This article first appeared in The Lansing State Journal on February 7, 2019. Read the original there.
GRAND LEDGE — Doreen and Madeleine are fast friends.
They only met in November, but now they spend hours together each day. Doreen reads to Madeleine, anything from Charles Dickens’ “Great Expectations” to the “Berenstain Bears.” She asks Madeleine about her favorite music and TV shows. They hold hands and laugh.
Madeleine Mulder is 23. She has cerebral palsy. She talks to Doreen with her hands and a speech-generating device on a tablet. She cranes her neck to see Doreen when Doreen leaves the room.
This is the happiest Doreen Bowerman has been in her working life. As Madeleine’s home-care worker, she feels like she makes a difference every day.
During the years she worked as a legal assistant, she had full benefits, she said, “but not these kinds of benefits.”
Odds are, someone like Bowerman will one day care for you or someone you love.
But, in Michigan and across the country, there aren’t enough home-care workers to help the elderly and people with disabilities.
Michigan alone will need more than 30,000 additional direct-care workers by 2020, and thousands more as the state’s senior population spikes over the next 15 years, according to projections from PHI, a worker advocacy organization focused on the direct care workforce.
But home-care jobs pay poorly. Most offer inconsistent hours, no benefits and few opportunities for advancement. And because compensation is often tied to what the federal government will pay, local employers don’t have easy solutions.
Researchers and advocates for the elderly say home-care workers are a vital bridge between independent living and more intensive forms of managed care.
What home-care workers do
Home-care workers help with personal hygiene, cooking and shopping. They administer medication and make sure clients get to doctor appointments. They can help catch health problems early, reduce fall rates, keep their clients out of hospitals and free up time for family members.
“Doctors are paid hundreds of thousands of dollars because we value that they’re saving lives,” Lansing home-care agency owner Meghan Pineda said. “We don’t value the people who were paid to care for them along the way.”
In Michigan and other parts of the country, industry leaders and advocates are searching for ways to alleviate the shortage by beefing up training, pushing new policies and connecting workers with one another.
Filling these jobs isn’t just about keeping people out of nursing homes, Pineda said. It’s about ensuring quality of life for some of society’s most vulnerable people.
And, maybe someday, for ourselves.
‘We’re very underpaid for what we do’
If nothing is done to bring in more home-care workers into the field, there will be a shortage of at least 350,000 by 2040, Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management argues in his book, “Who Will Care For Us?”
Part of the the problem is that average pay for a home-care worker is about $10 an hour, according to Bureau of Labor Statistics data.
One in five home-care workers lives below the federal poverty line. More than half rely on some form of public assistance, according to PHI.
The Tri-County Office On Aging pays agencies in Ingham, Clinton and Eaton counties approximately $15 an hour via Medicaid funds for personal care work, said Marion Owen, the organization’s executive director.
That $15 needs to cover home-care workers’ salaries as well as training, background checks, insurance and overhead costs for agency owners, Owen said.
On top of low wages, home-care workers typically use their own vehicles to get to and from their clients. They also aren’t guaranteed a 40-hour work week, and, for most, there’s little to no benefits offered through their employers.
“You’re asking a lot out of somebody for 10 bucks an hour,” home-care worker Jean Mumma said.
Still, three years into the job, Mumma said she can’t imagine doing anything but home-care work.
Mumma, who is 53, used to work as a safety sitter at Sparrow, ensuring that patients didn’t hurt themselves. She never really got the chance to get to know the people she cared for. She likes that, as a home-care worker, she forms relationships.
And having studied geriatric and adolescent psychology in college. Mumma especially likes working with people with dementia and other memory-related illnesses.
“It’s so important that you feel safe,” she said “When you don’t have your memories, that’s a scary thing.”
But Mumma has health insurance through her husband’s job as a construction contract administrator at Michigan State University. She’d have a difficult time making ends meet without his salary, she said.
“We’re very underpaid for what we do,” Mumma said. “And that’s not a criticism of my employer. That’s a criticism of our society.”
Meghan Pineda, who owns Wind Beneath Your Wings home-care agency in Lansing, said she’s constantly trying to recruit new workers.
Pineda estimates she hired about 45 people in 2018 but lost about 30. Her most recent hire just didn’t show up for her first day of work.
Still, home-care jobs are “a dime a dozen,” she said.
Most of Pineda’s clients get their home-care through Medicaid, which means her agency can’t just increase their rates in order to pay higher wages.
“We can’t afford to pay as much as caregivers deserve or as much as we’d like,” she said. “I’d like to pay them more … but we have to provide insurance and bonding and workers comp and all of those are expensive.”
But the health benefits and economic benefits of home-care are well established.
Trained personal-care aides can reduce rates of falls and hospital visits, said Clare Luz, a gerontologist and associate professor of family medicine at Michigan State University.
They can help to manage chronic conditions, catch medical issues before they get serious and expensive, give the people they care for choices and flexibility. Home-care workers also can also help people transition out of a hospital and ensure their clients take medication and follow up with doctors.
A 2011 study from Emory University found that improved transitional care and management of chronic conditions could save about $240 billion in federal health-care spending over a decade.
Part of that is the fact that keeping people in their own homes is also more cost effective, Luz said.
And staying at home makes it easier for people to contribute economically and socially to their communities.
“It’s not just providing care for an individual, it’s creating conditions for them to also be enriching society in a variety of ways,” she said.
Why home care matters
Patricia House, 92, has lived in the same Dimondale home for more than 60 years.
In the summer months, her daughter Dianna takes her onto their wrap-around porch. They have a drink and enjoy the weather.
Patricia has Alzheimer’s, and Dianna House said taking her mom to a new place would be jarring for her.
House retired early from an office job at Sparrow so she could move in with her mother and take care of her full time.
House also has a home-care aide to help 15 hours a week to help with laundry and household chores. House also gets an extra pair of hands to help bathe her mother.
It takes some of the pressure off.
“It allows me to go to a movie,” House said, “just get out of the house.”
Mark Hornbeck, a spokesperson with Michigan AARP, said there are about 1.3 million unpaid home-care workers in Michigan.
An estimated 1 in 5 Americans have provided unpaid care in the past 12 months. And about 66% of family caregivers are women. Many baby boomers are now part of what’s sometimes called the “sandwich generation,” taking care of a parent at the same time they’re caring for their own children.
“Just think how much bigger the shortage would be if the unpaid workers weren’t out there,” Hornbeck said.
Adding to the growing need of home-care workers, family structures have also changed. People live farther away from their families and people are less likely to live in multi-generational homes.
Before Dawn Schelthelm started working with home-care worker in July, she relied on her son and friends and neighbors to help her.
Schelthelm has a progressive form of rheumatoid arthritis and needs help with cooking, laundry and showering.
If she didn’t have a home-care worker, Schelthelm said, she’d either have to rely entirely on the goodwill of family and friends or end up in a nursing home. Since July, she’s had an aide visit for about two hours every day .
Now, when her 22-year-old, Oliver, visits, Schelthelm doesn’t have to worry about having a list of chores ready or scheduling their time together based on when she needs to run errands. Recently, they’ve watched movies and made Hello Fresh meal kits together.
“I think that Oliver feels a lot better about the situation knowing that I have an aide that comes in for two hours,” she said.
Madeleine Mulder has had about 10 home-care workers throughout her life, but by and large her parents have managed her care
Cheryl Mulder, Madeleine’s mother, hasn’t always connected with home-care workers in the past. She said it takes a big leap of faith to let someone into your home to work with your loved one.
But Doreen Bowerman was instantly a good fit.
“I know Madeleine loves me,” Cheryl Mulder said. “But she doesn’t see me when Doreen is here.”
What’s being done to help them?
Last year, the Minnesota Department of Human Services launched an online job portal that connects people who need home care with caregivers looking for work.
The free program, called Direct Support Connect, was paid for through collective bargaining agreements with Minnesota and Service Employees International Union Healthcare Minnesota, though anyone can use the site.
In Maine, a ballot measure on November’s ballot would have created universal home care in the state.
The idea didn’t pass, but it would have provided home-based care to people with disabilities and senior citizens regardless of their income, paid for by a 1.9% tax on earned income above $128,400.
And, on the East Coast, there’s a growing number of cooperatively owned home-care agencies. Under that employee-owned business model, workers buy a share in the company and have voting power regarding big decisions.
But what works in one state, might not work in another, said Ryan Cowmeadow, the executive director of Area Agencies on Aging Association of Michigan.
“It’s not an apples to apples situation,” he said. “You have to pull pieces out, and that takes time and energy and will to do that.”
Funds for Medicaid come from both the federal government and from state governments.
The federal government sets certain standards, but gives states considerable flexibility with regards to the services they provide, which means both state and federal reforms are likely needed, said Josephine Kalipeni, a director at Caring Across Generations, an organization working to expand long-term care services.
“I think there’s an obligation from both sides,” she said. “States might have the most ripe grounds to make progress given what the federal landscape looks like.”
In Michigan, educators and people within the care-giving community founded Impart Alliance, a nonprofit group established to create and expand a person-centered care training program.
Impart Alliance recently awarded a $407,000 state grant to establish a Caregiver Training Academy, which provides training for personal-care aides, trainers, family caregivers, and high school students.
Giving people more specialized training can play a part in helping drive up wages, Luz said.
“I will always argue that this is not a one-strategy problem,” she said. “Training is a key variable, a key factor … We need to hit it from a lot of different angles.”
And if home-care workers were better trained and higher paid, Medicaid and insurance companies would actually benefit economically, because patients would avoid more expensive medical care, she said.
The training focuses on the people receiving care, Luz said. People who take the training don’t just learn how to give someone a bath, they learn how to bathe another person in a dignified way, she said.
The Impart Alliance is also trying to create an association for personal-care aides that would create best practices and ethical standards while also offering support for workers and ideas within the industry, Luz said.
Raising the cap on Medicaid would make a large difference for recruiting a workforce, Luz said, but addressing the shortage will need variety of vantage points. It’s going to need the cooperation of home-care workers, people in the medical field and legislators to make change.
Urena Thomas works around 38 hours a week as a home-care worker, but she’s not guaranteed hours. Sometimes, her clients have family visiting or they are hospitalized, which means she’s out some of her shifts.
Thomas is taking classes at Lansing Community College. She hopes to become a social worker one day, working primarily with older people.
She has been in home-care for 20 years, an eternity in an industry where turnover is the rule.
“I probably could have switched fields a long time ago,” she said. “I have a heart for this.”