Tri-Lakes area is experiencing home care shortage, too

SARANAC LAKE — The shortage of elder care workers in the Tri-Lakes is not limited to nursing homes. At-home care, like that provided by North Country Home Services in Saranac Lake, is suffering the same low staffing numbers as the live-in facilities, and that sometimes means staff are not able to be there for all their clients.

NCHS has 50 clients in the Tri-Lakes, according to CEO and President Becky Leahy, and 13 aides to care for them all.

“Yup, we’ve got a staffing shortage. No doubt about it,” Leahy said. “The last five or six years the staffing shortage has gotten extreme.”

Agency-wide, Leahy said they may treat 700 to 800 clients every day, and though other areas they cover — like Malone, Plattsburgh and Ticonderoga — have shortage problems of their own, none have it as bad as the Tri-Lakes. Leahy said in the Tri-Lakes area around 208 hours go unfulfilled each week.

In NCHS’s 6,000 square mile area, which includes Essex, Franklin and Clinton counties, there are 1,000 unfulfilled hours every week. NCHS is the only agency at-home agency for much of this region.

Donna Beal, the executive director of Mercy Care for the Adirondacks said if seniors do not get the care they need, it could land them in the hospital.

NCHS is a not-for-profit organization started in 1982 which provides nursing, home health aides and personal care aides through contracts through Medicaid, long-term care companies like Fidelis Care, or the local county offices for aging. Private individuals can contract its services, too, but Leahy said 90% of business is done through Medicaid contracts.

“We have to live on the Medicaid rates that we get,” Leahy said. “They traditionally have not been adequate enough to meet our costs.”

Fifteen years ago NCHS had an office in Tupper Lake with 78 aides working out of that office alone. With a shrinking workforce, that office closed and the Tri-Lakes region was consolidated into the Saranac Lake office.

Then in 2015, NCHS stopped paying mileage. In one month the agency lost 40 aides. Leahy said that NCHS pays for mileage again now.

However, recruitment has continued to shrink every year. NCHS has the only certified licensed training program for home health aides and personal care aides in Clinton, Essex and Franklin counties and runs three or four training classes every year. Leahy said the last class was run at the Saranac Lake training site.

“I wanted to make sure that I had the best possible situation to recruit people from the area,” Leahy said. “We ended up with one person from the Tri-Lakes taking it and the other 15 in the class were from Malone and Plattsburgh.”

Wages raised

Based on Facebook comments left on the Enterprise’s other stories on the elder care staffing crisis, low wages are the main reason more people don’t work in the field.

Home care aides start making $14 an hour. Wages were raised recently due to improvements in at-home care billing and minimum wage increases, but Leahy would like it to be higher.

“Our aides provide excellent service,” Leahy said. “I mean, I’d love to pay them $25 an hour. They’re worth it.”

She said she has to be able to pay aides enough for a good living, factoring in the need a good car and good tires to get around to jobs in the winter.

She said the average cost to NCHS for an hour of care is $36. This includes paying for the aide’s mileage getting there and the registered nurse that supervises them.

“Our direct care costs — and actually paying the aides — often and usually does exceed the rate we get from the payers,” Leahy said.

Rates paid by the customers are averaging around $33-35, depending on the source, Leahy said.

Managing overhead

“We have worked hard to keep our administrative overhead down,” Leahy said, adding that it ranges somewhere between 8% and 10% of all spending, lower than the state recommendation.

Leahy said state Sen. Betty Little, R-Queensbury, and assemblymen Billy Jones, D-Plattsburgh and Dan Stec, R-Queensbury, were “extremely helpful” with setting a new “rural rate” for at-home care providers in the last two years.

Rates for areas deemed “remote” or “frontier” are now around $35, instead of the $25 average it had been before.

Much of northern New York is rural, but some areas are more remote than others.

“There’s rural and then there’s rural,” Leahy puts it.

Portions of Essex, Franklin and Clinton counties are designated by the U.S. Agriculture Department as “far remote” or “frontier,” which means that residents in a zip code live 60 minutes or more from urban areas of 50,000 or more.

With this designation pointed out to them, legislators got $3 million in the 2018 budget to put toward an increased remote and frontier health care rate, which is dispersed to providers like NCHS through the rate system through 2021.

Leahy said she wants to put more resources into improving the job status of care givers, so that it would be seen as a legitimate career option.

Big investment

Beal said the Ralph C. Wilson Foundation and Catholic Health in Buffalo recently invested $20 million in a pilot program to develop new strategies for recruitment and retention. She said she started responding to the crisis in 2015, running a “successful” media campaign, including the Enterprise, Press-Republican and Malone Telegram.

“With that media attention, it did receive the attention of policy-makers in Albany,” Beal said.

Leahy said at-home elder care has to compete with other care industries. She said it takes a “special type of person” to want to work in home care. It involves a lot of emotional and physical support.

She said home care is a good value for customers compared to other options.

Leahy, who said she will be 70 soon, said she is hopeful for the future of the industry, but knows it will be a challenge.

“I think home care has a good future, but rural home care is always going to be a struggle because of the population and because of the cost providing it,” Leahy said.


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