CNHI: Home health aide shortage leaves some without care

By Joe Mahoney, 3/3/17

ALBANY — Across upstate New York, agencies that provide health care services to home-bound patients say they are struggling to recruit and retain health aides, a shortage that is expected to become more acute as the population ages.

Home health aides are the lowest-paid workers in New York’s health care system, with many earning less than $13 an hour for work that often involves late-night and weekend shifts helping the home-bound with bathing, meal preparation and other personal needs.

“There are just not enough bodies to fill the home-care staffing jobs,” Lindsay Heckler, an attorney with the Center for Elder Law and Justice, said in an interview. The nonprofit provides legal services to seniors and income-eligible people in Niagara County and seven other western New York counties.

Advocates for the home care industry say New York is facing a surge in the demand for health care aides. The shortage is expected to become more prevalent over the next decade, with projections suggesting that nearly one in five New Yorkers will be 65 years of age or older by 2025, with many having to rely on public programs to pay for the services.

“The growth in the projected demand for health care workers that is driven by the aging population far outpaces the growth of the working-age population that could fill those jobs,” Amy Schnauber, vice president of LeadingAge New York, told lawmakers examining the worker shortage this week. The association represents some 600 care provider organizations, including nursing homes, community care and assisted living providers, serving more than 500,000 New Yorkers.

The home-care providers say they are being squeezed by what they call inadequate Medicaid rates that in some instances have led them to close offices and eliminate some services.

Rebecca Leahy, a registered nurse who heads North Country Home Services, a not-for-profit agency with 300 employees in a region spanning Clinton, Franklin and Essex counties, said 40 aides quit after mileage reimbursements were eliminated in January 2015, as a “last resort” because of funding gaps.

The state later offered short-term funding to fill the shortfall, allowing the agency to reinstate the travel payments, she said. But because of the ongoing worker shortage, she said, the agency in unable to provide care that has been authorized for about 400 hours each week.

As a result, she said, patients face a high risk of being hospitalized or placed into nursing homes when they could be staying in their communities if more aides were hired.

“My fear is that in the near future most home-care patients in the three northeastern Adirondack counties of Franklin, Essex and Clinton could be without services because the provider for most of this region will not be able to cover payroll,” Leahy told a panel of lawmakers headed by Assemblyman Richard Gottfried, D-Manhattan, the chairman of the Assembly Health Committee.

Leahy was among more than 40 people who urged lawmakers to find a long-term solution to the workforce shortage in home care.

A Cuomo administration official, state Medicaid Director Jason Helgerson, painted a different picture. He contended that the rates the state offers to the home-care agencies are adequate, noting the state will boost support for the sector by $4.9 billion over the next five years.

“We believe this is a very robust market with multiple choices for consumers,” Helgerson said. He insisted that New York is more generous to the industry than any other state.

The suggestion that the industry was running smoothly was challenged by Assemblyman Billy Jones, D-Franklin County.He said those who can’t get home care when they need it will end up in emergency rooms. “It’s just compounding the cost, not to mention the human effect,” Jones said. “We are in crisis mode in rural areas and we need to address that.”

Gottfried said in an interview he expects the Assembly will press for greater state support for the managed care plans from which the agencies get their funding, with assurances in budget bills that the added money will lead to pay increases for the caregivers.

He said no specific wage level has been suggested to curb the exodus of workers from home health agencies to fast-food restaurants and other places that pay higher salaries.

The bottom line, he said, is that “home health aides really need to be paid more than minimum wage in order to recruit people and keep them on the job.”

Leahy agreed with that assessment when she was questioned by lawmakers. “It all boils down,” she said, “to what you pay the aides.”