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The growth in the older adult and disability populations, compounded by the absence or inability of family to care for a family member, has increased the demand for paid para-professionals to provide care to frail and disabled residents. These para-professionals provide necessary assistance with activities of daily living, such as bathing, dressing, meal preparation and household chores.

The large majority of people requiring long-term services and support prefer to receive such services in their own home, as opposed to a long-term care facility. This is also the most cost-effective option, as the cost of nursing home care ranges anywhere from $8,000 to $10,000 a month, most often paid through local Medicaid dollars.

Although New York state continues to expand programs and services to support in-home care for aging and disabled residents, the effectiveness of additional funding and infrastructure is impeded by the lack of home health aides to provide the services. The shortage of home care workers is largely due to factors such as low pay, lack of benefits, transportation barriers and costs, and often difficult working conditions.

Local providers attempting to coordinate in-home care for people continue to express frustration and concern regarding the lack of aide availability. Additional challenges exist in providing in-home services to those individuals located in the most rural and isolated areas of the county, due to the workforce shortage. As the demand for home-based services continues to grow, waiting lists also continue to expand as providers struggle to meet needs.

The local EISEP (Expanded In-home Services for the Elderly Program) through the Office for the Aging currently has individuals waiting for services, due to the lack of aide availability. Even with the addition of more funding intended to increase service provision due to increased demand, the waitlist remains because local home health agencies do not have sufficient staffing levels.

Home health agencies serving clients have also shared the challenges and frustration in trying to meet the home care demands in the local area. From an employer perspective, there is simply not a sufficient pool of workers to fill the need. The issue of providing a living wage is most challenging as these agencies are primarily dependent on reimbursements from Medicare, Medicaid and other publicly funded programs. Low reimbursement rates and increased service delivery costs result in low wages and limited benefits to the home care aide.

As a result of these challenges, frail and disabled individuals are either forced to move into a nursing home or remain in their home without services, placing them at higher risk for falls, increased use of emergency services such as ambulance services and emergency departments, and further decline in health and well-being. At a minimum, even those served by home care are often only provided with a portion of aide hours of which they were authorized. High turnover rates, transportation and geographic isolation further compound the ability for individuals to receive quality care.

In order to attract and retain a qualified and dependable workforce, home care agencies will need to be able to provide a living wage to their employees. This requires state and federal public programs to increase reimbursement rates and overall funding for home care. The payoff is a significant reduction in turnover costs and a decline in the number of hospital and nursing home admissions, further reducing Medicaid and Medicare spending.

Minimal employment benefits would further attract and retain a qualified workforce. Paid leave time would support workers in taking necessary time off from job duties, and reduce unexpected absences. Creating work schedules that provide consistent and regular hours, or at least ensuring employees a minimum number of hours is also needed.

Having adequately trained staff and supporting those staff with continuing education improves overall service delivery in any environment. Investing in the knowledge and skills of home care staff enables them to complete their jobs adequately and safely, increasing overall quality to the consumer.

Increasing opportunities for leadership training, engaging home care staff in relevant decision-making, and valuing their interaction and knowledge of the consumer can also improve care coordination and overall service delivery. Furthermore, creating career paths within the home care industry, or the health care field overall will further attract skilled staff to the profession.

Janet L. Taylor is an aging services specialist with the Cayuga County Office for the Aging.