Iowans hurt by decline in home health care aides

Turnover is high, pay low for, state figures show

Tucker Cassidy of Iowa City checks emails in his office at his home in Iowa City on Thursday, Sept. 22, 2016. (Adam Wesley/The Gazette)
Tucker Cassidy of Iowa City checks emails in his office at his home in Iowa City on Thursday, Sept. 22, 2016. (Adam Wesley/The Gazette)

There’s a for-sale sign sitting in Tucker Cassidy’s yard. He didn’t want to put it there. But after struggling to find consistent in-home care, Cassidy, a quadriplegic, is selling his Iowa City home to move closer to his family in Waterloo.

“I’m 41 years old,” he said. “My mom is 61. I shouldn’t be put in that position.”

Cassidy — who accidentally was shot by his friend when he was a teenager — requires a lot of care. He needs someone to help get him in and out bed every day, to feed him and to replace his catheters.

Even still, he has been able to live a fairly independent life — he owns his home and has a sales job — through the help of direct care workers such as nurses, nursing assistants and home-health aides.

But over the years, he’s seen his home health care hours cut, agencies have dropped him and he’s had to rely more heavily on friends and family for help.

He’s also found creative ways to fill these gaps. He’s hired students from the University of Iowa. His brother set up a GoFundMe account to raise money for him to pay out of pocket for care.

Until about a month ago, he had workers from Optimae Life Services coming by about four days a week in addition to a nurse he pays on his own who comes by five days a week.


But then Optimae informed Cassidy it no longer would be able to provide services to him, he said. Cassidy said the agency told him it had lost several workers and were not planning to replace them.

Optimae did not grant The Gazette’s requests for interview.

“Agencies are just not around or not willing to take on new clients, especially clients with high-care needs,” Cassidy said, adding it’s likely due to myriad reasons such as low pay, larger agencies buying up smaller agencies and hospitals grabbing up the talent.

Unfortunately, Cassidy isn’t alone.

Low pay, high vacancies

Turnover in the home health care profession is high and pay is low. Home health aides make on average $23,920 a year, while nursing assistants make about $26,000, according to 2015 Iowa Workforce Development data.

Those figures show that in the past 10 years, there has been little growth in the number of these types of workers and, in some cases, there has been a decline.

In 2006 there were around 9,600 home health aides and 20,900 nursing aides and orderlies. In 2015, there were 5,700 home health aides — a decline of 40 percent — and about 23,300 nursing assistants and orderlies — an increase of 11 percent. State data does show a steady increase of personal care aides, rising from about 5,000 in 2006 to 14,300 in 2015.

And there are a high number of vacancies as well. A 2015 needs assessment report found that, for nursing aides and attendants, there is an average 574 vacancies per day; for home health aides, there is an average 162 vacancies per day.

What’s more, data from the U.S. Department of Labor estimate the national need for these workers will only grow as baby boomers continue to age and the elderly population grows.

According to the Bureau of Labor Statistics, between 2014 and 2024 employment of home health aids is expected to grow 38 percent as an additional 348,400 workers are needed — far faster than the average growth of other occupations, the bureau says.


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In addition, the need for personal care aides, registered nurses and nursing assistants are expected to grow considerably during that time period:

l Personal care aides employment opportunities will grow by nearly 26 percent or 458,000 workers

l Registered nurses will increase by 16 percent or 439,000 workers

l Nursing assistants will climb by 17 percent or 262,000 workers.

Relying on family

Garret Frey was in a motorcycle accident when he was a child that left him in a wheelchair and on a ventilator. Since then, the Cedar Rapids resident has learned to adapt.

But Frey has gone from receiving 16 hours of care each day to about three — one hour of skilled nursing care during which a nurse takes his vitals, weighs him and checks his skin for wounds, and two hours of home health aides.

Before workers would help him with laundry, clean his room, help him bathe and give him his medications, among other tasks. These days, they really only have time to get him out of bed and bathe him.

“After that, I rely on my mom,” he said.

His mother Charlene and other family care for him the majority of the time. Frey also has a former nurse come by a few times a week during the evening through the state’s Consumer Directed Attendant Care (CDAC) program, which is under Medicaid.

“At first, it was very frustrating,” he said about his cut hours. “It put more on my family and friends.”

Frey said he has seen more consistency with his caregivers as of late, and he understands that it is a difficult job with little pay. He also feels fortunate to have a strong support system filled with family and friends willing to help out.

He knows of other quadriplegics and paraplegics who aren’t as lucky.

“There are always going to be difficulties and problems that everyone faces — disabled or not,” Frey said.



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