March 2023: o4a Salutes Medical Mutual

O4a Home Care Roundtables Feature Direct Care Workforce Shortage

Starting in the fall of 2022, Ohio’s Area Agencies on Aging have been hosting home care roundtables in their communities to share with local and state elected officials and policymakers the challenges facing older Ohioans, people with disabilities, and home care providers and paid caregivers who are providing the most personal of care.

The Ohio Association of Area Agencies on Aging and other organizations are advocating for home care workers to be paid $20/hour, with at least a 50% increase in the Medicaid reimbursement rate for PASSPORT and the Ohio Home Care waivers (HCBS for older adults and people with disabilities, respectively). Coalition Letter

At the home care roundtables held around the state, older Ohioans, family members, direct care workers, Area Agency on Aging staff and home care providers shared their stories about the challenges they are facing.

Key themes emerged from these roundtables:

Low wages and low reimbursement rates drive workers away. Providers largely could only afford to pay $10-12 from the Medicaid hourly reimbursement rate for home care for older Ohioans and people with disabilities. People are interested in the work, but when they find out the wage, they leave for other higher paying opportunities. Providers will recruit, train and pay for background checks only for the individuals to leave, presumably for higher paying jobs. Providers identified childcare and health insurance as necessary for job seekers.
Recruitment and retention strategies will only go so far. Providers are employing many different strategies, including longevity and performance bonuses, using their own transportation services to help staff get to work, raffling off company cars, and wide-reaching recruitment outreach. They report that these strategies are barely helping retain staff, let alone recruit new staff to fill the gaps.
Other providers, programs and industries utilize the same workforce, and pay more. Medicaid reimbursement for developmental disabilities and Veterans HCBS is higher than for HCBS for older adults and people with disabilities (PASSPORT and the Ohio Home Care waivers, respectively), so providers will assign their workforce to those payors. Mileage and training are also covered by different programs like HCBS for developmental disabilities. Providers said that they will train new employees who then leave to work in nursing facilities for higher wages. In many cases these other programs provide rate increases which allow for pay raises, unlike the programs for older adults and people with disabilities.
Administrative work is not included in the rate. One of the most consistent issues was the RN supervisory requirement, which is not reimbursed separately and is not feasible for payment in the existing rates. The requirements and process for certification, and ongoing training and audit requirements also were identified as problematic given the low reimbursement rates.
Staff are currently living in poverty. Low wages mean that staff are in need of work supports including Medicaid health coverage, SNAP food assistance, subsidized child care and housing. Small increases in wages result in individuals experiencing a “benefits cliff” where they are still working at lower wages but are ineligible for these vital work supports. the benefit cliff – they want to pay more but are concerned about staff losing Medicaid and other benefits.

State leaders from the Ohio Department of Aging and Medicaid, as well as several elected officials from the state legislature and local government, attended the provider roundtables. State leaders shared efforts to address administrative burden and identify ways to build the capacity of the workforce through the efforts of the State Direct Care Workforce Expansion Working Group. Elected officials listened, shared their concern, and asked how they could make an impact.

The Ohio Association of Area Agencies on Aging shared opportunities for advocacy. At the federal level, Congress should support increased funding for states and Area Agencies on Aging for home and community-based services as part of Title IIIB of the Older Americans Act, as well as Medicaid.

At the state level, Ohio has special American Rescue Act Plan (ARPA) funding for home and community based services. That funding should be used to support and build the capacity of the direct care workforce. Also, the state can invest in home and community-based services through its two year state budget, which was introduced as HB 33 on February 15, 2023.

Notable Quotes

Home care “made the difference” for one participant “feeling connected and less isolated.”
For an older woman providing paid care, she spoke of the benefit of being “engaged and connected with the work and people” and having the additional money to support her.
“I want to go back to being her daughter” – family member caring for her motherWe don’t want people to feel like they are stepping down to be a caregiver”
“We can’t afford doing what we love at such low wages”
“It’s about helping people help people”
“They want to do this job but then they find out the wage and leave”
One provider said that her client called her worker “an angel on earth”