Southeast Ohio providers of home- and community-based care gathered on December 9 to discuss the workforce shortage that is leading to long waitlists for much-needed services for older adults. The roundtable discussion took place during a meeting of the Buckeye Hills Regional Council Aging & Disability Regional Advisory Council. In addition to home care providers working directly with older adults in Southeast Ohio, the discussion included perspectives from the Ohio Department of Aging (ODA) and the Ohio Association of Area Agencies on Aging (O4A).
“One of the primary reasons we wanted to bring providers together with ODA is to give an opportunity for the local providers to share what it is that they’re facing and what they’re trying to overcome within their agencies,” said Jennifer Westfall, BHRC Aging & Health Director.
Beth Kowalczyk, Chief Policy Officer for O4A, gave some context for the discussion, noting that currently, 4,500 older adults throughout Ohio are going without personal care services because of the shortage of direct care workers. These workers typically receive low wages and do not typically receive mileage reimbursement, benefits, sick leave, personal leave, or paid training.
“This is something that has been going on for quite a while but has been exacerbated with the pandemic,” said Kowalczyk. “Now, it’s come to a point where we have to take action. These are the workers who are doing the very basic work so people can remain in their homes.”
“This shortage is having a significant impact,” Kowalczyk added. “People are waiting months to up to two years for personal care. They’re choosing not to enroll, because they’re hearing that there’s no one there to provide them services. People may not be able to leave the hospital or nursing home because they can’t find the services to help them go home safely with support.”
The Paraprofessional Healthcare Institute (PHI) estimates that there will be nearly 230,00 job openings in direct care in Ohio between now and 2030, outpacing the demand for retail salesperons, laborers and freight workers. Yet wages in the industry have remained flat since 2008, at about $12 per hour. Because of this wage stagnation, an estimated 32% of these workers lack affordable housing, and 48% are living in or near poverty.
The low wages, dictated in large part by Medicaid reimbursement rates, have made service provision and recruitment a challenge for local agencies.
Connie Huntsman, Director of the O’Neill Center in Marietta noted that her agency has largely moved away from Medicaid-funded services in favor of other funding that allows them to provide similar, if not better, level of care. Those hard decisions have made it possible for the center to offer its staff 25% more than if they had continued funding their services under the current Medicaid reimbursement rate, Huntsman said.
Policy makers will have to carefully balance adjustment of Medicaid-funded services with those services funded under the Older Americans Act, noted Joyce Lewis, Executive Director of United Seniors of Athens County.
“Our recruitment spend has increased 22 percent,” added Angela Dooley, Regional Director of Operations for Addus Home Care. “It’s not just that we can’t get people in. When we’ve finally recruited them and they hear the wage, they hang up the phone.
The shortage is leading to long waitlists for services, stretching anywhere from a few months to as long as two years.
“If an individual would go to a hospital and be told to go home and wait because the hospital can bring in doctors, nurses, or technicians, we would never, as a community, accept that,” said Tebreigh Hollins, Regional Supervisor at Fosterbridge In-Home Personal Care. “But we are accepting that these older adults, who meet criteria for nursing home level of care need to just wait. Instead we’re asking them to take on the cost of being in a nursing home, which is astronomical, or we’re asking their family members to take on that care, or for them to move in with a family member.”
For those family members who are helping an older loved one, even something as simple as a moment to run errands can be hard to find, according to Darlene Hambel, Caregiver Advocate at BHRC.
“I work with family caregivers every day,” Hambel said. “The trend I’m seeing now is 90-year-olds taking care of other 90-year-olds. The other trend–that I didn’t see years ago—is working caregivers, caring for both parents and children or a disabled child. It doesn’t feel very good when they say, ‘all I need is for someone to come two hours so I can go to the grocery store because I can’t leave mom alone,’ and I have to say the staffing is not there.”
Stories like these are playing out not just across Southeast Ohio, but the state as a whole, said Jennifer Carlson, Assistant Director of ODA. Carlson said the state agency has been working with area agencies on aging across the state since February to better understand the issue. Carlson has also served on Ohio’s Direct Care Workforce Expansion Working Group, which is developing recommendations to the DeWine administration and the General Assembly ahead of the state’s biennium budget process to address the direct care workforce crisis.
“Our director is the chief advisor to the Governor for all aging issues,” said Carlson. “We take this obligation seriously. That’s why we have been actively participating in all these roundtable discussions across the state of Ohio.”
In addition to the stagnant wages, Carlson said it’s important to look at how a direct care job can help an individual find a career in nursing or another certified profession.
“My background is primarily in higher education, having worked for 18 years at Ohio State University,” Carlson added. “How do we work on career ladders? When you have a home health aide coming in, or a nurse practitioner, what are we doing as a community, to build that worker up to the next degree attainment, or certificate? What can we do to further encourage job satisfaction?”
The solutions proposed by O4A include increasing the reimbursement rate for personal care services for the state’s PASSPORT Medicaid waiver program by 50%, integrated with a $20 per hour wage for direct care staff, which would bring them into parity with other care providers.
During its lame duck session, the General Assembly has sent a measure to Governor DeWine’s desk that designates $10 million for provider relief for home and community-based services to address the workforce shortage. However, the longer-term wage issue will need to be addressed in state budget negotiations and in federal negotiations over Older Americans Act funding.
“Having an active voice and talking to your elected officials is really important right now,” said Carlson.