For years, Lewis Schuckett has had trouble walking or standing for long periods of time, making it difficult for him to clean his house or do laundry in southeastern Maine. Shacklet, 80, no longer drives, which makes it difficult to go to the grocery store or the doctor.
Her low income, however, qualifies her for a state program that pays for a personal aide 10 hours a week to help with chores and errands.
“It helps keep me independent,” she said.
But visitations have been inconsistent due to high turnover and a lack of associates, sometimes leaving her without assistance for months, although a cousin helps take care of her. “I want to get the help I need and deserve,” said Shekett, who has had no allies since late March.
The Maine Home-Based Care Program, which helps Shackett and more than 800 others in the state, has a waiting list of 925 people; Those applicants sometimes lack assistance for months or even years, according to officials in Maine, the country’s oldest population. This increases the risk of many people falling or not receiving medical care and other hazards.
The problem is simple: there are very few employees here and in most parts of the country. Still, the solution is anything but simple.
Katie Smith Sloan, CEO of Leading Age, which represents nonprofit aging service providers, says workforce shortages are a nationwide dilemma. “Millions of older adults are unable to access the affordable care and services they desperately need,” she said at a recent press event. He said state and federal reimbursement rates to elder care agencies are insufficient to cover the cost of quality care and services or to pay a living wage to caregivers.
President Joe Biden allocated $400 billion to his infrastructure plan to expand home and community-based long-term care services to help people stay in their homes and out of nursing homes. Republicans pushed back, noting that elder care did not fit the traditional definition of infrastructure, which typically refers to physical projects like bridges, roads and the like, and the bipartisan deal last week between centrist senators only tackles those traditional projects. But Democrats say they will push for funding of some of Biden’s “human infrastructure” programs in another bill.
As lawmakers tussle over the proposal, many elderly care advocates worry that this $400 billion will be too little or even exhausted.
But the need is undeniable, underscored by the math, especially in places like Maine, where 21% of residents are 65 and older.
“We’re looking for workers all the time because we have more than 10,000 hours a week for personal care,” said Betsy Sawyer-Munter, CEO of SeniorsPlus in Maine, one of the two companies that operates that assistance program. We can’t find workers in the cover.”
For at least 20 years, national experts have warned about the dire consequences of shortages of nursing assistants and domestic aides as millions of baby boomers hit their senior years. “Low wages and benefits, hard working conditions, heavy workloads, and a job that is stigmatized by society make worker recruitment and retention difficult,” concludes. 2001 report from the Urban Institute and the Robert Wood Johnson Foundation.
Robin Stone, a co-author of that report and senior vice president for Leading Age, says many of the labor shortage problems identified in 2001 have only gotten worse. Some of the problems faced by seniors during the pandemic were highlighted. “Covid highlights the challenges older adults are facing and how vulnerable they are in this pandemic and the importance of front-line care professionals being paid low wages,” she says.
Michael Stair, CEO of Waterville, Maine-based agency Care & Comfort, said the business has had its worst labor shortage in 20 years.
“The bottom line is that it all comes down to dollars — dollars for home care benefits, dollars for people to pay competitively,” he said. Agencies like theirs are in a tough position to compete for workers who can do other jobs that don’t require background checks, special training, or driving to people’s homes in inclement weather.
“Workers in Maine may be paid more to do other jobs that are less challenging and more lucrative,” he said.
His company, which provides services to 1,500 customers—most of whom are enrolled in Medicaid, the federal-state health program for low-income people—has about 300 employees, but 100 could use more. He said workers are hardest to find in urban areas such as Portland and Bangor, which have more employment opportunities. Most of their jobs pay between $13 and $15 an hour, what McDonald’s restaurants in Maine advertise for entry-level workers.
The state minimum wage is $12.15 per hour.
Steyer said half of his employees quit within the first year, which is slightly better than the industry average 60% turnover rate. To help retain employees, he allows them to set their own schedule, provides paid training, and provides vacation pay.
“I worry there are people who are going without care and there are people whose condition is deteriorating 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 eligible people, but it has limited rights for home-based services, and eligibility and benefits vary by state. Yet, over the past decade, states, including Maine, have increased funding for groups providing Medicaid homes and community services—anything from medical assistance to housekeeping assistance—because people like those services and their costs. Much less than a nursing home.
States are also funding home care programs like Maine for people who don’t qualify for Medicaid in hopes of preventing seniors from needing Medicaid coverage later.
But elderly care advocates say the demand for home care far exceeds the supply.
Bills in the Maine legislature would increase reimbursement rates for thousands of home care workers to ensure they are being paid more than the state minimum wage.
The state does not set the employee salary, only sets the reimbursement rate.
According to experts who have studied the issue, it is not just low wages and lack of benefits that hinder workers from getting hired. In addition, home care providers struggle to recruit and retain workers who don’t want the stress of caring for people with physical disabilities and, often, mental health issues, such as dementia and depression, says Sauer-Mentor of SeniorsPlus. he said.
“It’s backbreaking work,” said Kathleen McAuliffe, a home care worker in Bidford, Maine, who previously worked as a Navy medic and served in the Peace Corps. She provides housewarming services for a state-funded program run by a Catholic charity. She usually visits two clients a day to help them with floor cleaning and scrubbing, wiping the bathroom, vacuuming, food preparation, food shopping, organizing medications, and taking them to the doctor Can you
Her clients are between the ages of 45 and 85. “When I walk in, the laundry is piled up, the dishes pile up, and everything needs to be organized. It’s hard work and very taxing,” McAuliffe, 68, said.
She earns around $14 an hour. Although caring for vulnerable veterans requires extensive skill – and training in things like safe bathing – it is generally classified as “unskilled” labor. If he works part time, he does not get any benefit of leave. “Calling us housewives makes us think we’re coming to bake brownies,” she said.
According to Catholic Charities Maine, the housewarming program serves 2,100 Maine residents and has more than 1,100 on the waiting list. “We can’t find labor,” said organization spokesman Donald Harden.
The federal government is giving states more dollars for home care — at least temporarily.
The US rescue plan, approved by Congress in March, provides: Federal Medicaid funding increased by 10 percentage points to the states, or about $13 billion, for home and community-based services.
The money, which should be spent by March 2024, could be used to provide personal protective equipment to home care workers, train workers or help people reduce waiting lists to receive services.
For Maine, a jump in funding from the American Rescue Plan will increase funding by $75 million. But Paul Sausier, director of aging and disability at the Maine Department of Health and Human Services, said the money won’t make waiting lists disappear, because it won’t solve the problem of too few workers.
Joan Spaetz, director of the Health Workforce Research Center on Long-Term Care at the University of California-San Francisco, said throwing more money into home care will only work if the money is targeted to recruiting, training and retaining workers, as well. with. Providing benefits and opportunities for career growth. She suspects there will be significant improvements “if we put money out there to hire more workers.”
“The problem is that the people who are in these jobs always get the same pay and the same low level of respect, no matter how many years they are in the job,” Spatz said.
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KHN (Kaiser Health News) is a national newsroom that conducts in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of three major operational programs. kff (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.