Home health care worker shortage leaves families in a bind

BURLINGTON, Vt. (WCAX) - Health care workforce challenges are hitting home for many Vermont families. Some may be struggling to get the home health services they need because provider agencies have so many job openings right now. As one Central Vermont caregiver told me, that leaves her wondering day to day how much she will need to take on for her loved one.

“She’s been in her own home of her own free will for so long,” said Janet Hatch of Northfield.

Hatch says her aunt, Patricia Osterberg, wants to stay in her own home. But at 91, Osterberg needs someone to come for a few hours in the morning and evening to prepare meals and do other chores. At least four days a week, that someone is Hatch.

Reporter Cat Viglienzoni: Is this something you like doing?

Janet Hatch: Oh, no... I don’t have the skillset for it. I don’t have the desire to do it. I’d rather just go sit and talk to her or play a game of cards with her and not be like running in, making a meal, cleaning up after the meal, getting her ready for bed and everything. That’s not a relationship.

Hatch says that’s why she’s grateful when they can lean on the expertise of home health care workers who she praises. But with 14 visits needed a week, their provider warned her they couldn’t guarantee all those would be filled.

“They just don’t have people,” Hatch said.

Cat Viglienzoni: So does that mean that you’re still responsible for a lot of the care?

Janet Hatch: Oh, yeah... I basically leave the house at 8 in the morning and get home at 8/8:30 at night almost every day.

She’s not alone. I found out the caregiver crunch is being felt statewide.

“Many people are struggling to get all their care needs met,” said Angela Smith-Dieng, the director of adult services for the Vermont Department of Disabilities, Aging and Independent Living.

Smith-Dieng says they hear all the time from providers who can’t fill open jobs.

“They have a vacancy rate of one in three in terms of personal care attendants who are needed to meet the needs of people who are currently on our programs,” Smith-Dieng said.

She says that means providers then have to prioritize those who are at highest need or who don’t have family to help with their care.

“It’s certainly not ideal and not what we want for our long-term care system in the long term but it’s the reality of the workforce shortage right now,” she said.

But gaps in the schedule aren’t an option for Hatch and her aunt.

Cat Viglienzoni: Are you concerned for her safety if she doesn’t have someone there regularly?

Janet Hatch: Definitely, yeah.

Cat Viglienzoni: What does it do for you to not have the regularity of knowing that someone will definitely be there?

Janet Hatch: Oh, stress. Just worried.

Hatch says because her aunt is on Medicaid, it narrows her options for approved providers. She wants to see more flexibility from Medicaid during the labor shortage so more options for her aunt’s care would be covered.

“Somebody somewhere must have the power to say look, we need to make some concessions and make sure that people have the help they need,” Hatch said.

I asked what families like Hatch’s should do.

Smith-Dieng recommends a few things:

• Having a conversation with their case manager about their options for in-home supports or options outside of the home.
• Seeing if technology or home modifications could help make their loved ones more independent. For instance, devices to alert them to take medications at the right times or detect falls, or meal and laundry delivery services.
• Also, she says to see if there might be volunteers with the local agency on aging who can help.

The state is exploring strategies to try to address the home health care workforce shortage in both the short term and the long term.

Cat Viglienzoni: What’s being done to fill these jobs? Because that sounds like it’s the number one need. And then what’s being done to shore up the system so that down the line we don’t keep running into these same issues?

Angela Smith-Dieng: There’s an immediate focus in addressing recruitment and retention in our system... In the long term, the way to sustain the workforce is through the rates that are paid from Medicaid to providers to then be able to pay adequate wages to workers.

She cites one-time federal money on the way that can be used by providers to pay for recruitment/retention bonuses, scholarships or loan repayments.

And there was a 3% increase for Medicaid payment rates to providers in last year’s budget, and the Scott administration has proposed another one in this upcoming budget, too.

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