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As Senior Care Moves to the Home, Need for More Caregivers and Quality Training

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As America’s population ages and technology advances, more seniors are choosing to “age-in-place” in their own home., a publisher of online hiring tools for senior care companies, released the the 2013 Caregiverlist Employment Index, reporting a 40% growth in the number of senior home care agencies since 2008. Even during the “Great Recession”, this segment of healthcare grew exponentially..

This rapid growth in senior home care presents new challenges: where will we find enough quality workers to deliver part-time, full-time and live-in care and what training requirements should be implemented to maintain quality care in the home?

According to the Bureau of Labor Statistics, employment of personal care aides is expected to grow by 70% in this decade and home health aides by 69%, making them the first and second fastest-growing occupations.

The Caregiverlist Employment Index has compiled the only data for caregiver pay rates, industry size and growth, top cities for senior care employment and types of senior care positions available. The largest challenge in the industry is finding quality caregivers and implementing training standards. As more hospitals are monitoring the discharges of senior patients to include tracking of quality home care, or even requiring in-home care upon discharge,

Currently, even though senior caregivers are paid more than minimum wage and receive benefits, there are still times when senior care companies are unable to provide care services because of the inability to staff an adequately trained professional caregiver. In addition, some care positions require caregivers with unique skills and abilities when care services are provided in the home.

The staffing challenges also involve the unique dynamic of caregiving for a senior, which involves the occurrence of natural client turnover because seniors are going to eventually recover from their medical condition and no longer need care or pass away. Many times quality caregivers will take time off after a senior home care assignment ends. In addition, unique requirements for care in the home are also a factor. While a senior home care agency may have a caregiver available, perhaps the senior has a dog or cat in their home and the caregiver is allergic to pets and will decline the assignment. In addition, customized training may be required, for hospice care or memory loss care. All of these dynamics make hiring and training caregivers for professional jobs an added challenge.

Live-in senior care has also grown, and while live-in caregivers do not actually move in with the senior, they still must be able to stay overnight in a senior’s home. Because of this, not all caregivers are able to accept a live-in senior care assignment if they have children or spouses who they are unable to leave overnight.

Another trend impacting the senior home care industry is an increase in hospitals requiring senior home care around-the-clock for the first few days or even the first week after discharge. This is to avoid rehospitalization of the senior within 30 days and the penalties that come along with this, a new requirement added to the Affordable Care Act to increase quality hospital care and decrease Medicare costs.

More senior caregivers are needed nationwide. Solutions proposed are recruiting more early retirees to become companion senior caregivers. Seniors with memory loss often only need companion caregiving services initially. Educating retirees about these jobs which deliver fulfillment along with a paycheck, may be one way to attract more workers to the industry.

Certified Nursing Aides and Certified Home Health Aides receive training based on the certification requirements in their state. More states are now proposing and passing legislation to require mandatory training meeting a set standard of requirements for professional senior caregivers in the home. The training requirements are usually proposed by industry trade group. California has 2 bills in committee which would require mandatory training with one bill presented by professional senior care companies the other bill supported by the Service Employees International Union (SEIU).

Illinois passed legislation requiring 8 hours of training for professional senior caregivers and licensing for senior home care agencies in 2008. Currently 33 states have either licensing or training requirements for senior home care agencies.

The Nursing Home Reform Act, adopted by Congress as part of the Omnibus Budget Reconciliation Act of 1987 (OBRA) was designed to improve the quality of care in long-term health care facilities and to define training and evaluation standards for nursing assistants who work in long-term care facilities. Each state is responsible for following this federal law and can create their own additions to the minimum training requirements. Because of this, and individual who has obtained a nursing aide certificate in one state may transfer it to another state. Similar national standards may be needed for senior home care in order to make it easier for companies to employ quality caregivers.

Here are highlights from the Senior Care Employment Index:

· SENIOR CARE INDUSTRY SIZE: There are nearly 11,000 senior care agencies in the United States: 1,000 new agencies opened in 2012 alone. Each agency is hiring 3 to 6 new senior caregivers on a weekly basis and more than 4,000 caregivers and certified nursing aides (CNA’s) are hired monthly from by subscribing senior care companies.


  • 40% growth in senior care agencies across the United States
  • Nearly 4,000 senior home care agencies have opened
  • 10 new franchise corporations began selling territories to new franchisees
  • 1258 senior home care franchise locations opened
  • 2,000+ independently owned/corporate locations opened
  • 10,474+ senior home care agencies in operation nationwide

*Source: From subscribers and senior care franchise corporations

· 2012 PROFESSIONAL SENIOR CAREGIVER PAY RATES: Compiled from’s 2012 job applicants, nearly 19,000 caregivers reported a national average of $10 for an hourly rate and $120 for a daily caregiver rate. Even with states increasing the minimum wage in 2013, the average senior caregiver pay of $10 an hour is 38% more than the national minimum wage.

Top 20 U.S. City/Metro Areas for Senior Care Employment
1) Phoenix, AZ
2) Chicago, IL
3) San Diego, CA
4) Los Angeles/Orange County, CA
5) San Francisco, CA
6) Washington, DC
7) Baltimore, MD
8) Houston, TX
9) Dallas, TX
10) Pittsburgh, PA
11) Philadelphia, PA/Cherry Hill, NJ
12) Seattle, WA
13) Portland, OR
14) Boston, MA
15) St. Louis, MO
16) Atlanta, GA
17) New York City
18) Miami, FL
19) Orland, FL
20) Tampa/Sarasota, FL


  • Companion Caregiver: No training required other than a caring personality and personal experience is an added bonus.
  • Certified Caregiver: Must complete a 10-hour basic caregiver training to become certified caregivers.
  • Certified Home Health Aide: State specific (NJ, FL & CA) requirements of formal trainings and standardized testing needed for caregivers to become certified in the home as a health aide.
  • Certified Nursing Aide (CNA): Must take state-approved CNA course and pass state CNA exam ( has CNA school directory + admission requirements and costs + sample and practice CNA test). All Medicare and Medicaid certified nursing homes and hospitals must have a minimum number of CNA’s on staff to help with patient care and safety.

*Licensed senior care agencies provide training to new hires.

The future of senior caregiving is going to continue to exponentially grow as the number of seniors in America will increase by 75% in the next decade. There will be a lot of larger companies expanding through acquisitions of smaller, locally managed agencies along with hospitals getting involved to help senior care remain local. Bottom line, we need more senior caregivers since the need is growing so quickly and innovative programs will need to be developed to deliver quality caregiver training.



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