6 • SUNDAY, AUGUST 25, 2019 • CAREGIVER
GROWING CONCERNS
kids to school, go do your job and
know that mom is still OK,” she
said.
“It’s hard. It’s very hard to juggle
a job and kids and have your
loved one going through illness
or dementia and still have an
everyday life. Because life still
happens.”
Oswald said they’re always looking
for good caregivers, with the
emphasis on “good.” Her hiring
requirements includes at least two
years’ experience and a vehicle,
which can narrow an already thin
pool.
Pay at Happy at Home starts at
$11 per hour, which is the average
for the direct care worker in the
state, according to the Pennsylvania
Homecare Association.
But part of the problem, the
PHA notes, is that the state Medicaid
reimbursement rate of $17.52
per hour is inadequate when
taking into account that agencies
must not only pay wages but also
the cost of background checks,
tuberculosis screenings, training,
workers compensation and other
insurances, payroll taxes and administrative
costs.
There has been a small measure
of help from the state this year.
Pennsylvania’s budget for 2019-20
included a two percent Medicaid
increase for personal assistance
services, but for Oswald, the additional
35 cents per hour she’ll
receive starting in January isn’t
going to translate into being able
to offer a substantially higher pay
rate to attract more employees.
“If the state’s not reimbursing
me anything more, then I can’t
pay my employees more, and
that’s what ours and other agencies
are up against,” she said. “I
have some workers making $13
or $14 an hour if they’ve been
working here longer. But if they’re
making $13 or $14 an hour, I’m
making nothing. If they’re making
any overtime, well …”
As far as wages go, it’s really
important to understand that the
typical home care agency operates
on very thin margins, Threlkeld
said.
“With many patients they have,
there will be little or no profit,
so the best way to increase wages
is to increase the reimbursement
rates that agencies get from Medicare
or Medicaid,” he said.
“If those reimbursement rates
are kept where they are or are
cut, it obviously makes it more
difficult to pay people what they
want.”
According to the Bureau of Labor
Statistics, as of May 2018, the
national median hourly wage for
a home health aide was $11.63.
The median hourly wage for a
short order cook was $11.44 and
for retail sales workers it was
$11.33, by comparison.
Without the ability to pay home
health care workers more, agencies
often lose out to industries
that offer similar pay for what can
be perceived as less demanding
work, and even the rise in the
“gig” economy, such as driving
for Lyft and Uber, can cut into the
supply of those seeking part-time
work for whom the flexible schedules
of in-home care was often
seen as a perk.
All that could translate into a
reduced amount of care available
to patients and their families.
“Many of the people who work
in home health care have to see
multiple patients a day, and if the
number of patients keeps going
up, it will be difficult to meet
that demand, especially since you
don’t want to shortchange patients,”
Threlkeld said.
“If it means spending a certain
amount of time with a patient
in order to do the job right, then
that’s what it takes to do the job
right.”
Oswald said they’re always
trying to improve their offerings
to employees. She also looks to
target people such as nursing
students and others who truly
want to be in the field as a
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career for whom the opportunity
for education, training and skill
development will be considered
worthwhile as a way to ensure
supply can meet demand.
Threlkeld said that emerging
technology will be able to help,
at least somewhat, as the need
for in-home assistance increases,
with telemedicine and the growing
ability to monitor patients
remotely.
But in the end, he said, the
industry is going to have to add
more people.
“Policy makers are going to
have to make expanding access to
home health care a priority,” he
said. “That’s the issue we work on
every single day. You can’t expect
to keep doing things the same
way and get different results.
“Policy makers are going to have
to understand that home health
care is the future. It’s what people
want, it’s an affordable alternative
(to institutionalized care) and
they need to prioritize it.”