COA and ESP providers work to address home care aide shortage

Monday, November 13, 2017

Council on Aging (COA) and the provider network that delivers in-home care services to more than 20,000 older adults and people with disabilities in southwestern Ohio have been working together to tackle a difficult problem – a shortage of home care workers.

The shortage is not isolated to this region; it’s a national problem that will only worsen as the older adult population continues to grow.

“Direct care workers are providing personalized care in people’s homes but they are not paid enough for the critical work they’re doing. The situation worsens in an improving economy where people have more employment options,” said COA’s VP of Program Operations, Ken Wilson.

According to a 2016 New York Times article, home care aides earn a national median salary of $10.11 an hour, which is actually less than their median salary more than a decade ago.

Council on Aging clients who rely on home care aides for help with things such as bathing and housekeeping, have reported service issues related to the worker shortage. For example: home care aides who do not arrive when scheduled; inconsistency in the assigned aide who delivers their services; difficulty getting service in the evenings or on weekends; and going periods of time without services.

Organizations that provide or administer in-home care services, like Council on Aging, are taking steps to address the issue. At the state level, a rate hike took effect in January 2017 for providers of the state’s PASSPORT program after providers and Area Agencies on Aging reported that low Medicaid reimbursement rates were driving providers out of the market. PASSPORT is Ohio’s in-home care program for Medicaid (low-income) seniors.

In Southwestern Ohio, the Elderly Services Program (ESP) has also been affected by the worker shortage, especially in more rural parts of the region. ESP is funded by county-tax levies and is for seniors who are not eligible for Medicaid. COA manages the Elderly Services Program via contracts with county commissioners in Butler, Clinton, Hamilton and Warren counties. Provider agencies contract with COA to deliver in-home care services to seniors enrolled in ESP.

COA and providers who deliver home care assistance services (a combination of housekeeping, personal care and caregiver respite) have been working together to find solutions that will allow more flexibility in the way services are delivered and also identify and remove service requirements that increase costs but generally add little value to the program itself.

Examples of changes include:

  • More flexibility in how services are scheduled
  • Grouping providers and home care workers by region to reduce drive time for aides and create economies of scale
  • Increasing the reimbursement rate by $2.00 an hour in Warren County with the requirement that the increase is passed on to the direct care workers
  • Recruiting new providers to serve rural and hard to serve areas
  • Expanding the consumer directed care option to all ESP counties (client can hire a friend or family member to provide home care assistance services)
  • Changing training and certification requirements for aides who provide only housekeeping services
  • Providing education to clients about the home care assistance service and how to report problems with their service or aide

The rate increase in Warren County was recommended by leadership at COA and endorsed by the Warren County Elderly Services Advisory Council, whose members are appointed by county commissioners to provide oversight of the program.

“Home health workers provide an important yet undervalued service to vulnerable seniors in our county,” said Chuck Peckham, Jr., chair of the Warren County Elderly Services Advisory Council. “By requiring that the rate increase be passed directly to home health workers, we hope we are sending the message that we appreciate the important work they are doing every day for seniors in our communities.”

Additionally, COA is planning to competitively bid home care services during 2018, which would include setting new hourly rates for home care services and revising requirements for service delivery.