September 20, 2022
by Mark Friedman
The pandemic accelerated all aspects of the crisis. The Office of the Assistant Secretary for Planning and Evaluation researched the impact COVID-19 had on the home care workforce, and its findings were published in May 2021 by the US Department of Health and Human Services. Those findings focused on the caregiver shortage and the continued need for both focus and systemic solutions.
The pandemic created major disruption. Many Caregivers were unable to work due to child-care or home school support needs. Availability for most was, and continues to be, inconsistent. The ability to take a consistent ongoing schedule remains completely compromised for many. Additionally, many caregivers left to go be with family or found other work that they have continued.
We, like many, instituted a vaccine mandate in September 2021, but many caregivers were and still remain afraid of any form of vaccine due to negative experiences in other countries and as a result left the profession all together. This caused a further reduction in the workforce.
So, where are we now?
- Caregiver shortage is even more extreme and it has hit all aspects of the eldercare industry.
- Wages are at their highest ever with caregivers hourly pay rates ranging from $17-$25 an hour.
- Now that school is back in session, many caregivers are looking for school hours as many after school programs have not resumed due to teacher and/or other labor shortages.
- Call outs are frequent due to the above and many schools still required some form of quarantine.
The impact has been pronounced. In pre- COVID days, if we, like most agencies received a request for services, we would take the case and start within one to three days. Now it is a longer process. It can take up to 10 days to fully staff a large case with consistent caregivers.
We have always tried to staff a case with the minimum number of caregivers in order to provide a better client experience. A 24/7 case would be staffed with not more than 4-6 caregivers, albeit preferably four. Today, that is still the objective, but it is not always possible. The first two weeks of care may have more caregivers, as the focus is to cover the schedule and then stabilize the care team.
The “system” has not adjusted to this new, but permanent state. Families and referral sources (e.g. rehab discharge professionals) often need care “tomorrow.” While all agencies would love to accommodate these needs, many agencies are working from a waiting list that can be two to three weeks out.
What does this mean for families? Flexibility is key, advanced planning is critical, and patience is more than a virtue; it is a necessity to allow the care to be put in place and ongoing staffing to be accomplished. A thorough assessment process to identify the care needed must be a priority, and then the schedule and budget should be factored in. The focus must be on managing outcomes and risk. Costs will continue to rise – wages, insurance, transportation, etc. Agencies must truly partner with families to manage the economics, the care, and the quality to achieve successful outcomes. There must be a clinician (Geriatric Care Manager, Geriatric Social Worker or Nurse) defining and evaluating needs and creating the plan of care.
We, like many, remain committed to the quality of care and quality of the care experience. Our golden rule remains, “If it is not good enough for my parents then it is not ok for anyone else’s.” The need is for a true partnership between the agency, other providers and the family, to make sure all needs are met, economics are respected and patience prevails. Tradeoffs will have to be made and teamwork is the only bridge to success.
Coming up is a focus on strategies for managing cost and quality:
- The Life Profile Assessment – using science to define the Right Care
- The role of integrating technology and care to manage the new norm.