June 16. 2018 9:10PM

Silver Linings: Jobs crunch has seniors desperate for home care

New Hampshire Union Leader

Richard Jutras walks with Cherie Stevenson, an LNA home caregiver, near his Somersworth. U.S. Department of Health and Human Services estimates that by 2020 there will be 1.8 million fewer home caregivers than needed nationwide. (THOMAS ROY/UNION LEADER)

Silver Linings

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at rbaker@unionleader.com or (603) 206-1514. See more at www.unionleader.com/aging. This series is funded through a grant from the Endowment for Health.

Part 1 of 2

HAMPTON BEACH - One block from the oceanfront strip of condos, hotels and beachgoers, Regina, 84, works magic making Italian food - after spending hours giving pills, insulin and 8 ounces of water at regular intervals to her 77-year-old husband. He lies bedridden behind a curtain. Muffled cartoon laughter from a flatscreen TV competes with traffic noise from the street.

Regina has a heart condition. Her severe arthritis makes it difficult to rise from a chair. Yet she has been her spouse's primary caregiver for eight years, since pancreatitis and blood loss landed him in a Boston hospital, where doctors induced a coma in order to perform a life-saving procedure. Since then he has struggled with memory loss and hallucinations, which plague him mostly at night. He also has diabetes and orthostatic blood pressure, which drops dangerously low when he stands.

"My husband is a little bit forgetful, and a little bit hallucinating," says Regina. She asked that her real name not be used because she fears the attention of those who prey on the elderly. "Sometimes it's scary. When I married him, I thought he would take care of me in my old age. I don't believe in nursing homes. I come from Italy; we take care of the people."

Regina's situation represents a growing trend that is becoming more common as New Hampshire's population ages. By 2020, one out of five Granite Staters will be 65 or older, according to state demographic projections. The U.S. Department of Health and Human Services estimates that by 2020 there will be 1.8 million fewer home caregivers than needed nationwide. According to a 2016 report by the University of New Hampshire's Carsey School of Public Policy, 36 percent of older adults nationwide who need help with meals, medications and personal care aren't receiving any.

Today, more seniors are primary caregivers for medically fragile partners than ever before - at the same time that home care workers are becoming harder for seniors and employers to find. Across the state, but especially on the Seacoast and in regions where living costs are high, as well as in northern and rural counties with low populations, paid home care givers are in critically short supply, according to providers and state officials.

Compounding the problem is the state's record-low unemployment rate, and the fact that more women - traditionally caregivers for aging family members - are working full time and are unavailable to care for elderly parents and grandparents, many of whom need help with daily living or care round-the-clock.

"When you have a situation like you have now, with unemployment at 2.6 or 2.7 percent, it's very difficult to get people to do this work," said Douglas McNutt, associate state director for advocacy at AARP New Hampshire. 

Home care agencies compete with starting salaries in the manufacturing, retail and fast-food industries. "We just don't pay enough for these services. But we can't just raise the rates," said McNutt. He said state and federal grants that fund home care services are limited.

Amy Moore, director of Ascentria In-Home Care in Concord, the state's largest home care provider, says the shortfall has already reached crisis levels. Last month, her agency turned away 35 to 37 cases, compared to five to 10 a month four years ago. "Over the past few years I've seen it increase. It really means people are going without care."

Currently Ascentria's roughly 330 caregivers serve approximately 400 clients in every county but Coos, mainly through the Choices for Independence Waiver, which provides personal care to nursing home-eligible patients who want to remain at home. "It's heartbreaking to have to call and tell someone, 'You're not going to get out of bed today because I have no one to send to help you get into your wheelchair.' But that's the reality of what's happening in New Hampshire today," Moore says.

Ten years ago, caregiver requests came mainly from elderly people needing basic help. "Now we have a lot of clients who are brittle-diabetic, or have COPD (chronic obstructive pulmonary disorder). The biggest problem is a mental health problem such as bipolar disorder that isn't being addressed. These problems are happening at younger ages. I want to send in people who are well-trained."

In some cases, case managers will call agencies for weeks and weeks, trying to obtain services for elderly clients, Moore says.

Critical need

Rebecca Hutchinson of Deerfield, a retired home care administrator who serves on the steering committee of the New Hampshire Alliance for Healthy Aging, says gaps in home care for the elderly are being "filled by family members missing work and filling in when they can. The result is still people being alone."

"There is no one good answer to this," said McNutt. "We need to draw other people into this work, including older people in their 60s and 70s, who can't necessarily afford to stop work themselves, but they can work 15 hours a week."

Volunteer programs such as RSVP, the Retired Senior Volunteer Program based in Concord, and Senior Companions, a smaller statewide program that offers a stipend and mileage reimbursement, can help relieve the burden, he says. "But it's not the answer. ... We have to search out workers we haven't sought before. We have to raise wages. We have to speed up licensing and criminal background checks. And we have to increase access to training programs."

While the gap between supply and demand continues to widen, state officials, nonprofits, university researchers and home care agencies are trying to cobble together a multi-pronged solution. Agencies are trying novel ways to attract workers, including offering cash bonuses to employees who bring on new caregivers, creating employee-sponsored funds to support caregivers who lose income when assignments end, and sponsoring no-cost training and apprenticeship programs at community colleges.

Low pay

Every other week for three hours, a home caregiver comes to Regina's house in Hampton Beach to bathe and shave her husband and change the sheets on his bed. The cost is $81, which is covered by a state grant through the New Hampshire Family Caregiver Support Program, which provides part-time relief to family caregivers who don't receive support through Medicaid or other programs.

"They don't come every day so I wash him in the morning. He has no teeth so I make sure he can eat," says Regina. "But what happens if I have to go to the hospital? Why can't they find more people?"

Part of the problem is wages. Although home care services in New Hampshire are typically billed at $27 to $29 per hour, pay for home health aides usually runs $11 to $15 an hour. The difference covers agencies' costs of scheduling, administration, transportation, employee benefits and worker's compensation - which is expensive because personal care is physically demanding, requiring lifting, transferring patients from beds to wheelchairs, and steadying clients as they walk. And injuries are not uncommon.

The hourly rate doesn't go far on the Seacoast where rents and living costs are high.

"I've turned work away because I can't get staff," says Kim Fortuna, director of Griswold Home Care in Hampton. "There are some diamonds in the rough, but you have to look long and hard."

There are 105 licensed home health agencies currently in New Hampshire, including 82 that bill for caregiver services through the Choices For Independence program. A relatively new initiative allows seniors to use grant money to hire a trusted person such as a friend, neighbor or fellow church member to provide home care assistance until an agency home health aide becomes available. The New Hampshire Department of Health and Human Services is currently identifying staff to help home care agencies assist seniors to build off their natural supports. It's meant to be a bridge, not a long-term solution, state officials said.

"Even if there are pay increases, we still have a shortage of people," says Christine Santanello, director of Long Term Supports and Services at the state Department of Health and Human Services. "We need multiple strategies and to work with multiple organizations to meet the need today and in the future."

"We're currently looking at X number of people applying for services, but only Y are getting it," Santanello said. The exact size of the gap is unknown, she said, but the department soon plans to look at the number of requests it receives versus the number that are filled.