Seniors wait months for home care
CASTINE, Maine – For years Louise Shackett struggled to walk or stand for long periods of time, which allowed her to clean her home in Southeast Maine or do the laundry. Shackett, 80, no longer drives, making it difficult to access groceries or the doctor.
Her low income, however, qualifies her for a public program that pays a personal aide 10 hours a week to help with chores and errands.
“It helps me stay independent,” she said.
But visits have been irregular due to high turnover and lack of helpers, sometimes leaving her unassisted for months, although a cousin helps care for her. “I should get the help I need and to which I am entitled,” said Shackett, who has not had help since the end of March.
The Maine Home Care Program, which helps Shackett and more than 800 other people in the state, has a waiting list of 925 people; these seekers sometimes go without help for months or years, according to officials in Maine, which has the country’s oldest population. This leaves many people at an increased risk of falls or of not receiving medical attention and other dangers.
The problem is simple: here and in much of the rest of the country, there are too few workers. Yet the solution is anything but easy.
Katie Smith Sloan, CEO of Leading Age, which represents nonprofit aging service providers, says the workforce shortage is a national dilemma. “Millions of older people do not have access to the affordable care and services they desperately need,” she said at a recent press conference. State and federal reimbursement rates to elderly care agencies are insufficient to cover the cost of quality care and services or to pay caregivers a living wage, she added.
President Joe Biden has allocated $ 400 billion in his infrastructure plan to expand home and community long-term care services to help people stay in and out of nursing homes. Republicans backed off, noting that elderly care did not meet the traditional definition of infrastructure, which generally refers to physical projects such as bridges, roads, etc., and the bipartisan agreement reached the last week between centrist senators dealt only with these traditional projects. But Democrats say they will insist on funding some of Biden’s “human infrastructure” programs in another bill.
As lawmakers battle the proposal, many elderly care advocates fear that $ 400 billion will be drastically reduced or eliminated.
But the need is undeniable, underscored by the calculations, especially in places like Maine, where 21% of residents are 65 and over.
Betsy Sawyer-Manter, CEO of SeniorsPlus in Maine, one of the two companies that operate this assistance program, said, “We are looking for workers all the time because we have over 10,000 hours per week of personal care. , we cannot find workers. cover.”
For at least 20 years, national experts have warned of the dire consequences of a shortage of licensed practical nurses and home helpers as tens of millions of baby boomers reach their third years of age. “Low wages and benefits, difficult working conditions, heavy workloads and socially stigmatized work make recruiting and retaining workers difficult,” concludes a 2001 report from the Urban Institute and the Robert Wood Johnson Foundation.
Robyn Stone, co-author of this report and senior vice president of Leading Age, says many of the labor shortage issues identified in 2001 have only worsened. The risks and barriers that seniors faced during the pandemic have highlighted some of these issues. “Covid has revealed the challenges of older people and their vulnerability in this pandemic and the importance of frontline healthcare professionals who receive low wages,” she said.
Michael Stair, CEO of Care & Comfort, an agency based in Waterville, Maine, said the worker shortage is the worst he has seen in 20 years at the company.
“At the end of the day, it all comes down to dollars – dollars for home care benefits, dollars for paying people competitively,” he said. Agencies like his are in a difficult position competing for workers who can take on other jobs that don’t require background checks, special training, or driving in people in bad weather.
“Workers in Maine can be better paid to do other less difficult and more attractive jobs,” he added.
His company, which provides services to 1,500 clients – most of whom are enrolled in Medicaid, the federal state’s health care program for low-income people – has about 300 employees but could use 100 more. He said it’s harder to find workers in urban areas such as Portland and Bangor, where there are more job opportunities. Most of his jobs pay between $ 13 and $ 15 an hour, roughly what McDonald’s restaurants in Maine advertise for entry-level workers.
The state’s minimum wage is $ 12.15 an hour.
Stair said half of its workers quit in the first year, slightly better than the industry’s 60% average turnover rate. To help retain employees, it allows them to set their own schedules, provides paid training, and pays vacation pay.
“I am concerned that there are people without care and people whose conditions are declining because they are not getting the care they need,” Stair said.
Medicare does not cover long-term home care.
Medicaid requires states to cover nursing home care for those who qualify, but it has limited entitlement to home care, and eligibility and benefits vary by state. Yet over the past decade states, including Maine, have increased funding for groups providing home and community Medicaid services – from medical assistance to home help – because people prefer those services and that they cost much less than a nursing home.
States also fund home care programs like the one in Maine for these same services for people who do not qualify for Medicaid in hopes of preventing seniors from needing Medicaid coverage later.
But senior care advocates say demand for home care far exceeds supply.
Bills from the Maine legislature would increase reimbursement rates for thousands of home care workers to ensure they are paid more than the state’s minimum wage.
The state does not set workers’ compensation, only reimbursement rates.
It’s not just low wages and lack of benefits that hamper hiring workers, according to experts studying the issue. Additionally, home care providers find it difficult to recruit and retain workers who do not want the stress of caring for people with physical disabilities and, often, mental health issues, such as dementia and mental illness. depression, said SeniorsPlus’ Sawyer-Manter.
“It’s backbreaking work,” said Kathleen McAuliffe, a home aide in Biddeford, Maine, who previously worked as a Navy medic and served in the Peace Corps. She provides home help services to a publicly funded program managed by Catholic Charities. She typically visits two clients a day to help them with tasks such as cleaning and scrubbing floors, wiping bathrooms, vacuuming, preparing meals, doing groceries, organizing medications and bringing them home. doctor.
Her clients are between 45 and 85 years old. “When I come in, the laundry is stacked, the dishes are piled up and everything has to be put away. It’s hard work and very trying, ”said McAuliffe, 68.
She earns about $ 14 an hour. Although the work of caring for frail older people requires extensive skills – and training in areas such as bath safety – it is generally classified as “unskilled” work. Working part-time, she receives no vacation pay. “Calling us housewives sounds like we’re coming over to bake brownies,” she said.
The homemaking program serves 2,100 Maine residents and has more than 1,100 on a waiting list, according to Catholic Charities Maine. “We cannot find the workforce,” said Donald Harden, a spokesperson for the organization.
The federal government gives states more dollars for home care – at least temporarily.
The US bailout, approved by Congress in March, calls for a 10 percentage point increase in federal Medicaid funding to states, or nearly $ 13 billion, for home and community services.
The money, which is due to be spent by March 2024, can be used to provide personal protective equipment for home care workers, train workers, or help states reduce waiting lists for people to receive. services.
Kathleen McAuliffe, part-time home aide for Catholic Charities outside of Portland, Maine, visits two clients a day. She helps them clean, prepare meals and drive them to doctor’s appointments.
Kathleen McAuliffe, a home aide for Catholic Charities in a suburb of Portland, Maine, helps client John Gardner with his weekly chores. McAuliffe does Gardner’s groceries, cleans his house, and runs errands for him on his weekly visit.