Acute shortages of home health aides and nursing assistants are cropping up
across the country, threatening care for people with serious disabilities and
vulnerable older adults.
In Minnesota and Wisconsin, nursing
homes have denied admission to thousands of patients over the past year because
they lack essential staff, according to local long-term care associations
In New York, patients living in
rural areas have been injured, soiled themselves and gone without meals because
paid caregivers aren’t available, according to testimony provided to the state
Assembly’s health
In Illinois, the independence of
people with severe developmental disabilities is being compromised, as agencies
experience staff shortages of up to 30 percent, according to a court monitor
overseeing a federal consent decree.
The emerging crisis is driven by low
wages — around $10 an hour, mostly funded by state Medicaid programs — and a
shrinking pool of workers willing to perform this physically and emotionally
demanding work: helping people get in and out of bed, go to the bathroom, shower,
eat, participate in activities, and often dealing with challenging behaviors.
It portends even worse difficulties
to come, as America’s senior citizen population swells to 88 million people in
2050, up from 48 million currently, and requires more assistance with chronic
health conditions and disabilities, experts warn.
“If we don’t turn this around,
things are only going to get worse” said Dr. David Gifford, senior vice
president of quality and regulatory affairs for the American Health Care
Association, which represents nursing homes across the U.S.
“For me, as a parent, the
instability of this system is terrifying,” said Cheryl Dougan of Bethlehem,
Pa., whose profoundly disabled son, Renzo, suffered cardiac arrest nearly 19
years ago at age 14 and receives round-the-clock care from paid caregivers.
Rising demand, stagnant wages
For years, experts have predicted
that demand for services from a rapidly aging population would outstrip the
capacity of the “direct care” workforce: personal care aides, home health aides
and nursing assistants.
The U.S. Bureau of Labor Statistics
estimates an additional 1.1 million workers of this kind will
be needed by 2024 — a 26 percent increase over 2014. Yet, the population of
potential workers who tend to fill these jobs, overwhelmingly women ages 25 to
64, will increase at a much slower rate.
After the recession of 2008-09,
positions in Medicaid-funded home health agencies, nursing homes and community
service agencies were relatively easy to fill for several years. But the
improving economy has led workers to pursue other higher-paying alternatives,
in retail services for example, and turnover rates have soared.
At the same time, wages for nursing
assistants, home health aides and personal care aides have stagnated, making
recruitment difficult. The average hourly rate nationally is $10.11 — a few
cents lower than a decade ago, according to PHI, an organization that studies
the direct-care workforce. There is a push on
now in a handful of states to raise the minimum to $15 an hour.
Even for-profit franchises that
offer services such as light housekeeping and companionship to seniors who pay
out-of-pocket are having problems with staffing.
“All the experienced workers are
already placed with families. They’re off the market,” said Carrie Bianco, owner
of Always Best Care Senior Services, which is based in Torrance, Calif., with
franchises in 30 states.
Finding new employees was so
difficult that Bianco started her own 14-week training program for caregivers
nine months ago. To attract recruits, she ran ads targeting women who had left
the workforce or been close to their grandparents. In exchange for free
tuition, graduates must agree to start working for her agency.
“There’s much more competition now —
a lot of franchises have opened and people will approach our workers outside
our building or in the lobby and ask if they want to come work for them,” said
Karen Kulp, president of Home Care Associates of Philadelphia.
Hardest to cover in Kulp’s area are
people with disabilities or older adults who live at some distance from the
city center and need only one to two hours of help a day. Workers prefer
longer shifts and less time traveling between clients, so they gravitate to
other opportunities and “these people are not necessarily getting service,” she
said.
It isn’t possible to document
exactly how common these problems are nationally. Neither states nor the
federal government routinely collect information about staff vacancy rates in
home care agencies or nursing homes, turnover rates or people going without
services.
“If we really want to understand
what’s needed to address workforce shortages, we need better data,” said Robert
Espinoza, vice president of policy at PHI.
Hard times in Wisconsin
Some of the best data available come
from Wisconsin, where long-term care facilities and agencies serving seniors
and people with disabilities have surveyed their members over the past year.
The findings are startling. One of
seven caregiving positions in Wisconsin nursing homes and group homes remained
unfilled, one survey discovered;
70 percent of administrators reported a lack of qualified job applicants. As a
result, 18 percent of long-term facilities in Wisconsin have had to limit
resident admissions, declining care for more than 5,300 vulnerable residents.
“The words ‘unprecedented’ and
‘desperate’ come to mind,” said John Sauer, president and chief executive of
LeadingAge Wisconsin, which represents not-for-profit long-term care
institutions. “In my 28 years in the business, this is the most challenging
workforce situation I’ve seen.”
Sauer and others blame inadequate
payments from Medicaid — which funds about two-thirds of nursing homes’
business — for the bind. In rural areas, especially, operators are at the
breaking point.
“We are very seriously considering
closing our nursing facility so it doesn’t drive the whole corporation out of
business,” said Greg Loeser, chief executive of Iola Living Assistance, which
offers skilled nursing, assisted living and independent living services in a
rural area about 70 miles west of Green Bay.
Like other short-staffed operators,
he’s had to ask employees to work overtime and use agency staff, increasing
labor costs substantially. A nearby state veterans home, the largest in
Wisconsin, pays higher wages, making it hard for him to find employees. Last
year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an
“unsustainable amount,” Loeser said.
Wisconsin Gov. Scott Walker has
proposed a 2 percent Medicaid increase for long-term care facilities and
personal care agencies for each of the next two years, but that won’t be enough
to make a substantial difference, Loeser and other experts say.
The situation is equally grim for
Wisconsin agencies that send personal care workers into people’s homes. According to a
separate survey in 2016, 85 percent of agencies said they
didn’t have enough staff to cover all shifts, and 43 percent reported not
filling shifts at least seven times a month.
Barbara Vedder, 67, of Madison,
paralyzed from her chest down since a spinal cord injury in 1981, has witnessed
the impact firsthand. Currently, she qualifies for 8.75 hours of help a day,
while her husband tends to her in the evening.
“It’s getting much, much, much more
difficult to find willing, capable people to help me,” she said. “It’s a
revolving door: People come for a couple of months, maybe, then they find a
better job or they get pregnant or they move out of state. It’s an endless
state of not knowing what’s going to happen next — will somebody be around to
help me tomorrow? Next month?”
When caregivers don’t show up or
shifts are cut back or canceled, “I don’t get proper cleaning around my
catheter or in my groin area,” Vedder continued. “I’ll skip a meal or wait
later several hours to take a pill. I won’t get my range-of-motion exercises,
or my wheelchair cushion might slip out of place and I’ll start getting sore.
Basically, I start losing my health.”
Debra Ramacher and her husband have
been unable to find paid caregivers since June 2015 for daughter Maya, 20, and
son Michael, 19, both of whom have cerebral palsy, epilepsy and other
significant disabilities. The family lives in New Richmond in western
Wisconsin, about 45 minutes from the Minneapolis-St. Paul metropolitan area.
“At least three agencies told me
they’ve stopped trying to hire personal care aides. They can’t find anybody and
it costs them money to advertise,” said Ramacher, executive director of
Wisconsin Family Ties, an organization for families with children with
emotional, behavioral and mental disorders.
“It’s incredibly stressful on all of
us, living with this kind of uncertainty,” she said.
Every few months, Ramacher tries
to find caregivers on her own by putting ads up on Craigslist, in local
newspapers and on job boards.
“We get a few bites,” she said.
“Most recently, two people came and interviewed. One never got back to us; the
other got a better job that paid more.”
In the meantime, she and her husband
are being paid by Medicaid to look after Maya and Michael.
“We don’t want to be the caregivers;
we want to have our own life,” Ramacher said. “But we don’t have any option.”
KHN’s coverage related
to aging & improving care of older adults is supported by The John A.
Hartford Foundation.
