By ADAM FEDERMAN
Every Thursday morning, Lisia Colegrove, a home health aide with North Country Home Services, begins her shift by preparing a cup of coffee for her client, Thomas Wells. She’ll spend the next couple of hours doing light housekeeping, laundry and helping Wells get in and out of the shower. She’ll also check on his two dogs, Angel and Digger, and make sure that Wells is keeping up with his medications and has everything he needs, including his emergency alert device and an adequate supply of oxygen. Occasionally she’ll take him to a doctor’s appointment.
She’ll make him breakfast: fried eggs, bacon and toast.
Like many elderly residents in the Adirondacks, Wells, a 69-year-old former farm hand and machine operator who lives in Willsboro, relies on aides like Colegrove to assist with basic home care services. He has visits three days a week for two and a half hours each day. Without it there’s a good chance Wells, who has a number of chronic health issues, would end up in a nursing home or the emergency room. Asked how he managed before connecting with North Country Home Services (NCHS), Wells said, “I got by. But it was tough.”
In many ways Wells is lucky. An increasing number of elderly residents in the region are unable to get the care they need because of a severe shortage of those willing to do the work. Even as the number of home health aides has declined, the elderly population in the Adirondacks is growing. By 2030, according to data from the New York State Office for the Aging, more than a third of most Adirondack counties will be over the age of 60.
“Whatever is happening today in 2019, if you look at the aging demographic, particularly here in the Adirondacks, the number of people who are going to need home care is only going to increase,” said Donna Beal, executive director of Mercy Care for the Adirondacks, a nonprofit in Lake Placid that trains “friendship volunteers” to work with seniors. “Whatever problem we have today, unless there’s a solution, is going to get much, much worse.”
Home health aides provide a range of services from basic personal care, including housekeeping and cooking or grocery shopping, to more advanced support for clients who need assistance bathing and using the toilet.
‘People are dying at home’
Colegrove, a 40-year-old mother of five who lives in the Town of Lewis, has been doing home health care work off and on for 20 years. She finds it rewarding and it’s clear that her presence alone offers comfort to Wells, who lives alone, no longer drives and is unable to leave his home without assistance.
If elderly residents do not receive the services they need, there’s a much greater likelihood that they will end up needing costlier acute care.
“People are dying at home without services and supports because they can’t get what they need,” said Becky Preve director of the Franklin County Office for the Aging.
The decline in home health aides paints a troubling picture. According to Becky Leahy, executive director of NCHS, the number of aides working for her agency in the Adirondacks—the largest provider in the region—has dropped dramatically over the past decade from about 350 in 2010 to just over 200 today. Every week Leahy says there are between 700 and 1,000 hours of authorized care that go unfilled due to the worker shortage. In one case, a 96-year-old woman in Tupper Lake has been authorized to receive 20 hours of personal care through Franklin County. That was in 2017. Two years later, she has still not received an hour of care.
State and local officials have been sounding the alarm about the North Country home health care crisis for years. In 2015 Franklin County Office for the Aging, the New York StateWide Senior Action Council, and Mercy Care for the Adirondacks launched a campaign to raise awareness about the issue.
According to Beal, Mercy Care’s executive director, they’ve been successful in defining the problem and getting the word out. This has had some tangible results. Last year the New York Legislature devoted significantly more resources to counties for home health care services. The state not only put up $15 million for in-home services—the largest amount in two decades—but also changed the funding formula so that allocation of money is based on unmet needs at the local level rather than the number of elderly residents in any particular county.
This gives county Offices for the Aging a bigger piece of the pie and more discretion over how they spend the money. In Franklin County, for example, the increased funding has allowed the Office for the Aging to cluster services where needed and enlist family members and friends as aides, significantly reducing the number of individuals on the wait list, which was more than 100.
But increased funding for services doesn’t solve the larger conundrum of how to rebuild the home health care workforce, which is seen as essential to meeting the needs of an aging population. A variety of factors have contributed to the decline in the number of aides in the region and across the state. Low pay and the difficulty of the work itself are often cited as the primary drivers. Home health aides typically receive between $12 and $14 an hour, depending on experience, and must have their own vehicle.
Around 2010 a change in Medicaid reimbursement rates had a devastating impact on the home health care industry. At one point, Medicaid rates were frozen and New York instituted a 2% cut in reimbursement funds for home care visits even as costs were increasing. According to Leahy NCHS was no longer able to give out even modest raises or seniority bonuses to its employees. Eventually the agency was forced to close its Tupper Lake office, no longer offer incentives and even discontinue paying mileage to aides who often drive hundreds of miles a week to see their clients. In 2015 they lost 40 aides in one month alone Leahy says.
A rural problem
In addition to low wages, the work itself can be emotionally and physically taxing. Aides are often thrust into the middle of challenging family dynamics and must help clients with bathing and toileting, not something everyone is willing to do. Attracting young workers who can get the same hourly rate in the service industry or manufacturing has led to a further decline in the workforce.
“It takes a very special type of person to be in people’s homes and deal with situations that aren’t always pleasing to be in,” said Preve.
The Adirondacks are not unique: Rural and urban counties across the country are grappling with the challenges of caring for the aging population. But the geographic isolation of much of the park and limited access to resources, including health care, can pose additional problems.
Beal says the advocacy groups that have devoted time and resources to raising awareness about the home health care crisis are now turning their attention to possible solutions. In early November, Mercy Care hosted an educational forum at Paul Smith’s College with representatives of Catholic Health Buffalo and the Ralph C. Wilson, Jr. Foundation, which has embarked on a new initiative aimed at increasing retention of certified nursing assistants and home healthcare workers. With $20 million in grant funding, Catholic Health, the Cleveland Clinic and Ascension Michigan are participating in a pilot program called THRIVE designed to address the decline in home health care workers. Although the program is in its infancy, Beal says some of the ideas could be adopted here in the Adirondacks.
“This is really hopeful because for the first time we’re seeing some potential solutions,” Beal says.
Mercy Care itself has become a statewide model for how nonprofits can help to meet some of the needs of an aging population. Founded in 2007 by Sisters of Mercy, the organization trains volunteers and pairs them with elderly residents who need basic care or companionship. Mercy Care now has more than 100 volunteers in the Tri-Lakes, one of the most underserved in the park, and has become an important advocate for home health care workers and the push for inclusive, age-friendly communities. In addition Mercy Care is working with other towns in the park to help them develop their own community friends volunteer programs.
A government solution
Preve says the home health care industry will likely be one of the fastest growing employment sectors in the state in the coming years. She sees this as an opportunity: If the state can provide the financial support and benefits to home health workers those individuals will in turn help to boost the local economies of the towns and communities they live in.
NCHS recently raised its starting hourly wage and has started to pay those who take part in the agency’s three to five week training session. And if state funding continues to increase as it did this past year, counties will be able to expand the services that they offer.
HCR Home Care, a private-service provider based in Plattsburgh, currently has 20 aides and could easily double that number to meet the needs of Essex, Franklin, and Clinton counties. “The wait list is growing,” said Melinda Clark, HCR’s case manager. “We need to pull in more aides in order to staff the amount of referrals I currently have.”
But Preve says any long term solution will have to involve offering enhanced Medicaid reimbursement rates for home health care services in rural areas so that aides can earn a livable salary and the profession is able to reverse the decline of the last decade.
“The solution really needs to come from the government in the form of an enhanced rate,” Preve says. “The rate right now just isn’t sufficient to retain workers.”
Meanwhile the home healthcare workforce itself is aging out; many current aides have worked in the field for more than 20 years. Auretta Laribee, 57, from Crown Point joined NCHS 24 years ago and before that did similar work for the county and also worked in a nursing home. She has eight or nine clients, typically works nine- to 10-hour days, and drives close to 300 miles a week to see her clients.
But Laribee says she wouldn’t trade the work for anything else. She finds it deeply rewarding and believes that clients benefit from being able to stay at home as they get older. “If they stay home, they bloom,” she says. “If they go into a nursing home, forget it.”
Laribee had one client for 14 ½ years. The client had multiple sclerosis, lived alone, and couldn’t walk or get out of bed on her own. Toward the end of her life, Laribee was visiting four times day.
“She was family,” Laribee said. “And I know we’re supposed not to do that but you know what, when you’re with somebody that long you’re family.”