The Growing Demand for Home Health Care Workers in the Suburbs Raises Housing and Transportation Challenges

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  • December 02, 2014

Nurse and elderly man spending time together --- Image by © Jose Luis Pelaez, Inc./Blend Images/Corbis

Kathleen Costanza and Sarah Jackson

As a home health aide, Jasmine Almodovar earns $9.50 an hour. Though she spends her days providing care for senior citizens, she doesn’t have health insurance of her own—much less life insurance or a retirement plan.

“We work really long hours, really hard work,” Almodovar recently told NPR in a story about home health workers in suburban Cleveland. “A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”

Almodovar is part of the rapidly growing home health care workforce that’s caring for aging baby boomers who want to stay put in their suburban homes. The US Department of Labor estimates approximately 1 million more home health jobs—comprising home health aides and personal care aides—like Almodovar’s will be needed in the next decade.

As Brookings Institution demographer William Frey reported in 2011, 72 percent of those ages 45 or older live in the suburbs. And 40 percent of the suburban population is age 45 or older, up from 34 percent in 2000.

But will health aides be able to afford to live near their patients in the suburbs? If the current landscape is any indication, we may be facing a new suburban challenge: a housing mismatch between suburban baby boomers and health aides who help them “age in place” at home.

Home health care workers could affordably rent a two-bedroom home in only one metro area of 210 analyzed nationwide, according to a report from the National Housing Conference and the Center for Housing Policy. And although the demand is quickly increasing, a recent Brookings analysis found most health care occupations that do not require a bachelor’s degree saw wages slip during the last decade, after adjusting for inflation.

“Wages are not rising as fast as rents of home prices in many metro areas, and this is creating a severe housing cost burden for health industry workers,” said Janet Viveiros, National Housing Conference research associate and report coauthor.

With a median income of $20,820, renting in the suburbs where their patients live could be out of reach for many home health aides. Suburban rentals are in high demand after the housing crisis and rents have risen as a result. As a Harvard University study found, “In 2011, 36 central city rentals were affordable and available for every 100 extremely low-income renters, compared with 31 in suburbs.”

And building new affordable housing units in the suburbs is notoriously a struggle. We’ve written before about zoning restrictions that bar multifamily homes, apartments, and subsidized housing. In some cases, prejudice and stigma add to residents’ opposition—as was played out in the 30-year battle for an affordable housing development in Mount Laurel, New Jersey, which resulted in the New Jersey Supreme Court mandating all suburbs in the state to rewrite their zoning laws.

If health care workers can’t live near their patients, whether they live in the city or in a more affordable suburb, they need to be able to affordably and reliably commute to their patients’ homes. Public transit in the suburbs is spotty, especially between suburban communities. Even if workers can get to a train station or bus stop, the trip from the station to homes is typically on foot. And most public transit service in the suburbs is less frequent after rush hour. The costs of owning a car for long daily commutes are also burdensome. All these factors point to a potential geographical gap between aging baby boomers and the workers who will play an important role in helping them stay in their homes.

Personal care aides and home health aides are the second- and third-fastest growing professions in the country. Workers in the profession are more than 90 percent female, more than one-half are racial minorities, and 21 percent are single parents. As the baby boomers continue to age in their suburban homes, a shortage of housing and transportation options for the workers who care for them could prove to be yet another set of complicated problems the suburbs face.

Photo credit: Flickr user

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