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Old pressures and new ones put home health aides in short supply

The website for the home health care agency

The website for the home health care agency Right at Home lets people know it's hiring. Credit: Phyllis Newbert

Tamara Chase said she’s nervous every day.   

The Roslyn Heights woman, a home health aide, is concerned about the elderly client she looks after, diligent about wearing her personal protective equipment – “a lot of people I know died from COVID-19,” she said – and careful to wipe down surfaces   after visits by her client’s family members, some of whom, she says, don’t take stringent safety precautions.

But that’s the life of a home care professional in the age of COVID-19 – front-line workers being paid at or around minimum wage, whose ranks are thinning just at the time people might need them the most. The result on Long Island is a big push to fill these roles, and a hope that high unemployment numbers will entice people to consider a job in a government-subsidized field that will continue to require a steady workforce, regardless of what happens to the economy.

And though it can be a uniquely rewarding field, said Janet Koch, CEO of Life’s WORC, a Garden City nonprofit that provides aid to those with developmental disabilities, the challenges can be daunting: hard work for low pay, lack of child care in a time when schools and some day cares are closed, and the fear of working closely with others, some of whom have tested positive for the coronavirus.

“It’s not just a New York crisis, or a Long Island crisis, it’s a national crisis,” said Koch, whose group has raised wages $5 an hour during the pandemic.  “But there is something just beautiful about forming relationships and having that human connection and just seeing that you made someone happy and it’s part of your daily job to do that.”

Over 90% of state home care services are funded by Medicaid or Medicare and rates are both determined by the state and paid for by the state budget; rates vary based on the type of care needed. There's nothing in these mechanisms that accounts for "hazard pay," so agencies  that choose to do this do it out of pocket, according to the state Home Care Association (HCA).

Koch’s team is looking to fill dozens of roles, from administrative to hands-on, and they’re far from alone.

“If we could find the most good people, we would take them all,” said Phyllis Newbert, vice president at Right at Home, where Chase is an employee. “You’re talking about employment that’s at minimum wage [so] you might not think of these people as being the value that they are, but they truly are the most essential part of our society. They’re taking care of the most valuable and fragile entity.”

In April, 73% of agencies saw a 1% to 10% loss of their home health aide and personal care aide workforce, according to HCA, which lobbies for protections and wage increases for home care workers. Twelve percent of agencies saw a loss of 11% to 20%.

Considering that about 20% of positions were unfilled in January, before the pandemic, “there’s a need,” said HCA spokesman Roger Noyes. Some left the job because they themselves were elderly or with pre-existing conditions, while in some cases, the lack of PPE made continuing to work too great a risk.

There’s need in the usual categories – help for the elderly, those with developmental disabilities, and those with health and behavioral problems – but also in some new arenas, due to the pandemic. Some may have recovered from COVID-19 but must now deal with complications. In other cases, Noyes noted, families may be wary of putting their loved ones in assisted living facilities for risk of spread and prefer one-on-one care.

“Home care agencies are going to need to work more aggressively to fill unfilled positions,” Noyes said, “but because there’s unemployment in other areas of the economy, that might provide an area of help in this regard.”

Life’s WORC -- which as of Friday had over 30 jobs listed on Indeed and Glassdoor (over 20 on Long Island) and 10 just in Garden City -- has seen about a 20% decline in applications in recent weeks, said Rosemary Kelly-Frank, the director of marketing who's helped spearhead the hiring campaign. But with the fear of COVID-19, “you might expect it to be higher,” she said.

Though there’s a distinct need for those with experience, they're also filling entry-level positions, which can involve less challenging medical or behavioral situations. Training has moved online. 

“For $15 an hour you can work at Home Depot as a cashier, so for us, it’s finding the people that are mission-aligned and really committed to the work that we’re doing,” Kelly-Frank said. “It’s more than a job. It’s a job with meaning.”

That’s what first attracted Simone Rogers, who cares for a 94-year-old woman as part of her work with Right at Home. “I don’t think about the fear,” said Rogers, of St. Albans. Working during a pandemic is “trying, very trying, but you know what? Because of who you are and the empathy that you have for the people that you’re working with, we do take the chances sometimes. … It’s something that I really love doing.”

It might be one of the reasons that Life’s WORC has actually lost less staff than it usually does, Koch said. Hazard pay has made the job more attractive, meaning those who like the work are more likely to stay on.

The next hurdle, Noyes said, is making higher pay and other benefits the norm, even outside of a pandemic – especially since there could potentially be a recurrence. Lobbyists have used the #befair2directcare rallying cry for years in attempts to get more state funding, but recent bills for better funding and other types of supports, like day care, haven't passed at the state level, Noyes said. Historically, Koch noted, health aides in New York State  were paid a few dollars more than minimum wage, but when the minimum wage increased, their pay stayed static, making the job a less enticing landing spot.

Before the pandemic, 67% of certified home health agencies had negative or negligible operating margins, according to the HCA.

That isn’t likely to change soon. Until the next federal aid package for states is settled, lawmakers are unlikely to deal with any COVID-19-related bills that call for the spending of more state money, sources said. New York is facing about a $10 billion revenue shortfall.

“We have to reward people for doing a job many people wouldn’t consider doing,” Newbert said. “They’re heroes in this environment. They’re up on the front line.”

 With Yancey Roy

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