Last March, Stephanie Chiha started worrying about her 92-year-old mother.
Previously, Chiha had believed that the residential retirement community she had chosen was the best place for her mother’s senior years. But the sudden restrictions on visiting as COVID-19 descended on Massachusetts alarmed her.
“I knew she could not stand the isolation, physically or mentally,” said Chiha, an educator from Arlington. “So I decided to bring her home to live with me for the time being.”
As the extent of her mother’s dementia became clearer, however, Chiha had second thoughts. “She was very confused in my home, and there was no one to help me. I couldn’t leave her alone, and I began to panic. I realized she was going to need more care than I was capable of giving her.”
For Chiha, the answer was to hire a home health care aide from a local agency to cover a couple of hours, three days a week.
As more seniors or their families face similar dilemmas, demand is beginning to outweigh supply — and home health care agencies are scrambling to keep up.
Dave Tasto, president of Bedford-based Assisting Hands Home Care, is seeing numerous situations like Chiha’s, in which a family has moved a senior out of a group setting during the pandemic. Adding to the demand, he said, is that hospitals are placing more of a priority on moving patients home quickly; previously those same patients might have stayed longer or transitioned to rehab.
“Because hospitals are discharging patients earlier, those patients are requiring more support at home, and sometimes the support is more complex,” Tasto said.
The hourly rate clients pay agencies in Greater Boston for non-medical home health care typically ranges from $29 to $33, according to Patricia Kelleher, executive director of the Home Care Alliance of Massachusetts. Costs are generally paid out of pocket unless consumers have long-term care insurance. Medicare and Medicaid cover home health care services only when deemed medically necessary.
Efforts are currently underway by AARP and other advocacy organizations to find more federal funding for these services, and President Biden’s Plan for Older Americans, released last fall, expressed the intention to revamp Medicaid to include home care.
Still, for those who can manage the costs, these services can make it possible to keep a loved one living at home.
For Sherry Seaver of Concord, the need arose when her husband, Bill, suffered a serious cardiac event just before his 77th birthday in August. Though it took time and effort, she has managed in the past few months to put together a team of regular health care aides to cover the hours she most needs help. Still, the extra precautions necessary during a pandemic have made the situation far more difficult than she imagines it might have been a year ago.
“I know all our regular caregivers, and I feel comfortable asking them about their safety measures, like how many people they would be spending the holidays with,” Seaver said. “But if one of them gets sick or has to quarantine and someone new comes in, I have to start with all my concerns again.”
“As an industry in Massachusetts, we were operating before the pandemic with approximately 20 percent too few workers to fill the demand,” said Jim Reynolds, CEO of Connected Home Care, which has offices in Burlington, Malden, Concord, Framingham, Peabody, Gloucester, and Waltham. “And then this tsunami hit. Demand spiked, and we’ve got caregivers who can’t work because they don’t want to get sick, or because they’ve already been exposed, or because of their own family needs. If you make $15 an hour and you’ve got two or three kids doing virtual schooling, you’re not going to keep working.”
As they watched general unemployment numbers in Massachusetts grow, Reynolds and his team wondered if there was a creative way to bridge that gap — perhaps by attracting some of the workers laid off from the hospitality sector.
In response, Connected Home Care has recently launched a major training initiative combining online and in-person elements and offering certificates in three levels of care. “Our hope is to attract people who are interested in learning new things and gaining new skills,” said Nancy Johnson, head of HR/Strategy for Connected Home Care.
Kelly Magee Wright, executive director of Minuteman Senior Services, which contracts with agencies to provide in-home care in communities north and west of Boston, sees it as a larger issue facing the profession.
“We have to really look at the existing structures we have in place and make necessary investments, starting with supporting wages for the direct care workforce,” Wright said. “The increase in minimum wage will help with that, but it’s a national challenge. We need to utilize opportunities for helping direct care workers to see this as a career path.”
According to the US Bureau of Labor Statistics, the national median yearly salary for a home health aide in 2019 was $25,280, or about $12.15 per hour.
Even as home health care aides were included in Phase 1 of the state’s vaccination rollout, the pandemic has changed the way they do their jobs.
“I think we have lost some of the closeness we used to have with our clients,” said certified nursing assistant Alexandria Nakato Owuma, who works with seniors in Somerville, Burlington, and Newton. “You don’t get a chance to create the camaraderie that would have otherwise allowed you to give exceptional care.”
“A lot of my job is not just personal care but social interaction,” said Tricia Gagnon, a home health care aide on the North Shore. “That can be pretty challenging when you’re wearing a mask. Not to mention that some of my clients are hard of hearing and rely on reading lips.”
Among the clients Gagnon assists is Alfred Wolfe of Peabody. He has had home health care ever since his dementia diagnosis a decade ago, but when the adult day-care center he was attending twice a week closed down last spring due to the pandemic, their presence became even more important — not just for practical tasks like bathing, but also to keep his mind busy with games, exercises, and outdoor walks.
According to Wolfe’s wife, Phyllis, having a long and trusting relationship with a consistent team of caregivers kept her from worrying more than she needed to about the pandemic. “I know the agency tests them regularly, and they are all very careful,” she said. “They are like family to us.”
“This is a touchy-feely business,” said Molly Rowe, co-owner with her husband of FirstLight Home Care of the North Shore. “Our clients want you to hold their hand, rub their back, see your smile. It’s very hard to operate when we are trying to keep six feet of distance.”
It’s bad enough for clients who understand the restrictions, Rowe said; it’s far worse with those who might not. “If you take a client with dementia and you show up with a mask on, that’s going to be really scary. If you have a client who relies on reading lips and you’re standing six feet away yelling from behind a mask, it’s frustrating both for us and for them.”
Though she initially had high hopes for necessity-driven innovations such as transparent masks, Rowe said that the reality has not yet panned out.
Ultimately, as Reynolds of Connected Home Care points out, any progress that can be made now is an investment in the future. “Infectious disease experts have long known an event like this was coming, and another one will come as well,” he said. “It might not be for another 20 years and it might be in three years. But we need to use what we know now to get ready for the next time.”
Nancy Shohet West can be reached at firstname.lastname@example.org.