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The home health industry is heavily populated by nurses nearing retirement age, and providers are seeing the benefits and drawbacks of an aging workforce.
Generally, the working age of a registered nurse varies depending on the practice setting.
In home health and hospice, the number of retirement-age nurses is expected to exceed the number of new nurses, according to data from the American Medical Group Association.
For comparison, the average retirement age is 63 for women and 65 for men, according to U.S. Census Bureau data.
One reason that retiring or retired nurses make up a large portion of the home care industry is because newly graduated nurses typically were not trained to provide home care while in school.
“There are no nursing schools that train in the home; they focus on facility-based settings,” Katie Barnett, LeadingAge’s director of home care and hospice operations and policy, told Home Health Care News. “Sometimes you get lucky and you find people that are trained in long-term care facilities, but it’s very rare to find that in the home.”
Meanwhile, Barnett noted, experienced nurses are often attracted to home health care.
“We really want nurses with years of experience in other settings who come into our home health care so we know they have the flexibility but also the clinical ability to serve patients on their own,” she said. “They feel comfortable and confident serving patients when there isn’t a clinical supervisor across the hall.”
The ability to feel confident in home care is especially important because it’s an environment that requires autonomous decision-making, according to Mary Carr, vice president of regulatory affairs for the National Association of Home Care and Hospice (NAHC).
“At home, you have to make a lot of decisions independently. There are no other nurses or clinical staff to rely on, like in a hospital,” she told HHCN. “I think home is a more favorable environment for experienced nurses.”
Another benefit of having a workforce made up primarily of veteran nurses is that they are better equipped to deal with burnout, Barnett said.
“They’ve been through a lot, they’ve seen a lot,” she says, “and they understand the strain of the job they’re taking on, so the burnout rates are a little lower.”
At Masonica, a nonprofit senior care provider based in Wallingford, Connecticut, 15% of nurses are over 60 years old.
“If you look at the numbers in the last year and a half, we’ve actually hired four nurses who work with patients between the ages of 60 and 63,” Laurie St. John, Masonica’s executive director of home health, hospice and palliative care, told HHCN.
As a company, MasonicCare operates the entire continuum of care, including independent living, assisted living, skilled nursing facilities, memory care and Continuing Care Retirement Communities (CCRCs), across three main campuses. The company also provides home health, hospice, palliative care and inpatient behavioral health care.
St. John has found that working with more experienced nurses reduces turnover.
“Our highest turnover rate is among new nurses,” she says.
Although nurses approaching retirement age often bring a wealth of experience to the job, an aging workforce still has downsides.
“Obviously we want people to experience the benefits of retirement, but it creates problems for the whole nursing pipeline and I think that’s one of the big shortcomings,” Barnett said.
Additionally, the departure of experienced nurses can mean an exodus of vital knowledge and experience from across the industry.
“Home health care and home-based community services have matured over the last 20 to 30 years, so the nurses who are retiring … are pioneers in this field,” Nicole Howell, director of workforce public policy at LeadingAge, told HHCN. “They’ve seen the early days, the more sophisticated systems, the changing needs of both the individuals receiving care and the families who support them. As they move on to the next stage in their lives, we’re losing not only the practical knowledge of care, but also the institutional knowledge of the field and how far we’ve come.”
Masonic Care has been able to avoid this talent drain across the company because retiring nurses often take non-patient-facing jobs, and many of these nurses transition into educator roles where they can mentor other nurses within the company.
Additionally, nurses, many of whom are no longer seeing patients, have played a key role in the company’s efforts to strengthen its orientation process.
“We revamped our orientation process, and the nurses were so helpful in helping us,” St. John says. “We did focus groups with the nurses because we wanted to hear from them what kind of support was most effective. As a result, we were able to add resources to our quality and education team.”
