The U.S. needs more home care workers. Is this the solution?

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America's home care shortage is critical, and growing. The industry's shortage seems to be driven by low wages, few benefits and a lack of respect for workers, 90 percent of whom are women. Would giving them more responsibilities and more training help workers earn more? In the second part of our reporting, economics correspondent Paul Solman takes a closer look at whether there is a solution.

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• William Brangham:
  
  Many of us say we want to stay at home as we grow into old age.
  
  But as economics correspondent Paul Solman recently reported, the country is facing a shortage of home care workers, the very people who can make staying at home possible.
  
  Tonight, Paul looks at efforts to address that shortage. It's part of our weekly series, Making Sense.
  
  
• Paul Solman:
  America's home care shortage is critical and growing.
  
  
• Woman:
  All right, Tom, come sit down for breakfast.
  
  
• Paul Solman:
  Right now, 90 percent are women, who help older adults and people with disabilities get through the daily tasks of living at home.
  The key drivers of the shortage, according to gerontologist Clare Luz.
  
  
• Clare Luz:
  Low wages.
  
  
• Paul Solman:
  Right.
  
  
• Clare Luz:
  Virtually no benefits, lack of guaranteed hours and lack of respect. Those are the big-ticket items.
  
  
• Paul Solman:
  The pay? A national average of $10.49 an hour. And that's not nearly enough to make up the shortage, says MIT management professor Paul Osterman.
  
  
• Paul Osterman:
  We have to find ways to make these jobs for these home aides better jobs, so more people are willing to do the work.
  
  
• Paul Solman:
  On the demand side, the reason is obvious and pressing, the number of elderly and disabled in need of assistance is expected to double in the next 25 years.
  
  
• Paul Osterman:
  It's going to put tremendous pressure on unpaid family members to step in, but they're not going to be there in the numbers that we need.
  
  
• Paul Solman:
  There aren't enough Hellen (ph) Kwants, that is. She's been caring for the elderly since she arrived from Colombia at age 22.
  
  You're now how old?
  
  
• Hellen Kwant:
  Eighty-seven.
  
  
• Paul Solman:
  And you're still doing it? How old is the person you're taking care of?
  
  
• Hellen Kwant:
  Eighty-seven.
  
  (LAUGHTER)
  
• Paul Solman:
  Hellen's daughter, Martha,` is also a home care worker.
  
  
• Martha Kwant:
  My mom raised us to care for our elderly neighbors, so since we were knee-high to boll weevils, we were taking food and helping do this.
  
  
• Hellen Kwant:
  Yes, we adopted like a grandma.
  
  
• Paul Solman:
  But Martha wonders if the rest of her fellow Americans are equipped to take in aging relatives.
  
  
• Martha Kwant:
  As a society, we're not so good about having the patience, as other cultures do, to have family move in, or to have that person move in with family and soften the approach to that ledge and the fall. That's not something most Americans are prepared to do.
  
  
• Paul Solman:
  So, what to do?
  
  In his book "Who Will Care For Us?" Osterman argues home care workers should be given more responsibilities, like managing chronic conditions, and especially more training.
  
  
• Paul Osterman:
  If they could do more they would be more productive. That would justify better compensation for them, which would mean that more people would enter into the market, and we will be able to avoid the shortages we will inevitably face as the baby boom ages.
  
  
• Woman:
  I'm tearing that off. I'm not touching my hand.
  
  
• Paul Solman:
  At a recent session in Grand Ledge, Michigan, called Building Training, Building Quality, or BTBQ, experienced home care workers were learning how to train new employees.
  
  BTBQ curriculum provides baseline training for home care workers. The goal is to attract and retain more people, because last year the industry had a median turnover rate of 67 percent.
  
  
• Alyssa Lawrence:
  We're constantly looking for other ways to retain our staff.
  
  
• Paul Solman:
  Participant Alyssa Lawrence thinks more training could lead to higher job satisfaction among her employees.
  
  
• Alyssa Lawrence:
  We're trying to break that stigma of you're just a home health aide, so this way we're looking at trying to better educate them, better train them and hopefully retain our staff a lot better.
  
  
• Paul Solman:
  But here's the problem, more training in no way guarantees higher pay.
  
  
• Wendy Martin:
  I was gobsmacked on how little they pay for this.
  
  
• Paul Solman:
  After Wendy Martin (ph) lost her automotive job, she decided to run a home care agency with her mom.
  
  If your work force is better qualified because they have gotten the training that you're learning how to give, are they going to earn more money?
  
  
• Wendy Martin:
  Probably not.
  
  
• Paul Solman:
  The reason for that is, most long-term home care is paid for through Medicaid.
  
  
• Paul Osterman:
  The financing system is a tremendous challenge. Medicaid has to compete with education and public safety for resources. Medicaid today caps what you can do for these aides in terms of compensation.
  
  
• Paul Solman:
  But, he says, if home care workers were better-trained and higher-paid, Medicaid and insurance companies would actually benefit economically, because patients would avoid more expensive medical care.
  
  
• Paul Osterman:
  Fewer emergency room visits, fewer readmissions into hospitals. Secondly, they will save money because they could shift some work from higher paid folks, largely nurses, to these aides. And they will save money because they will avoid unneeded nursing home entrances.
  
  
• Paul Solman:
  Clare Luz says the Michigan training program has already provided evidence of cost-saving.
  
  
• Clare Luz:
  We were able to demonstrate empirically an association between this comprehensive training program and expensive client outcomes, like falls and emergency room visits.
  
  Just from an economic standpoint, a business standpoint, it's foolish not to be looking at this work force.
  
  
• Henrietta Ivey:
  Your hair is very, very curly and pretty.
  
  
• Paul Solman:
  Henrietta Ivey has many years of experience, but she says when workers like her care for clients dependent on government reimbursements in her native Detroit, the pay is still a measly $9.50 an hour.
  
  
• Henrietta Ivey:
  They tell you, get skilled, get trained. And we do get skilled and get trained, but that money has not changed. It hasn't.
  
  
• Paul Solman:
  After talking to her for a while, I wondered, could Ivey cater to private clients who could afford to pay more out-of-pocket to a loving, seasoned pro like her?
  
  Maybe it's that there is a big entrepreneurial opportunity.
  
  
• Henrietta Ivey:
  You have got a good point there, but say, for example, me and a group of home care workers say, you know what, let's just start a home care agency.
  
  
• Paul Solman:
  Right.
  
  
• Henrietta Ivey:
  If we don't have money saved, which we don't, because we don't make any money to save anything to think on that level, those are our barriers. When you don't have that money for your basic needs, those types of ideas are just ideas for us.
  
  We work, we sweat!
  
  
• Paul Solman:
  So Ivey has become an activist with the Service Employees International Union to press for higher wages.
  
  
• Henrietta Ivey:
  Somewhere, somebody is going to snap and say, you know what? We see the problem here now. It ain't that people don't want to work. It's not that people are not smart enough. We're not paying them enough.
  
  That's what I like to hear, that sizzle.
  
  
• Paul Solman:
  And, says Paul Osterman, if we want there to be more home care workers like Henrietta Ivey around when we need their services, we will have to advocate for them too.
  
  
• Paul Osterman:
  We're going to need help, and we're going to wonder where it is and why it's not forthcoming. And then we will complain. And there will hopefully be a politician who will see it in his or her interest to make this their issue.
  
  
• Paul Solman:
  For the "PBS NewsHour," this is economics correspondent Paul Solman reporting from Michigan.
  
  
• Henrietta Ivey:
  You're welcome.
  
  

Full Article & Source:
The U.S. needs more home care workers. Is this the solution?

Shortage of home health workers forcing young Minnesotans with disabilities into institutions

Every so often, Korrie Johnson closes her eyes and tries to forget that she is a healthy 25-year-old living in a nursing home surrounded by older people with dementia and other debilitating conditions.

Time and again, reality intrudes. In the past year, more than a dozen of her new friends at the GracePointe Crossing nursing home in Cambridge, Minn., have died of various health problems. Staff wearing hospice badges pass through the hospital-like corridors outside her room. Propped on her pillow is a stuffed animal given to her by a resident just days before his death.

“This is no place for someone my age,” said Johnson, who has cerebral palsy and limited mobility of her limbs. “I love these people, but I feel like I’m missing out on life every day that I’m stuck here.”

Johnson dreams of living in an apartment of her own, but the bright and outgoing young woman has been forced to put her dreams on hold because she can’t find enough home health workers to care for her at home.

Across Minnesota, a chronic and deepening shortage of home care workers is forcing scores of younger people with disabilities to move into sterile and highly restrictive institutions, including nursing homes and assisted-living facilities, designed for vulnerable seniors. Pleasures that young Minnesotans take for granted — visiting friends or even stepping outside without permission — are beyond their grasp.

The trend worries civil rights advocates, who say it could imperil decades of effort by state officials to desegregate housing for people with disabilities and to help them live more independently in the community.

Around the state, some 1,500 people under age 65 are living in nursing homes under long-term stays paid for by the state’s Medicaid program. Hundreds more are in less formal assisted-living facilities designed for seniors.

With help, many of these individuals could live at home, hold jobs and lead productive lives, say disability advocates. In addition to impinging on their freedom, the shortage of home aides creates extra costs for taxpayers, because nursing home stays are usually far more expensive than home care.

“This is a civil rights issue,” said Barnett Rosenfield, supervising attorney for Mid-Minnesota Legal Aid’s Minnesota Disability Law Center. “We have too many people in our state stuck in nursing homes who don’t want to be there and have no easy way out.”

Some national disability law specialists say state and county agencies are now vulnerable to legal action. In a 1999 ruling, the U.S. Supreme Court ruled that, unless a nursing home is medically necessary, people have a right under the Americans with Disabilities Act to receive care without being segregated from mainstream society. The ruling, known as “Olmstead,” required states to eliminate unnecessary segregation of persons with disabilities, and ensure they receive care in the “most integrated setting appropriate to their needs.”

In 2016, the U.S. Justice Department determined that thousands of people in South Dakota were being illegally institutionalized in nursing facilities because the state failed to provide adequate services for them in the community. Many South Dakota residents were confined based on disabilities, such as cerebral palsy or multiple sclerosis, that they acquired at birth or at a young age, the Justice Department found.

“People get dumped into nursing homes because there is no community option for them,” said Jennifer Mathis, director of policy and legal advocacy at the Bazelon Center, a nonprofit group that has sued several states over the segregation of people in nursing homes.

In Minnesota, advocates argue that underfunding of the state-supported personal care assistance program is partly to blame. The program was created 40 years ago to help people with disabilities live in the community and today serves more than 40,000 people. But its reimbursement rates have not kept pace with the cost of doing business and the growing demand for workers. Personal care aides typically make $12 to $13 an hour, often part-time and with few benefits.

As a result, even those who qualify for state assistance under the program are often unable to find and retain home health aides who can help them with basic activities like eating, dressing and bathing. As of December, there were nearly 8,000 unfilled home health care jobs across the state — the most in at least 16 years, according to the Minnesota Department of Employment and Economic Development.

“It’s difficult to find quality staff when they can make the same pay flipping burgers at McDonald’s and do a lot less work,” said Carla Friese, 54, of Hopkins, who has quadriplegia.

Prediction comes true

In the spring of 2016, Lauren Thompson delivered a stirring speech at the state’s annual “Ms. Wheelchair” pageant in Forest Lake.

Thompson, who is 29 and was born with cerebral palsy, broke from the event’s normally upbeat program and warned of a “catastrophic crisis,” in which the shortage of support services would leave large numbers of people stranded in care facilities. “Too many people with disabilities live in inappropriate, more-expensive settings, and that makes me so sad I’m speechless,” Thompson said.

Two years later, Thompson finds herself living the crisis she predicted. Unable to secure round-the-clock care, she moved into an assisted-living facility in Champlin, where she is isolated from her friends, family and the political advocacy work that she always envisioned. Her schedule is largely dependent on the facility’s staff, who come and go from her room at all hours of the day.

“I survive here,” Thompson said, “but I want to do more with my life than just survive.”

An aspiring writer, Thompson has begun composing poetry in her head, often as she lies for hours waiting for someone to help her in the mornings. Lying in bed one day recently, she recited verses from one of her poems, “Walking with Words”:

“The many roads

that I cannot travel;

the joys of a moonlit stroll is

beyond my comprehension.”

No other options

Josh Berg is director of program services at Accessible Space, Inc., a nonprofit that provides round-the-clock care at 16 assisted-living facilities across the state. The facilities were designed to provide a “bridge” to help people stabilize before returning to their own homes or apartments. In recent years, however, many people have been staying in his facilities even after they no longer need intensive services.

“With the workforce challenges, they can’t get their needs met in their homes,” he said. “They stay because they have no other options.”

Kim Higgins never imagined that she would consider moving into an assisted-living facility for seniors while still in her 50s. Higgins, who has quadriplegia from a spinal cord injury, had built a network of reliable caregivers who helped her live and work from her small apartment in Hopkins. But her life was thrown into turmoil last summer by the sudden departure of a longtime caregiver.

After a fruitless effort to recruit a replacement, Higgins toured an assisted-living facility in Blaine, but she was turned off by the cramped rooms and lack of independence. Fees there would have consumed nearly all of her Medicaid funds, which meant Higgins would have to give up the wheelchair-accessible van that she used to go shopping and visit friends. She also feared that no one would want to visit her at the facility, and her life would be controlled and limited by schedules set by staff.

“Suddenly the thought of having to live in an assisted-living facility became terrifying,” she said. “You lose a lot of freedom in an institution like that.”

Still, without someone to help her bathe and dress each morning, Higgins had to make a move. Last August, she left the Hopkins neighborhood that has been her home for 30 years and moved three hours away to Marshall, Minn., closer to her sisters and other relatives. The move has enabled Higgins to continue living on her own but has cut her off from the many Twin Cities friends that she made over the years.

“It hurts,” she said. “I miss the barbecues in spring. I miss the Twins games. I miss all the friends who made my life special.”

Stigma

This week will mark the one-year anniversary of Johnson’s arrival at the nursing home in Cambridge, a move triggered by the sudden illness of her mother, who was unable to take care of her following a serious car crash.

Since her move, Johnson has been afraid to talk to old friends and classmates from Cambridge, fearing their reaction to her living situation.

“There is a certain element of stigma and shame,” she said. “People assume that there must be something seriously wrong with you to end up in a nursing home at my age.”

Johnson still dreams of becoming a schoolteacher one day and has not given up hope of living independently. Last fall, she rented a small apartment in nearby Braham, Minn., which she has prepared for the day when she has adequate home care. She’s already decorated the apartment with her artwork and hand-painted birdhouses.

She looks forward to the small freedoms: waking up when she wants to and making coffee the way she likes it, without someone telling her what to do.

“I can go crazy in my own home,” Johnson said, her eyes widening. “Just imagine — I can be my own person again.”

Full Article & Source:
Shortage of home health workers forcing young Minnesotans with disabilities into institutions