Almost a third of Americans who pay for senior caregivers who are not affiliated with a regulated agency a new study by the RAND Corporation suggests. Instead, these individuals hire or employ workers from the “gray market” or the unregulated market of the under-the-table labor.

For professional home care facilities, the results suggest that there is a huge, untapped market for their services, but only if they can tailor costs to middle-income individuals.

In general, families use the gray market for a variety of reasons, some of which are still unclear. But often it’s because they don’t qualify for Medicaid and can’t afford privately paid services.

“They don’t really have a good care solution to provide affordable, high quality care to their loved ones,” Regina Shih, lead author of the study and senior policy researcher at RAND, told Home Health Care News. “You’re kind of stuck in the middle with no other choice. And the gray market could fill the need to find affordable, high-quality care. “

RAND Corporation, headquartered in Santa Monica, California, is a not-for-profit research organization.

RAND’s Esther Friedman and Emily Chen also helped prepare the study, as did Grace Whiting of the National Alliance for Caregiving. The study was supported by the National Institute of Minority Health and Health Disparities.

To better understand the gray market in long-term care, RAND surveyed 1,037 U.S. adults in 2017. Respondents were asked whether they had cared for a senior and whether the nurse employed was employed.

The study defines gray market operators as paid providers who are not related to the recipient. Gray market nurses did not work for a regulated agency, and they may have been untrained and untrained.

Of those surveyed, 28% had arranged age-related long-term care for themselves or a loved one. Of these, 31% hired a gray market provider.

“The spread of the gray market is alarming because we simply don’t have a solid infrastructure for affordable home care in this country,” Shih said. “The demand for home care will only increase over time.”

The USA. I am “in a crisis at the moment,” she said. Beyond Medicaid, there is simply no affordable option for people looking to age locally.

“We’re kind of in a situation where people can’t find good, quality care,” Shih said.

People using gray market carers were less likely to be self-employed and more likely to use unpaid care for family members. Rural residents almost five times more likely to arrange dementia care for a senior than urban residents.

RAND researchers acknowledged that seniors with dementia who lived in rural areas may have more difficulty accessing home and community-based services, even if they were willing and able to pay for them.

“I think the gaps in access to paid care in rural areas are a serious problem in this country,” Shih said. “Part of the problem is that many home health authorities cannot find workers for their positions in rural areas. And it’s this cyclical problem of not finding a workforce and then that people who need care cannot find care. “

The need for care workers in the US is already overwhelming for some home care facilities and the problem is expected to worsen over the next decade. According to RAND, the need for household help and personal care aids will increase by 36% from 2019 to 2029.

Other labor shortage research has found the problem to be even worse. A current report from PHI found that by the end of the decade approximately 4.5 million home care jobs will need to be filled.

One possible solution to the problem is for home care agencies to find out who these home care workers who work in gray markets, especially in rural areas, are. You could then hire them, get them trained and get benefits for their jobs.

Using non-regulated caregivers does not completely eliminate the problems of long-term care gaps. The gray market could potentially place seniors in a vulnerable position as they are cared for by individuals who are likely not properly trained or vetted for the job.

Authorities also generally conduct criminal background checks, review training, and keep clinical records. In the gray market, these details are usually unknown.

The gray market, especially in home care, is full of unknowns. But it’s not inherently a bad thing, Shih said.

“It shouldn’t be portrayed as a problem. I mean, this is a clearly robust market, ”she said. “It could be that the care and the quality of care are actually at the level of the regulated market. But I think there is also the possibility of training gray market providers because they are not necessarily linked to best practices that are offered in the regulated market or by agencies that monitor the quality of care. “