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AGING WELL

Cayuga County Office for the Aging: Home care workers in short supply

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Elderly woman holding on handrail for safety walk steps

It is no surprise that the number of older Americans in the United States only continues to grow. According to the U.S Census Bureau, the number of Americans aged 65 years and old is expected to double by 2050. In New York state alone, the current population of older adults is approximately 2.9 million and is expected to double to 4.4 million by the year 2040. As the number of older adults increases, there will continue to be a growing demand for services and supports for adults to live out their “golden years,” and age in place. One of the primary supports older adults rely on in the community is home care. Home care includes a range of medical, social, assistive and other services provided to an individual that would typically be provided in a hospital or facility setting at a lower cost to the long-term care system. One of the primary community services often required is in-home aide assistance. But what happens when this crucial support is simply not available? This is the reality many older adults and their caregivers are facing, and unfortunately this crucial long-term care system component was on the brink of collapse well before a global pandemic set in.

Direct care workers are leaving the job at alarming rates. According to PHI a nonprofit research and consulting group, one in two direct care workers leaves their job within 12 months, citing low wages, limited benefits, overwhelming workload duties and limited advancement opportunities as some of the reasons for seeking other employment. Residing in a rural area such as many areas in Cayuga County come with additional challenges — the lack of public transit workers often rely on, and other challenges, such weather conditions and traveling distance between clients, that can make the job more challenging. The federal and state government set fixed reimbursement rates for Medicare and Medicaid that have not kept up with other trends, such as the $15 minimum wage increase in New York state. It is now more lucrative for a person to work in a fast food establishment than provide home care to a frail, older adult in the community. The already depleted home care shortage is stretched even further when all entities (Medicare, Medicaid and private pay options) are simply trying to retain workers from the same “pool” of individuals. There will be over 800,000 job openings for home care workers in New York state in the next five years alone, and we simply do not have the individuals to meet the growing demand.

The home care worker shortage is creating a dangerous situations for older adults, resulting in increased falls, re-hospitalizations and overall poor health outcomes. Older adults are being left with two choices — to receive inadequate care (or no care at all) in some situations, or to seek out institutional settings that are often much more costly, and often unwanted. We are relying on already burnt-out caregivers to pick up the burden, who are often not trained or equipped to deal with these situations at all.

With a worsening home care shortage, one option to retain necessary care in the community is through the Consumer Directed Personal Assistance Program, also known as CDPAP. You may have seen the commercials on TV about paying a friend, family member or neighbor to help you remain in your home. Participants of the program have the flexibility and freedom regarding whom they hire as their caregivers, within certain parameters. Eligible caregivers may provide any of the tasks that are typically provided by a personal care aide from an agency. These include tasks such as bathing, housekeeping, shopping, laundry and errands. Unlike home care agencies, the CDPAP program doesn’t require the caregiver to have specialized training or certificates. CDPAP is primarily a Medicaid-funded program, although the Cayuga County Office for the Aging has the consumer-directed option under the Expanded in Home Service for the Elderly Program and through the Caregiver Respite Program. It is important to note, however, that CDPAP funds primarily come from Medicaid.

There are efforts being made to improve the aide shortage locally. Syracuse-based CenterState CEO Work Train partners with Cayuga-Onondaga BOCES and Loretto for an innovative program to help area job seekers becomes certified aides. At the state level, New York Caring Majority is "a campaign to create jobs for New Yorkers, support seniors, people with disabilities and caregivers, and rebuild the economy by paying home care workers a just wage.” While there is a long ways to go to resolve the aide shortage, these efforts offer some encouragement.

The reality is, we will all most likely face a time in our lives when we will need to seek out home care, whether it be for a parent, spouse, child or grandparent. What can we do as a society to ensure we all have the right to age in our homes and communities, with dignity and quality of life? We have a responsibility to support those who provide crucial care to our most vulnerable.

Danielle Schneider is an aging services specialist with Cayuga County Office for the Aging. For more information, call (315) 253-1226 or visit cayugacounty.us/507/Office-for-the-Aging.

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