The Aide Crisis in Healthcare

Dec 09, 2019 at 06:42 pm by pj

1.2 million additional aides needed in the next ten years




The lack of qualified and compassionate aides is a crisis that impacts many facets of health care adversely. We are all aging, and many of us work, play and live in Florida, which has one of the fastest growing populations in the U.S. Think about the age of those around you. 10,000 Baby Boomers turn 65 every day!

As a long-time nurse and author of books on home health care, hospice, and family caregiving, it is obvious to me that the need for caring and competent aides has never been greater. For those who are in a caregiving role, the challenge to find and hire aides can be difficult. Organizations who provide aide services experience the task of finding qualified aides and also may struggle with turnover and retention. Regardless of our roles and business, there is a need to increase the number of aides who provide this essential health care.

Depending on the scope of the aide’s skills and training, “aides” can be called a number of titles such as a home health aide, hospice aide, home care aide, personal care aide, certified nursing assistant (CNA) or state- tested nursing assistant (STNA).

According to the Bureau of Labor Statistics (BLS) it is projected that by 2028, approximately 1.2 million additional home health and personal care aides will be needed to provide this fundamental care. I believe we all have a role in identifying people who might be/become great aides and helping them in that mission.  

Aides should be valued and recognized as the foundational structure for health care in the United States. They work in a variety of settings, such as nursing homes, home health, hospice, hospital, assisted living and other community and home-like settings. So, what exactly do home health and personal care aides do for patients? Simply put, they assist with or perform tasks and activities we do (and sometimes take for granted that we can do) every day. This includes activities of daily living and at times very personal care. Think about this from an aide’s perspective—the environment and culture can be very different from one patient home to another. Oftentimes, within an hour, an aide is assisting the patient sometimes to awaken/get up, take a shower or help with bathing, oral care, encouraging independence and assisting when needed in activities such as choosing clothes, dressing, preparing and serving meals. Depending on the patient’s needs, sometimes the patient is fed, toileted and assisted with other basic elements of body functions.

Depending on the organization in which the aide is employed, other tasks may include observation, taking vital signs, practicing infection control, documentation of the patient’s status, and tasks performed.  The aide must be knowledgeable and aware of changes to report to their supervisor.

Communication and interpersonal skills are so important for those who are infirmed, may live alone and be isolated, and who are very dependent on others for their needs. This is where aides come in.

Challenge of successfully recruiting over a million more aides is complex and nuanced. R and R, or recruitment and retention, needs to be reframed and switched to retention and recruitment. The emphasis on retention is important to keep great aides in the profession. This then is the challenge and also a great opportunity for performance improvement and to drill down and identify the real reason(s) aides leave.  Analyzing those reasons, exploring potential solutions, and working toward defined objectives are all parts of this process. Of course, there may not be one answer.  

Remaining at home is most often preferred as we age. For many this requires the valuable skills of that qualified and compassionate aide, wherever the healthcare setting. The future is here, and so the aide shortage should be approached with new eyes when seeking a workable solution. Let’s encourage a collaboration with stakeholders in the challenge of promoting aide -related initiatives and work together toward the goal of effective long-term answers to this dilemma of the aide crisis.


Tina Marrelli, MSN, MA, RN, FAAN is the President of Marrelli and Associates, Inc. a consulting and publishing firm.  Tina is the Chief Clinical Officer for and the author of a number of books including the award-winning, “A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself” which recently was awarded a 2019 Caregiver Friendly Award by Today’s Caregiver Magazine. This book is also an e-book. Tina is also the author of “Home Health Aide: Guidelines for Care –Instructor Manual”.

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