A shortage of health aides is forcing out those who wish to get care ...

Miller sustained severe brain damage, and requires the help of home health aides to continue living in his home.A lot has changed in Jonathan Miller's life in the past decade, but one thing that's remained consistent is his house.The brick two-bedroom, ranch-style house in West Des Moines, Iowa, is filled with Jonathan's art, photos, puzzles and a substantial collection of University of Iowa gear.Jon bought the house in 2007, and for three years put a lot of work into the fixer-upper — repairing storm damage, planting trees in the backyard and completely remodeling the interior.Then, in the summer of 2010, when Jon was 25, he suffered a major stroke. It's the one thing that he [doesn't] want," Don said.More seniors and people with disabilities are choosing to stay in their homes — and with the number of adults aged 60 and older in the U.S. expected to increase 30 percent by 2050, home health aides are predicted to be one of the fastest growing professions nationwide in the next decade.The federal Bureau of Labor Statistics projects the number of openings for home health and personal care aides will increase nearly 37 percent by 2028.This means families like the Millers will likely continue to face challenges.In the U.S., long-term care is going through a process of "rebalancing" overall — shifting from institutional care to more home-based services, said John Bowblis, a professor of economics at Miami University in Ohio."In the last 10 years, there's been this push to try to get people long-term care in a home setting, and particularly their own home," he said. It means the most she can pay is $13 an hour, as that's the current reimbursement rate under the state's Medicaid program.Nelson said she struggles to retain employees, and she'd like to pay them at least $20 an hour."They're taking care of people's loved ones in their homes and giving them baths and helping them to go to the bathroom and helping them get dressed and doing things they can't do on their own," Nelson said.Pay remains one of the biggest barriers to attracting more home health aides.Connie Corchan works in central Iowa for an agency run by a hospital, and she says she loves her job."These people are so appreciative of what you do for them. Don and Laurita Miller say they've spent more time caring for their 36-year-old son, Jon, in recent months due to a shortage of home health aides.Experts say raising wages is an important first step, but it's not the only change that's needed."We can't rely on especially altruistic people to fill these roles at a great personal cost,"said Stephen McCall, a data and policy analyst with PHI, a group that advocates for direct care workers.McCall said home health aides need more training opportunities and support to develop specialized skills, and most don't have career opportunities that would allow them to move up into other related health care or social work positions."It means that their skills that they're developing over time, providing services to older adults and people with disabilities, often go unrecognized and unrewarded," he said.Recently some lawmakers have proposed increasing resources to help address this growing shortage.The Biden administration proposed investing $150 billion towards home health care as part of the Build Back Better Act, but it stalled after West Virginia Sen. Joe Manchin withdrew his support.The Indiana Legislature approved $20 million in 2021 to help those who need home care stay in their homes. A current budget proposal in the Iowa Legislature would raise Medicaid pay from $13 to $16 an hour.This comes as Iowa is working to increase home- and community-based services for disabled Iowans following a federal investigation last year that concluded the state likely violated the Americans with Disabilities Act for failure to provide enough community-care options.Werner, the University of Pennsylvania professor, said to address this workforce shortage, leaders are going to need to invest a lot more money into resources like Medicaid.But she's skeptical that it's going to happen any time soon."It's not clear to me that the country is ready to make that commitment to invest in long-term care infrastructure," Werner said.