LABOR GAP: Shortage of home health care aides is serious, agency says

The staff at North Country Home Services include, from left, Karla Clark, Trinity Bushey, Pattie Sauvie, Valerie Malski and Tammy Rocque. (Enterprise photo — Glynis Hart)

SARANAC LAKE — By taking care of elderly and disabled people in their homes, home health aides contribute mightily to the economy.

That’s not why they do it, though.

“If I can make somebody happy, that makes me happy,” said Karla Clark. She has been working as a home health aide since 1989. She and Valerie Malski, who started three years ago, say it’s the emotional component of the job that they love. They both work for North Country Home Services, which has a home base in Saranac Lake and branch offices in Malone, Tupper Lake and Ticonderoga.

“It’s a tough job emotionally because you get attached to your patients,” Malski said. “But the appreciation level is great.”

“I wish more people would help out the elderly,” said Clark, “because when I’m older, I hope I can stay home.”

During the work day, aides perform a variety of services, from administering medications to cooking meals, helping people bathe and maintain an independent lifestyle.

“There’s no typical day,” said Malski.

The Labor Gap — as the Enterprise is calling the worker shortage — hits especially hard in home care in the North Country. The region has the highest percentage of elderly persons in the nation, except for the west coast of Florida.

“Their families aren’t here, or are working elsewhere,” said Becky Leahy, director of patient services. “The aging population is growing faster than the younger population.

“It’s a crisis. It’s a crisis in our rural region.”

Leahy said the competition between employers for health care workers is stiff. Nursing homes, assisted living facilities and home care agencies are chronically understaffed. NCHS currently employs 250 aides across the region, but “I would hire another hundred if I could,” said Leahy.

The agency doesn’t turn patients away, but sometimes visits are fewer and shorter than it would like to provide.

People who work in direct care can also take jobs at the Sunmount Developmental Disabilities Services Office in Tupper Lake, or at another agency, which explains some of the HHA gap — but those agencies are also looking for more workers.

“We also compete with the tourist industry,” said Leahy.

Reimbursement keeps wages low

Leahy said NCHS faces two main hiring challenges. She’d like to pay the aides more, but her budget is limited by reimbursement rates for in-home care. Medicaid and Medicare pay for in-home care, but not only are their rates low, they reimburse according to the number of hours the aide spends in the home.

“Our average visit is 1.7 hours,” said Leahy. The reimbursement for that visit must cover the aide’s training and travel costs, and often aides spend hours on the road every day. NCHS pays for time and gas mileage, as well as providing a benefits package.

With a 5,000 to 6,000 square mile coverage area, NCHS serves about 700 people, from Minerva to the Akwesasne Mohawk reservation to Plattsburgh. The aides spend a significant amount of time traveling.

“I think we pay as well as most,” said Leahy.

“We have to. They have to have a car, with good tires,” she continued.

Leahy has joined the NYS Home Care Crisis Campaign, an advocacy group pushing for better reimbursement for home care. There are several bills pending in the state legislature to address the issue, including one in the Assembly sponsored by Billy Jones, D-Chateaugay, and one in the Senate sponsored by Betty Little, R-Queensbury.

According to the Crisis Campaign, both the Medicaid and non-Medicaid populations are underserved, and there are just not enough home health aides to reach everyone who needs them, regardless of their income.

The Crisis Campaign is also working to overcome what it sees as a negative image of home care workers and rebrand them as “paraprofessionals.” Aides perform a key role by observing people in their care, and research has shown they notice changes in a client’s condition five days before a visiting nurse does. Also, by making sure their patients are eating and drinking, they prevent many emergency room visits, as these are often caused by dehydration and poor nutrition.

Similarly, simple tasks such as bathing are safer with help.

“When am I going to fall in my home?” asks Leahy. “Getting in and out of the bath. Having someone there to help with bathing is invaluable.”

Leahy said that studies prove having an aide visiting keeps people out of the hospital and prevents their having to go in skilled nursing facilities prematurely.

Good parents wanted

Women and men with experience raising families often make good home health aides, Leahy said. “Those skills are really invaluable. The skills you learn caring for a family are easily transferred to being an aide.”

The job also offers flexibility and a fair amount of independence. Malski works six days a week, more than 40 hours most weeks. “That’s my choice,” she said.

Clark, on the other hand, likes to work in the morning. “I always chose lesser hours because I could,” she said.

Leahy said they offer paid training for the job, but lately even when people sign up for the class, they often don’t complete it.

Malski took the class when she started three years ago, after 30 years working in retail. Of the 20 people who took the class with her, she’s the only one left on the job. “You can go to a hospital or ARC and do the same thing for two or three more dollars an hour,” she said.

But for those who stay, it’s not about the money.

“I get more out of it helping somebody,” said Malski.