A Crisis of Care

A Crisis of Care

The pandemic and a growing population shine a light on the shortage of home-care workers

In 1992, when SourcePoint began to offer its services for Delaware County adults 55 and older, it had one primary goal in mind—to help local seniors live safely at home and avoid premature nursing home care and long waitlists.

Nearly 30 years later, SourcePoint and similar organizations around the country are faced with the same challenge—a shortage of home-care workers to help achieve that goal.

Part of the shortage is due to the growing number of baby boomers. According to information in the 2020 census, about 10,000 people per day have turned 65, and all boomers are expected to be at least 65 by the year 2030. Additionally, life expectancy is going up while the birth rate is going down, resulting in fewer people in generations behind the boomers.

According to a Kaiser Health News article, subject experts have been warning about a home-care worker shortage for at least 20 years. The article cites a report from the Urban Institute and Robert Wood Johnson Foundation, the co-author of which said many of the problems identified 20 years ago have only worsened.

Those issues include low wages and benefits, difficult working conditions, and heavy workloads. Add the pandemic to the mix and you have a perfect storm for those involved with providing home care and home-care workers for clients who need them, including SourcePoint.

“The home-care industry for unskilled or non-medical home care, which includes things like bathing, showering, and homemaking, has historically been undervalued and underpaid in the state and the country,” said SourcePoint Quality Assurance Administrator Amelia Tucciarone. “That means razor-thin margins for companies that can’t pay staff well. It’s been tough, especially in Delaware County.”

Tucciarone said it’s always been a challenge to find home-care workers, but filling lower-paying jobs—especially in the home-care industry—has become nearly impossible during the pandemic.

“You have places like McDonald’s offering jobs starting at $15 an hour, and other places doing sign-on and retention bonuses. Home-care companies don’t have the flexibility to do that,” she said. “That’s one reason we’re seeing the industry being hit as hard as it has. Additionally, the work is typically done by younger females, and many of them were forced out of the job market during the pandemic to take care of their own children. We lost a ton of workers who haven’t returned yet.”

Returning to home-care work may also hinge on personal safety, as workers wonder whether going into someone’s home puts them at increased risk of COVID exposure.

“We’ll see what the fall brings, but right now, folks are going home from hospital stays with no continuum of care in place and we’re seeing the highest rate of unfilled referrals that we’ve ever seen,” Tucciarone said. “We are consistently hearing back from providers that they don’t have the staffing.”

SourcePoint’s director of client services, Karen Waltermeyer, said the rate of unfilled referrals for the year to date through June was 21%, and 60% for June alone, far exceeding SourcePoint’s target rate, which is always less than five percent.

Holly Novak, branch manager for Interim HealthCare, an in-home provider that works with SourcePoint to provide care workers for clients, spoke about the shortage of workers during state budget testimony before the Ohio House of Representatives in March of this year.

“Sadly, I am aware of all too many employees that left home care, what they loved to do, in order to access a more livable wage,” Novak said in her testimony. “Health care and home care, in particular, are not keeping pace—we just can’t with the current reimbursement structure.

“I’ve been part of the home-care community for more than 30 years and I currently manage home-care offices in Delaware, Union, and Marion counties,” Novak continued. “In 2020, we served 340 clients with 65 direct care employees. In our Marysville office, in all of 2020, we hired four employees. In the same year, we lost 15 employees for a variety of reasons, though many attribute their decision to a better wage, away from home care.”

Tucciarone said the fall months should provide SourcePoint with a better idea of whether home-care workers are returning.

“The first thing we were waiting to see is when Ohio opted out of the additional unemployment benefits. That just happened toward the end of June,” she said. “Now folks are getting the credit for their children, so we don’t know what type of impact that will have. We’re probably looking at September and the report we’ll do in October to show whether people are coming back.”

The impact of the worker shortage trickles down to the clients and their families. Stephen Darke is the owner of Assisting Hands, another in-home care provider that works with SourcePoint. He said it isn’t unusual to speak with prospective clients who have tried more than 10 companies for care with
no luck.

“Having to say no to people who are in need is very hard to do and very stressful on our staff,” Darke said.

“We are seeing more people come to us and want the care, and we’re trying now to moderate their expectations,” Waltermeyer said. “We have not stopped sending referrals, but we are trying to be realistic. It may be several weeks before you can get the service you need now.”

In her House testimony, Novak said, “We regularly hear that providers just aren’t accepting referrals in our area. It’s an awful feeling to know the need and not have the capacity to respond.”

In some cases, clients working with SourcePoint end up having a family member assist if they can’t get an in-home care worker. “That puts more stress on the family caregiver, and it means losing the case manager here who can help the client navigate other areas of aging,” Tucciarone said. “We had a lot of people pull back from home care when the pandemic started because they didn’t want to have people in their home. But as things get back to normal we are unable to provide the support to these caregivers, and the caregivers are reaching their breaking point.”

A bright spot
If there’s a silver lining to all of these challenges faced by the home-care industry, Darke said it could be the increased awareness of the worker shortage, which leads home-care companies and organizations—and those who work with them—to evaluate how they operate and how things could be changed.

“The biggest changes for us have been in how we hire and how we accept new clients,” Darke said. “Hiring has become the most important function in our company, and we have increased our efforts in this area. We have tripled our hiring budget in the past year and are spending money with various job boards. There are also some community-based initiatives to get the word out, like this article.”

“We’ve changed the way we do our job in that nearly every aspect of our job includes a focus on recruitment and retention,” said Novak. “We’ve shifted resources at every level to bridge the gap in needed workforce.”

Tucciarone said SourcePoint is seeing an increase in reimbursement rates and has other things in the works with its provider networks that are meant to lead to higher wages being passed on to the home-care worker. SourcePoint also is taking this opportunity to let the community know that the paycheck is not the only rewarding thing about being a home-care worker.

“This is a job that is more than just a job. It can bring something that feels a little more valuable, and we’re trying to educate the community on that,” Tucciarone said. “If people aren’t being cared for in their homes, they are in nursing homes. We want to create a better understanding of how important this work is to prevent unnecessary nursing home placement.”

Part of increasing the number of home-care workers is bringing those new to the position into the field. To be a homemaker aide for SourcePoint, you need only to have a high school diploma or GED; the agency for which you work will do the training.

“You can come in as a homemaker aide and get enough experience to do more of the hands-on care that requires more training,” Tucciarone said. “And our providers can offer an advancement opportunity after a couple of years.”

What does the future hold?
The home-care crisis didn’t happen overnight and won’t be solved overnight. But those working closest to the situation have advice for getting through it one day at a time, whether you’re the one providing the care or receiving it.

“My advice to anyone seeking care right now is to be very flexible in the time of day, day, or week you will be willing to have service,” Darke said. “We are not scheduling you into a blank calendar; we are trying to shoehorn you into a schedule that is already full. If you are not flexible, your options will be limited, potentially down to no options at all.”

“In the long-term, efforts to connect with those who are looking to make a difference in their careers are key,” Novak said, adding that could include finding workers who are pursuing a second career or who are looking for a more flexible part-time work schedule. “Flexibility has always been a bonus in-home care, and if we can couple that with an improved wage, we may expand our workforce again.”

Looking ahead, Darke said while he is hopeful that there will be an increase in the number of available home-care workers in the months ahead, that will address only the immediate need.

“Unfortunately, when the pandemic finally disappears I don’t think we are out of the woods because the pandemic primarily affects the short-term supply of labor,” he said. “The long-term situation needs to be handled by convincing more health care companies to cover home-based care services, especially with Medicare and Medicare advantage. There has been some movement here, but there needs to be more.”

Darke said he’d like to see the health insurance industry cover home-based care services more than it does currently. “After all, it’s less expensive than facility-based care and has better outcomes,” he said.

Despite the obstacles faced by those in the home-care industry, Waltermeyer said one critical point has emerged—hopefully, for good.

“This has put more of a spotlight on how important these workers are,” she said.

Jeff Robinson is a feature writer for SourcePoint’s My Communicator.

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