The pandemic highlighted the numerous challenges the home care industry faces as the U.S. population ages, Robert Espinoza, PHI vice president of policy for the nonprofit PHI, which tracks the direct care market, said Tuesday. Among them, nearly half of the nation’s 4.6 million home care workers and nursing assistants live at or below the poverty line, and more than half receive public assistance.

“This is more pronounced among women of color. When you look at the median family income of women of color working in direct care, they make $20,000 less than white men working in direct care,” Espinoza said on a webinar sponsored by the Kaiser Family Foundation and John A. Hartford Foundation about the value of home care workers in the pandemic.

Espinoza said insufficient training is also a problem. The federal government has no training requirements for personal care aides, and state requirements vary. That stands in stark contrast to other segments of healthcare, in which there are more uniform training standards.

“No state goes past 40 hours for personal care aides for training,” Espinoza said.

To attract more people into home care, the U.S. must elevate home care workers to the same level as healthcare workers, he said. 

The pandemic also has taught home care companies valuable lessons about staffing and training, participants said during the webinar. Joanne Taylor, owner of Senior Helpers in Westchester, NY, talked about the importance of supporting staff. She said she was able to retain most of her staff during the pandemic — even those who initially took time off.

“We respected their decision to work or not. If you decided not to work, you were still part of our team and that was OK,” Taylor said.

Taylor, who, besides supporting staff, said she focused on safety and marketing over the past year, said vaccine hesitancy remains a challenge; only about half of her staff has been vaccinated so far. “We do have some sitting on the sidelines for now. It’s an issue, especially with communities of color,” Taylor said.