Barbara Lyons

The COVID-19 pandemic intensified shortages in the direct care workforce long driven by low wages, high turnover rates, and recruitment challenges. In some cases, these shortages contributed to the closure of home and community-based services providers, including adult day health programs, group homes, and assisted living facilities, which typically employ direct care workers. These closures then led to still further shortages and added new burdens to family caregivers.

Direct care workers — home health and personal care aides, for example — play pivotal roles in providing essential personal care, homemaking, and home health aide services to people who need help with daily tasks. These services allow Medicaid and Medicare beneficiaries to live at home and avoid costly medical or institutional services.

The Medicare home health benefit is designed to provide in-home assistance to beneficiaries who are recovering after a hospitalization or are “homebound” and need help managing medical conditions. Despite a growing aging population, the US has seen home health visits decline steeply over the past two decades, as the share of visits has increased for skilled care, particularly therapy services (exhibit 1).