In-home companion care or healthcare roles are tough to staff
By Deborah Jeanne Sergeant
If you or a loved one need homecare to recuperate or as ongoing support to age-in-place, you may be out of luck. Home health agencies, like all segments of healthcare, are struggling to find staff for home-based roles.
“It is difficult,” said Cassie Clare, executive director of Peregrine Home Care Services in Syracuse.
Part of it is the agency’s rigorous screening process — a must-do part of hiring for this type of work. Candidates must pass criminal background checks, Department of Health requirements and more.
It also has to do with the demands of the job.
“The demographic for this work skews toward the younger age group and it’s difficult for older people to do this work,” Clare said.
Home health is generally divided into companion care and healthcare. The former includes workers who help clients with housekeeping, meal preparation, errands, transportation, personal care, medication reminders, wellbeing and companionship. They do not perform any medical tasks. They generally receive some type of employer-based training, but are not required to be certified or licensed.
Home healthcare workers can perform the above tasks, but also can administer medication, provide therapy and take vital signs. They receive formal training and licensure. Because both types of home health providers could work in many other venues, it’s tough to recruit them to home health, which requires driving to private homes which are less predictable than a conventional workplace.
Clare said that finding reliable people can challenge companies in her industry.
“Homecare is a one-to-one staff-to-patient ratio,” she said. “The people at home are really counting on that person to show up. Reliability is a major factor.”
The need for homecare also makes staffing tough. Clare said that her organization could be much larger if she could find more people to hire who meet her company’s standards. The number of baby boomers wanting care at home for themselves or elderly parents has only increased since the pandemic, as more people realize they do not want to receive care in a nursing home unless absolutely necessary. According to a 2024 article in Forbes, “92% of older adults surveyed prefer to live out their later years in their current home, while 8% said they would prefer to live in an assisted living facility.”
Home care can help make that happen — if only companies could find enough staff. Despite paying competitive wages, Clare still struggles to attract as many qualified candidates as she would like to meet the growing need.
Even though companion care services are seldom covered by insurance (only the long-term care variety at some companies) and is not covered by Medicare, agencies have much more demand for services than coverage to meet those needs and must turn away potential clients.
Clare said that competing with retail and hospitality employers is tough, as some people would rather work in those predictable environments than providing personal care in clients’ homes.
Deb Turner, co-owner of Seniors Helping Seniors in Deansboro, serves Oswego, Cayuga, Seneca, Oneida and Madison counties. The organization seeks to target retirees who want to earn part-time income helping older adults with non-medical companion care.
Turner views her services as a way to help older adults stay in their own homes as long as it’s safe “by giving them a little bit of help.”
Her 65-plus workforce took a hit during the pandemic because many of them didn’t want to go into clients’ homes and risk exposure. Or, they were experiencing illness in their own household and could not endanger their clients.
“Fifty percent of our business dropped.” Turner said “The seniors didn’t want people in their home. It was scary for everyone.”
With careful precautions like frequent hand washing, masking and taking temperatures, clients and their families felt reassured and business slowly picked up again.
Joe Murabito owns Elemental Management Group in Oswego, which owns, co-owns or operates eight nursing homes in Upstate New York, said that another reason that home care agencies struggle to staff is that families are picking up the slack and caring for their own older relatives.
While this may seem an ideal solution in that having multiple generations living together can be both enriching and money-saving, Murabito’s issue with the arrangement is that with Medicaid paying qualifying caregivers, the funds aren’t going to agencies trying to hire trained workers.
“The program has exploded because why would anyone want to work in a home health company formally if they could get paid by Medicaid to take care of someone at home?” he asked. “What was a good idea and is still a good idea, was completely mismanaged by the state. They pushed billions of dollars into it and all you hear about being short on homecare workers is because of this program. The program spiraled out of control for a decade.”
Patients qualify for the program if they fall under an income threshold and are enrolled in Medicaid.
The Medicaid program “has its place but it’s consuming a great deal of resources that could be directed toward formal employers so they could pay better wages,” Murabito said. “It’s a mismanagement of dollars and oversight. The state needs a consistent standard for care. They have to pay attention to the components of the continuum of care.”
Daughter-for-Hire in Clinton, owned by Denise Flihan, provides companion care. Flihan said that finding good candidates is challenging, especially to meet the needs of rural clients since that requires more driving time.
“We are always hiring,” Flihan said. “There’s so much turnover in the industry. It’s tough because people are always job hopping. You may have employees who don’t care if they show up.”
She said that she tries to keep the pay competitive and offers an employee referral program.
Despite the challenges, Flihan views Daughter-For-Hire as providing a valuable service, not only for clients who get to remain in their homes, but also to the healthcare industry in general, as aides can help ensure their clients are eating right, staying hydrated and taking their medication on time. Companions also provide mental and social stimulation, which is vital for wellbeing for those living alone.
“Our culture is to help seniors live a great life independently,” Flihan said. “If there’s something we can do for referrals, we suggest it. If their health and physical ability changes over the years we’re helping, we communicate with the family and refer to places we trust so the family isn’t left out there flailing.”
