Report: Advancing the Home Care Workforce

2. Fund a campaign to raise the social status of home care workers Rationale: Low social status is widely recognized as a major barrier to the adoption of advanced roles in home care. The public does not see this work as specialized, and therefore has not fought for better working conditions and wages. Clinicians do not view these workers as team members. And family members of clients, who generally serve as an intermediary between the client and health care team, do not necessarily trust the care worker to communicate directly with health care teams. Campaigns to raise the status of workers have been successful in other fields. Community health workers (CHWs) have fought to advance their own agenda and are now widely respected, and their employment has vastly expanded. A public relations campaign was developed by Johnson and Johnson to elevate the public’s perceptions of nursing with extraordinary success. Aims: This recommendation includes two parts, which could be implemented together or separately. The first is to assess the history of a similar occupation with low status in healthcare that has been able to change public perceptions and advance integration with the health care teams: CHWs. The second is to study the lessons of the Johnson and Johnson campaign and to use these and the CHW findings to plan and conduct a public relations campaign that aims to elevate perceptions of home care worker value among families, clinicians, employers, and workers themselves. The campaign could also identify ways to engage the public in organizing to promote HCWs. 7.2. Program Pilots These two recommendations seek to convince local healthcare leaders of homecare’s opportunities for growth. The first focuses on health systems, likely an Accountable Care Organization (ACO) that includes dual-eligible and SNFs. The second focuses on home care agencies. 3. Develop a pilot program to help a large health system (or community health center) in rural counties to expand their business to acquire or grow their own homecare and home health care offerings . 4. Rationale : Our review suggests that among the most important barriers to advanced roles with higher wages are 1) the fragmentation of the home care and home health industry and 2) the small size of most firms. Both constrain the goal of developing economies of scale that allow for investments in the workforce and standards for its diversification of roles. This is especially problematic in rural areas, where workers must travel further to get to clients (cost for the company and for worker) and where there are especially severe shortages of workers. Additionally, all of the experts interviewed argued that integration of home care workers with the health system is a major goal, such that the care team benefits from home workers report

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