential clients into skilled nursing facilities because they couldn’t find an agency like mine with staffing to provide the care,” Fisher said.

In a recent instance, the California BrightStar franchisee Sweiger said, a patient with a terminal illness called his franchise hoping to transition from a skilled nursing facility back to home. But Sweiger said he didn’t have enough caregivers for around-the-clock care to make that happen.

“All he wanted to do was die at home, but he needed home care to do that,” Sweiger said. “I think there were two shifts we could cover that week.”

After two days of Sweiger and other people involved in the man’s case calling around, they were able to find enough shift coverage for him to go home. The patient spent two extra days in a skilled nursing center when he had days to live, Sweiger added.

“We’ve got vulnerable people with major health issues that can’t get the care they need,” Sweiger said.

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