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 arent available, according to testimony provided to the state Assemblys health committee in February.
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.
Renzo Viscardi (center), pictured with his parents, Anthony Viscardi and Cheryl Dougan, relies on round-the-clock care from home health aides. (Courtesy of Cheryl Dougan)((Courtesy of Cheryl Dougan))
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 Americas 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 dont 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. 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 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. Theyre 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.
Theres 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 Kulps 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 isnt 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 whats 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, ; 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 Ive 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 doesnt 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, hes 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, Iolas 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 wont 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 peoples homes. According to a in 2016, 85 percent of agencies said they didnt have enough staff to cover allshifts, 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.
Its getting much, much, much more difficult to find willing, capable people to help me, she said. Its 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. Its an endless state of not knowing whats going to happen next will somebody be around to help me tomorrow? Next month?
When caregivers dont show up or shifts are cut back or canceled, I dont get proper cleaning around my catheter or in my groin area, Vedder continued. Ill skip a meal or wait later several hours to take a pill. I wont get my range-of-motion exercises, or my wheelchair cushion might slip out of place and Ill start getting sore. Basically, I start losing my health.
Debra Ramacher is executive director of Wisconsin Family Ties, an organization for families of children with emotional, behavioral and mental disorders. Her daughter Maya, 20, pictured in 2015, has cerebral palsy, epilepsy and other significant disabilities. (Courtesy of the Ramacher family)((Courtesy of the Ramacher family) )
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 theyve stopped trying to hire personal care aides. They cant 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.
Its incredibly stressful on all of us, living with this kind of uncertainty, she said.
Every few months, Ramacher tries tofind 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 dont want to be the caregivers; we want to have our own life, Ramacher said. But we dont have any option.
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