S2E3: What Future Can We Imagine for Home Care Workers?

Home care workers are a lifeline to millions of older adults and people with disabilities, ensuring they live safely in their homes. However, these workers struggle in substandard jobs, often exiting this field frustrated in search of better jobs and leaving critical jobs unfilled.

In this episode, host Robert Espinoza speaks with Helen Adeosun, CEO and Founder of CareAcademy. They discuss the needs of home care workers, how businesses can support this workforce to succeed on the job and beyond, and how to imagine a better future.

Robert Espinoza: What would happen to families everywhere if more than 5 million direct care and childcare workers in this country were to vanish overnight? Welcome to Season 2 of A Question of Care, a podcast that explores this question through different viewpoints and topics. I'm your host, Robert Espinoza, a national expert and frequent speaker on aging, long-term care, and the workforce. In this episode, we'll explore the world of home care work with Helen Adeosun, the founder of CareAcademy.

Helen Adeosun: I am the CEO and founder of CareAcademy. We are a skills-building platform for direct care workers. In our very heart of our vision and mission, we believe that caregivers are the very center of an accessible and equitable healthcare ecosystem. And, to that end, we have to take care, uplift caregivers to enable the future of healthcare. So, we're really excited in terms of thinking about the capacity building that really can happen with caregivers, and really tap into their talents and their energy, and support their talents and energy, in order to meet some of the upcoming opportunities within healthcare.

Robert Espinoza: Helen, what compelled you to create Care Academy?

Helen Adeosun: Yes. My first work, the first meaningful work that I did outside of college was in education. I've been a Teach for America educator. Before then, I have been a direct care worker myself. And I just believe fundamentally and think even beyond sort of the industry, but the sort of the through line of my life is just innate belief in human potential and elevating human potential. I also look for opportunities to see opportunity and talent where others do not see it. In my life, I have benefited from that very directly, and I wanted a way to do that writ large.

And this is part of why I became an educator to begin with, but the essence of all of those things is really what undergirds CareAcademy. The belief that we are overlooking folks who, day in and day out, are massively upholding, really, on their shoulders, the brunt of our healthcare ecosystem, and overlooking them. I think our very mission is that we already believe that caregivers contain multitudes, just to maybe rephrase that saying a little bit, and our chance and opportunity as a company and more, writ large, is to really uplift and shine a light on what is already happening, and give even greater opportunity and potential to it.

Robert Espinoza: Our episode is focused on home care workers. And I'm wondering how you would describe, in your own words, what is a home care worker?

Helen Adeosun: A home care worker, and I think the phrasing is something that is also like, sort of a perennial challenge, but really can inhabit multiple roles. There are a number of companies that are sort of phrasing what this person is, but anyone who's providing an extension of health care in home and communities is who we really think about as the home care worker.

And that encompasses, overall, typically a woman. The field is roughly, based on sort of estimates, 90% plus women, largely women of color, of largely immigrant backgrounds, typically within middle age. But we also now see caring happening across the ages and across different demographic groups, from a generational standpoint as well. So, I don't want to flatten that. But we're typically seeing that as the demographic, the broad demographic, of folks who are providing home and community-based services.

Robert Espinoza: And Helen, what are some of the primary responsibilities of home care workers?

Helen Adeosun: Absolutely. So, to date, and I think about this from a historical lens, I think about home care, home health, really coming into its own over the last 30 to 40 years. It’s almost, if we think about the broader span of the American healthcare ecosystem, it's almost the newest kid on the block in a lot of ways. And so, largely, and historically, that has encompassed activities of daily living. It has included also providing personal care.

So, the things that folks would need to do to maintain active and daily healthy life. So, toileting, bathing, feeding, doing things such as going to the store, and leading just a healthy, active, communicative life as an adult, not just those basics. So, we also now talk about the social determinants of health—a lot of those systems run through folks who are providing home and community-based services. One of the things that we want to bring attention to in sort of that 30-year arc, and what we think the future is of some of these activities, is that we're increasingly seeing a lot more complexity as we understand the interconnectedness of health needs of not just older adults, but just us as humans.

A healthy human doesn't need to just eat three meals a day and go to sleep for eight hours a day, but they need to be part of the fabric of their communities. They need to communicate with other people. They need to sort of share and grow from a sort of mental health capacity. We know, increasingly, especially with the research of the last 10 years, that all of those actually have impacts on the overall health of a human being. And, largely, over and over again, we're finding out that home and community-based [care] workers are encompassing of all of those systems.

They are also subject to more technology. We think about the rise of AI in home in community-based services, and technologies that we interface with, and the iPhones, and all these different sort of communication systems are also part of the expectation of the direct care worker. So, we see all the things that we expect in our lives that we know are basic and necessary, and there's so much more that, even to the point where, anecdotally, we hear about family members or families of clients and patients in home and community talk about the caregiver, not only as an extent of their own family, but also a nurse almost. Very often, I'd hear folks use the terminology when it referred to me or other folks who were providing home and community.

So, it just points to that, over the last 30 or 40 years, we really sort of understood the full arc of what it means to care for someone and for ourselves. And all of those lines run through what we expect of the home and community-based [care] work.

Robert Espinoza: Yes, absolutely. In fact, anyone who's ever benefited from the support of a home care worker knows how much skill it takes to be a worker, and how they serve as lifelines for many people. What have you learned in your professional experience are the qualities and characteristics that allow a home care worker to succeed?

Helen Adeosun: I think that, increasingly, we have to see the home care worker, the direct care worker as the Swiss Army knife across all the things we expect lots of clinicians to do in our lives. In my life, I have what I call my “health stack.” Those are these sets of individuals who are responsible or who manage some part of who Helen is, and what makes Helen. It is having a therapist. It is having a sort of primary physician. It is having someone who is interfacing with me on either monthly basis, just to make sure that the system’ my body, my health, all things, are sort of running well.

Increasingly, I think of the direct care worker as the Swiss Army knife. They have to contain the multitudes. It is being empathic, it is listening, it is all the things that we expect from a good clinician or physician. And it also means those sort of “hard skills.” And so, I think we're moving away from what we used to call them, sort of “soft skills,” now we're calling them “power skills,” but all of the language is being revised.

But I think down, when it comes down to it, Robert, it's essentially having the empathic emotional skills to see your patient or your client as a whole person, and then also be able to communicate out the needs, fulfill some of those needs, and then also really work in connection with either family or what I call “the circle of care” that surrounds the individual, including the individual themselves, to make sure that they're getting great resources. That's a Swiss Army knife of skills, really.

Robert Espinoza: Absolutely. Your website at CareAcademy reads, “It's time to realize the unmet potential of caregiving in our homes and communities.” What is the unmet potential of caregiving?

Helen Adeosun: I think about what we do from a possibility sense and also from a sort of margin sense. That if you're running a business, you, your output, and your opportunity is only as good as you sort of invest in it. And I think the unmet potential is the opportunity to invest further in caregivers. As I've talked about in this conversation, I think caregivers already do so much. We have a sense of the opportunities and the possibility. But as a system, we really haven't set ourselves to measuring that impact. Healthcare works on behalf of understanding data and outcomes.

We know we have outcomes; we don't really understand them. And whatever you don't measure, whatever you don't understand, you really don't invest in. And so, I think the statement is less about the caregivers, and more so about the system writ large, to say: how do we understand the value of caregiving in order to invest in it, in order to see greater opportunities and outcomes? And that means a range of different things. It means investing in the people who do the work, investing in the ecosystems that undergird caregiving. Not just for direct care workers but thinking more broadly about family caregivers of 60-million-plus family caregivers in this country. And when we do that, we increase the opportunity for even expanding, what we still consider “unmet need.”

Robert Espinoza: Helen, I want to ask you a little bit about the challenges that are facing home care workers. In your experience, what are some of the major barriers that these workers are facing?

Helen Adeosun: Absolutely. It is the same thing that we all face, and I think they have it in greater numbers. It is time. Time and resources, I think, is one of the biggest things. If we think back to the outlines of a direct care worker, they need a swath of resources. Over the last three to five years, we've seen sort of a waning and a waxing of the resources that allow for caregivers to show up and fully give their attention to the work that they are doing. And if they're not supported, we're not enabling supports even further in terms of meeting the needs of their patients and their clients.

The other thing that I think about, too, is CareAcademy is a resource and a technology built to create accessibility, but how are we doing that, and thinking about creating accessibility, and managing the time that caregivers have? So, rather than a caregiver going into the office, receiving training, what we often found, in our own view and landscape of caregiving, is that caregivers really struggle to find the timing between managing their own caregiving responsibilities at home, as well as driving into the office. Even if they wanted to do those things they didn't have the time, the capacity, or even the resources to do them.

So, how do we create time, capacity, and resources? I think there are many nuances to why we see such high turnover in this space. But if I had to summarize them for the audience, Robert, I think it is about giving back the capacity, the time, the resources, the investment of public dollars to ensure that caregivers have access to the things that they need to support their families in order to provide care and extend care.

Robert Espinoza: Helen, in this season of A Question of Care, we're asking all of our guests to imagine for our listeners what a society would look like if there were no care workers. And I'm curious, in your perspective, how would our society change if there were no home care workers?

Helen Adeosun: I think A-jen [Poo] says it best, I think it eco-systemically, but I think the saying is that “caregiving is the work that enables all other work.” So, if we think eco-systemically, if you didn't have the home health aide, if you didn't have a personal care attendant, if you didn't have, I’ll expand it even more, your wife at home who's probably providing full-time care to your children, or having the babysitter at home, or any one of the number of folks who are part of the ecosystem of caring, our economy falls apart. We’re disabled in many ways.

And we're seeing it, as a return to some sense of whatever normal was before the pandemic, we're seeing this in real-time where the lack of access to resources, whether it's eldercare or childcare, is really having an impact in constraining whole economies. Imagine the chaos of that writ large.

I was actually hoping to do maybe a thought exercise the other way of the utopia that would exist if we had paid family leave, and a whole other set of resourcing that would allow for caregivers to really show up. When I think about the other way, it is very dystopic. In some ways, humans, families, communities are living some version of that dystopia right now, not having enough resources.

Robert Espinoza: Absolutely. And we're going to talk a little bit about solutions. How can we ensure that home care workers receive adequate training and support to meet the diverse needs of the people they're serving?

Helen Adeosun: We need to make it part and parcel of any other training system and expectation that we have within healthcare. I think some states are already moving ahead in that. I think, federally, we sort of thought about that for certain role types. And I think part of the market, right, really demands quality and consistency. And so there's also sort of the market forces from there in terms of the organizations that are sort of home care and home health, community facing, are also pushing for greater understanding of the skill sets, but I think, always, more can be done.

The future of this is that that home and community-based worker in that full 30-year arc is now part and parcel and is a provider themselves. Just as you see your family physician, just as you see your gynecologist, this is a provider of choice that is interfacing on an almost daily level. And so, to that extent, how do we empower that caregiver?

I think there's an article in The Washington Post from last year that you were quoted in, Robert, and I really loved the opening segment where they were describing a gentleman who had just come into caregiving, and he described himself among the set of nurses talking about what we call, in our industry, the “care plan.” So, the management of care of the individual.

And him feeling completely disconnected from the conversation that was happening around the needs of the individual. And what's even worse is this is the individual who's going to interface with that person the most right of all the people who are sort of sitting and discussing the needs in the room. So, I think about training as, three to four years from now, I would love for the same writer of that article to talk about how that gentleman, as well as millions of caregivers, feel fully empowered and capable. That's how we need to think about training and resourcing for this field.

Robert Espinoza: Helen, you and CareAcademy have brought so much learning about the potential of virtual training for home care workers. What are some of those lessons that you think should be replicated around the country?

Helen Adeosun: Absolutely. Thinking about accessibility at the forefront is absolutely necessary. And accessibility means many things to me. Accessibility in terms of the way in which learning is conveyed. That the way you and I learned, and I learned this in my educational programs by teaching firsthand that everyone has different ways and nuances in which they learn, really appreciating that from an individual perspective and a role perspective is really key.

I think folks think, okay, what's good for one end of healthcare is also good for another part of healthcare. I contend that we all need to know sort of what's happening with someone who may have dementia—we just maybe need to learn it from different facets. And from that point of accessibility, making sure that the learning is really pertinent to the role, and folks can see themselves directly in the role. When we put out content and education, our thinking is, within three to five minutes, I want you to know something that you never knew, and something you can use right away. It's a very different way of thinking about healthcare education. But we thought of it as a necessary condition in engaging a direct care worker. I've been one, and you're learning on the spot constantly. You're having to react, given immediacy of tools and that building of a tool belt to be able to react. So, accessibility is one.

The other thing too is that we see that attrition in this industry, especially within the first 90 days, is an occurrence by which caregivers have told us is because, “I didn't know what to expect. I have this grand idea of what caregiving was going to be. I'm going to engage, I'm going to be working with elders, I love that. But then there's also the stuff that is unpleasant and hard.” It is hard work, and I think we short shrift by not giving people access to understanding what parts of it are hard, and then what to do in those times that are hard. I think that's where our education really comes in and steps in to be a part of that understanding of, “If I face this situation, here's what I'm going to do, and here's what I can understand that I need to do. That eases me into the industry.”

So, just from an accessibility standpoint, really, understanding the needs of the role, and then also seeing the role right, and being able to understand that. That's something we've brought into our learning, and I think that folks can also take away with. And then maybe a third thing, if I may, Robert, that I want to add, my thinking about CareAcademy and just education writ large for the population of home and community-based workers, direct care workers, I don't come from technology. I realize the value of technology providing access, but I also think that innovation can come one of a number of different ways.

I would also, from the standpoint of an educator, never advocate for technology only as a way to do this. I think because it's healthcare, you also need to touch, feel, and see. So, very often, we all say there are moments where technology-based education is right. There are moments where you just gotta do it in person, and our platform also tries to account for that. The fact that you have to feasibly learn in person while also retaining practice online, as well. So, I also think that's part of what we've learned over the years at CareAcademy.

Robert Espinoza: Thank you for that and thank you for all the innovation that you’re bringing to this sector. Helen, I want to ask you one last question. If you could wave a magic wand and implement one significant change to improve jobs for home care workers, what would it be?

Helen Adeosun: Oh, my gosh, I have a list of things. I went in my head and pulled out this massive list. I think top of that list though, for me, would be what we already see our customers and the best-practicing customers do on our end. When I think about the value of home care, beyond sort of the mission orientation, there's a margin in the business of home care. There's a lot of alignment, more than people think. In fact, in CareAcademy, we call it the “win, win, win.”

That if we can find systems that are really good on behalf of the caregiver, it can be good for the business of home care, and ultimately good for the outcomes and for patients and their families. So, when I think about that, one of the really great home care agency owners talked about in this dinner that we held the fact that she was using our education as a way of providing raises. So, as they were learning really valuable skills, and wanted to learn valuable skills, she was providing them with a pay increase and a pay upgrade on every single thing that they were doing, learning, and so they became almost this complete caregiver, and their pay reflected it.

Robert Espinoza: Helen describes poetically that care workers contain multitudes, perhaps riffing on Walt Whitman. And she's right. Those multitudes of skill and hard-earned wisdom. Not to mention the grueling work that is often physically dangerous and isolating.

They carry the multitudes stemming from decades of government denying them the compensation, training, and career pathways they deserve. And they live with the grief that comes with watching clients struggle and often pass away, of watching a culture disrespect them, all without sufficient bereavement leave or grief counseling.

Increasingly, state leaders are thinking about policy solutions for home care workers in multitudinous ways. New Mexico adopted legislation that has changed how home care workers are counted, literally, through data collection, and how their wages are calculated at 150% of the state's minimum wage. California, Wisconsin, and Washington State translate their home care training materials to reach immigrants, and New York State invests in teaching English as a second language in home care. Wisconsin has created a premier certified direct care professional training and credentialing system that dramatically elevates this job sector.

We have a long way to go as a country, but these states are at least showing us how workers need financial freedom—and their clients need good care. Also, our economy cannot afford a growing workforce shortage or a society without a strong home care workforce.

Thank you to my guest, Helen Adeosun, and to you, our listeners. If you enjoyed this episode of A Question of Care, please share it on your social channels and stay tuned for future episodes. This podcast was produced by me, Robert Espinoza, in partnership with Modry Media. Please make sure to rate and review the podcast wherever you're listening.