The Crisis in Senior Home Healthcare

In a previous blog on Connelly Law’s Senior Issues, we wrote about the concerns that an aging America is presenting to our financial and health care infrastructure. One of those concerns is the rising cost of long term care and the benefits in keeping seniors in their homes. This is certainly a positive thing but it is also bringing with it some unique problems that we will discuss in this week’s blog.

But before we do that, let’s take a brief look as to how we reached this point.

Following World War II, the American family changed dramatically. Marriages began occurring at a higher rate and the ages of those tying the knot became much younger. The result was something we have referred to before as “The Baby Boom” as births topped 75 million between the years of 1946 and 1964.

With so many children and so many newly married young people, the “American

family” consisted of a home where dad went off to work while mom remained in the home to care for the children and run the household. There seemed to be a new factory opening everyday in major cities attracting workers but also increasing the crowding that made it difficult to raise an increasingly larger family. With a booming economy and families having a better standard of living, many wanted to leave the hustle and bustle of the city and as a result, suburbia grew rapidly.

The automobile industry also flourished in the 1950s as did the highway system and other public works projects. Between the years of 1950 and 1980, the number of cars in this country increased by 200 percent. Shopping malls, big box stores and fast food restaurants sprung up in all areas of the country as the population of cities began to decline.

The GI Bill allowed 8 million Americans, to whom college was traditionally out of reach, to increase their education and walk away from traditional factory jobs and farming. Unions increased wages and corporations, seeking a cheaper workforce, moved their factories to foreign countries, which were looking to grow in a post war economy.

In the health care field, antibiotics, new vaccines and other medical procedures extended life for many who would have died just decades before. Television hit the scene and the invention of the transistor allowed small radios to be in every American’s hands allowing them access to the rest of America and even the world.

The country became a hotbed of affluence which led to larger families who sought better opportunities and were no longer forced to remain in areas where the rest of their family grew up.

This affluence continued into the 1960s followed by a period of unrest in the country

as the civil rights movement and opposition to the Vietnam War led to the development of a counter culture complete with drugs, sexual freedoms and rebellious attitudes against authority.

Changes in the family structure in just a few short decades was indeed striking. No longer were there family meals as mom and dad stayed late at work, grabbing a burger at McDonald’s for dinner while the children ate a crockpot meal – often unsupervised. With the decrease in the price of televisions and cable hitting the scene, homes now had multiple sets which led to a further separation of traditional family time.

Members of the baby boom generation were now confronted with the results of the miracle of technology, medicine and the affluence of America – parents lived longer and often independently – while they left home to live on their own at much younger ages. Problems began to arise as parents aged alone with children living elsewhere and popped in from time to time to say hello.

In previous generations, aging parents and grandparents could rely on their children to provide care in the home until their death. Now, the baby boomers could not be counted on to provide such help and senior care facilities became the landing spot for baby boomers too busy to help. As the birth rates among baby boomers dropped, the costs of senior care started to rise as the need for such programming began to expand rapidly.

Thanks to a prosperous economy of the 1990s, the “entitlement” belief over took the baby boomers, believing that the government would take care of everyone. When the new century started, the guarantees made by the government were being honored thanks to high tax collection, low unemployment, a balanced federal budget and a steady economic growth.

But one thing about history, it is cyclical and as in the past, economies rise and fall, and fall it did. Soon, favorable economic trends reversed and America headed into a deep recession. Federal budget deficits ballooned out of control and cuts began in programs that just a decade earlier seemed to take care of Americans from cradle to grave. In the crosshairs of this downward spiral were seniors, who began to realize that the promises of the government were just that – promises and not guarantees.

Today, we have come full circle back to keeping mom and dad in the home once again due to rising care costs and comfort. But what hasn’t changed is the family, which continues to be scattered around the country and sometimes the world making it impractical to provide care for parents who do not meet the requirement of nursing home treatment.

We are now in the second decade of the new century and keeping mom and dad at home is the preferred choice but caring for them is the presenting problem. Americans are getting older and less active, driving more of a need for home health and personal care aides across the country.

The demand now for home healthcare workers is expected to increase dramatically in the coming decades. Government employment specialists state that providing home care will be one of the nation’s fastest growing occupations with an additional one million employees needed by 2026, just eight years from now.

On the face of it, it sounds like a great opportunity for businesses to sprout up and provide this service to our aging baby boomers, but it is fraught with peril. The biggest one is the shortage of professional workers due to the low wages, poor advancement opportunities and inconsistent work schedules and benefits.

Don Drake, one of Connelly Law Offices, Ltd.'s Community Education presenters and retired human services program administrator, states that this has been a problem in the human service field for decades.

“It always amazed me of the price we put on taking care of people versus material things. We had tremendous expectations of direct care staff, putting them through hours of training and supervision and placing the responsibility of another human’s well being upon them, only to pay them an hourly wage barely over what they could make at a fast food restaurant. Staying fully staffed for any significant period of time was something we aspired to but never achieved. And why would they stay when they could load trucks for nearly twice the pay with better benefits”, said Drake.

"Unfortunately, human resource departments are forced to hire people who lack a real commitment to the mission of the agency and as a result, the client is not always getting the treatment they deserve. Of course, you try hard to pick out the right person but what happens is those who have the skill often move on because they become burnt out and those who stay behind aren’t always there for the right reasons.”

“In one of our older adult programs, we paid the staff $9.25 an hour to do group therapy work, provide individual supervision and even observe medication use. They could have made over $14.00 an hour working at the local grocery store without the high level of responsibility that was placed upon them in that position.”

“To make matters even worse, the majority of our staff were single parents and could not survive on that money so they had a second or even third job. Would you fly on an airplane being flown by two pilots who worked 16 hour days, seven days a week? Yet, it's acceptable when providing care to our most vulnerable citizens."

A government study today found that the average direct care worker tending to seniors receives a wage of approx. $10.66 and hour, about $5 below what they would make working in retail outlets. That low pay makes it hard to attract new talent to the field. And with more workers retiring, it is projected that there will be a shortage of 446,300 home health aides by 2025.

Recently in Massachusetts, the Home Care Aide Council, with a grant from the Tufts Health Plan, conducted an assessment of the Commonwealth’s workforce and found the following:

  • Almost 40% of the home health care aides currently employed indicated that they were likely to leave that work within the year

  • Home health agencies reported a quarterly health aide turnover of 16%

  • On a quarterly basis, for every 18 people hired, they lost 15 for just a net gain of 3

  • During the fall of 2016, nearly half of the agencies had difficulty filling openings both on weekends and weekdays

  • Nearly 9 out of 10 agencies reported that their top challenge was recruiting qualified people as well as retaining them

  • Nearly half of the aides working in the field reported to have at least one other job.

  • 4 out of 10 of the aides reported living in a household with an annual income of less then $20,000 and nearly half were on MassHealth (Medicaid).

Also of interest in this report was the fact that, at the time, nearly 50% of the home health care aides were born outside the United States with the highest immigrant population employed were from Haiti (27%).

“When you spend most of your time recruiting and filling positions, other areas tend to suffer”, said Drake. "Oft times it’s the training and supervision component. It’s easy to point fingers and blame the agency directors when a problem occurs but if they don’t provide the coverage for the shifts, they are criticized for that as well. It’s a no-win situation for them.”

Drake continued, “When you look at the numbers in the Massachusetts survey that indicated that some home health care providers have turnover rates of nearly 80%, its really demoralizing. Imagine any other business where your employees leave as quickly as they are hired -- how long would they stay in business and what kind of product do you think they would put out?"

"I firmly believe the overwhelming majority of those in this field are committed and caring individuals, and make no mistake, working with people is a hard job. Without the supervision and training from their over-worked supervisors who don't have the time to provide this support, they become burnt out and will look elsewhere. How do we solve this?"

So, what does the future hold when it comes to meeting the needs of our seniors -- would you believe robots? In next week’s blog, we will discuss where robots are being used to provide care for seniors and if technology can really replace the human touch.

Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.

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