carer helps her elderly pactient by cooking her a meal

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ITHACA, NY – An elderly, wheelchair-bound Tompkins County woman says she was left for almost two months without the home care aide she needs.

Lane Woods, 68, of Trumansburg says this isn’t the first time this has happened. A six-week stint without an aide when she lived in Niagara County ended with her being sent to the ICU due to the strains of caring for herself and maintaining her home without assistance.

Woods suffers from a number of conditions that make living on her own a difficult proposition. She suffers from complex PTSD, has nine herniated spinal discs in her as well as a birth defect afflicting her lower spine. She says her knees are so bad that her kneecap “migrates an inch or two” if she stands up. On top of all that, both of her shoulders have been replaced. “I’m lucky I can move it at all,” she says. “That’s a major problem with me trying to take care of myself and trying to keep the house clean.”

Woods’ previous aide, contracted through Stafkings, quit. The company, according to Woods, made no further attempt to secure another aide for her. Woods says her other option is to obtain an aide through the Consumer Directed Personal Assistance Program, or CDPAP – a program designed to allow the disabled to contract their own aides directly.

Unfortunately, CDPAP aides, contracted through the Finger Lakes Independence Center, are difficult to find in Tompkins. “I’ve tried that, you just can’t them here,” Woods said, going to explain that CDPAP aides are paid roughly a dollar less than those working through Stafkings. The implication being that most people who choose that line of work end up working for Stafkings.

“So here I am, stuck out in Trumansburg, NY. I have to ask a 72-year old neighbor, a veteran who was machine-gunned in Vietnam and has COPD (Chronic Obstructive Pulmonary Disease) to come into my apartment and change the sheets for me once a week. How would you like to do that to a neighbor?” said Woods.

Woods has complained to the county about her situation but gotten little results, only confirmation of the growing issue: “They tell me there are lots of elderly and disabled people waiting long periods of time for aides.”

Woods’ situation is an indication of a looming crisis in Tompkins County. According to a report from the Tompkins County Office for the Aging, with many “baby boomers” now crossing the 60+ threshold, the 60+ population is projected to almost double between 2000 and 2030. The report notes that while many 60+ citizens are “actively employed, socially engaged, own their homes, drive themselves, and have relatively few long term care needs… This will change over time.”

Similarly, a report from PHI, the Paraprofessional Healthcare Institute, projects that between 2010 and 2020, demand for home care aides will increase by 71 percent. By comparison, the projected growth averaged across all occupations is only 14 percent.

Behind the worker shortage

There are a number of factors behind the shortage of home care aides. At its most basic, the problem is the job just doesn’t pay enough. According to Lisa Holmes, Director for the Tompkins County Center for the Aging, wages for home care aide work top out at around $10 an hour, often less, with no benefits. Hours can be limited and unpredictable.

A home care aide prepares a meal for their patient. Image courtesy US Bureau of Labor.

The work of caring can be difficult, both physically and emotionally. Those who take the job see little recognition for their work, Holmes said. Those who work in the field require extensive training and credentialing. It’s a lot of effort and responsibility with little return.

“For individuals who want to do it, it’s a calling. It takes a certain skill set and level of caring,” said Holmes.

For those who aren’t “called,” there are plenty of better options, she said. There are many opportunities in the hospitality and retail worlds that offer similar pay without the same level of stress.

Woods learned through a county employee that employment opportunities at Cornell may also contribute to the issue. The University “offers  good wages to uneducated people, benefits, sick days and retirement. Who wouldn’t prefer that to low pay, no benefits – not even a reliable number of hours weekly?,” Woods said.

The biggest culprits behind the low wages are the the Medicaid and Medicare programs. According to a New York Times article, those programs pay for about about 75 percent of services provided by home care aides. These programs are stretched thin as it is, meaning the likelihood of seeing a significant wage increase for home care aides is low.

Low quality of care

Even for those who are able to secure care, the labor pool for these jobs presents its own problems. Another PHI report summarizes the issue:

“Low wages—along with inadequate training and the sheer difficulty of the work—result in extremely high turnover. Half the home care workforce turns over every year, disrupting the continuity of relationships that is essential to quality care. To put it simply: workers leave because they cannot afford to stay.”

The report says the conception of home care aides as “low-skill workers” is false.  “Home care is physically punishing and mentally challenging. It requires emotional sensitivity, knowledge of body systems and chronic diseases, and important skills that are often learned on the job (current formal training requirements are inconsistent and largely inadequate).”

The agencies responsible for training home care aides struggle to keep up with the demand for training newcomers, according to Holmes. Training sessions are hard to organize because they require a certain number of interested applicants. Once started, training programs can take several weeks.

Some aides are not only not qualified for the task, but could pose a physical, emotional, or even financial threat to their charges, an AARP report suggests. Many organizations do not test potential aides for drug use, and even fewer test to see if the applicant even has a basic understanding of caregiving.

Woods experienced this first hand, telling us, “One of these aides actually ended up in prison for stealing my credit card and charging $700 in 24 hours.”

What’s being done locally?

New York State is in the process of revising it’s Medicaid plan, which may provide some improvements to the system. However, another PHI report suggests that the redesign has it’s own share of problems that may make the situation worse for some home care workers and smaller agencies. In the meantime, local agencies are doing what they can to attack the problem from other angles.

Following a national initiative from the National Association for Home Care and Hospice, the Tompkins County Legislature issued a proclamation declaring November as Home Care Month in Tompkins County during its November 17 meeting.

The goal of Home Care Month is to “encourage the support and participation of all citizens in learning more about the home care and hospice concepts of care for the elderly, disabled, and infirm.”

Sue Ellen Stewart from the Visiting Nurse Service, an agency that provides home in Tompkins County, spoke after the proclamation. She expressed thanks to all the employees and agencies involved in home care, saying “it’s important work, I consider it sacred work, and it means a great deal to patients and their families.”

Stewart went on to talk about the “age in place” initiative, the goal of which is to keep the elderly in their homes so that they don’t face as much “isolation” from their families and from their community.

The Ithaca College Gerontology Institute has been contributing its expertise to the Finger Lakes Geriatric Workforce Program, an initiative based out of the University of Rochester.

The program’s goal is, “developing a competent health care workforce which maximizes patient and family engagement and improves health outcomes for older adults by integrating geriatrics with primary care.” One of the programs methods will include “the establishment of a unique ‘Caregiver Institute’ that will serve as the single point of entry for information, education, assistance, and referral for community resources.”

The Tompkins County Office of the Aging has been focusing its efforts on improving the profile and recognition for this sort of work. Director Lisa Holmes says they want to provide better training and create career training ladders so that aides can have a path for advancement. Their 2015 Strategic Plan offers an in-depth break down of the elder care situation in Tompkins and offers some recommendations on how to face some of these issues.

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Michael Smith

Michael Smith reports on politics and local news for the Ithaca Voice. He can be reached via email at msmith@ithacavoice.com, by cell at (607) 229-0885, or via Google Voice at (518) 650-3639.