Newbury, Vt.
“I love to be around old people,” Payne said in a recent interview at the Oxbow Senior Independence Program, an adult day program on Route 5 in Newbury that she attends on weekdays.
Now, at 73, Payne is the one in need of assistance. She lacks some mobility in her arms due to an injury caused by a fall and subsequent surgeries, and also has muscle spasms in her legs, which put her at risk of falling.
Payne, who lives with her cat Gabriella in a first-floor, subsidized apartment in the Montebello Hill development where the day program is located, could use some help with what are known in the industry as “activities of daily living.”
That includes showering on the weekends when the day program is closed, doing laundry, making her bed, mopping her floors and cleaning her bathroom. But she’s had trouble finding someone to assist her.
“I’ve been looking for quite a while,” she said.
Payne is not alone in finding it difficult to get help at home.
It is a pretty simple math problem: The “patient population is growing well beyond the applicant pool,” said Mary Lambert, the human resources director for the New London-based Lake Sunapee Region VNA & Hospice.
Contributing factors include the overall low unemployment rate — about 3 percent in both Vermont and New Hampshire — the aging demographic, and the low pay and hard work that caring for aging adults at home entails.
The workforce shortage in both states affects all sectors of the economy. In health care, for example, the shortage has forced employers to offer nurses and nursing assistants flexible hours, loan repayment, on-the-job training and opportunities to continue to work part-time after retirement. Upper Valley nursing homes and hospitals often turn to traveling nurses to fill in when they can’t find local workers to do the job.
The so-called “travelers,” who are staffed through employment agencies, are more expensive than regular employees, and also leave after a few weeks or months, increasing turnover and disrupting the continuity of care.
Home health workers, sometimes known as personal care assistants or direct care providers, are integral to enabling seniors and adults with disabilities to remain at home and in their communities.
But as the number of people needing such care grows, without a source of workers to provide the care, the shortage is becoming more acute.
The workforce shortage is a national challenge, said Dr. Adam Groff, chief medical officer for Bayada Home Health Care, which has offices in 22 states including Vermont and New Hampshire.
But, the “unique thing about this region is that we have an aging population, (which is) aging faster than some other parts of the country relative to the workforce,” said Groff, who also works as a part-time hospitalist at Dartmouth-Hitchcock Medical Center.
In New Hampshire, residents 65 and older will make up almost 30 percent of the state’s population by 2040, while the share of residents ages 25 to 64 will drop from 54 percent in 2015 to 45 percent by 2040, according to population estimates from the state’s Office of Energy and Planning (now the Office of Strategic Initiatives).
Similarly, 27 percent of Vermonters are expected to be 65 and older by 2030, according to estimates prepared by the Vermont Agency of Commerce and Community Development in 2013, the most recent data available.
As in New Hampshire, this increase coincides with a projected decrease in people of working age — ages 25 to 64 — who represented about 54 percent of the population in 2010 and are expected to drop to about 46 percent of the population by 2030.
It’s unclear exactly how acute the current need for home care is but anecdotally people working in social services in both states say the need has grown in the past couple of years as the labor market has tightened.
“I don’t have any data,” said Megan Tierney-Ward, the adult services director for Vermont’s Department of Disabilities, Aging and Independent Living. But, “there’s a feeling of urgency now that wasn’t there last year.”
The risks of failing to provide home care services when they are needed include forcing a person into a more expensive, higher level of care, such as assisted living or a nursing home. The workforce shortage can also put increased pressure on family caregivers, such as an aging spouse or adult child, who may also be juggling job and child care responsibilities.
“Burnout is a real thing,” Tierney-Ward said.
The Lake Sunapee Region VNA & Hospice struggles to fill positions and retain employees in its private care services program, said Lambert, the human resources director. The program assists people with activities such as showering, toileting, dressing, laundry, meal preparation, medication reminders, errands, transportation and pet care.
Challenges include low rates of pay — often well below $15 an hour — competing with other employers for employees, the stress of the work and the region’s demographics, Lambert said.
One of the difficulties with attracting employees to the Lake Sunapee VNA’s private care services, which patients and families primarily pay for out of their own pockets, is that they are not guaranteed hours and they do not receive benefits, Lambert said.
“When they leave we have to turn cases away,” she said.
And, “every time we post a job there are fewer and fewer applicants.”
Pressures on Families
The problem, though growing in part due to the aging demographics, is also a challenge for families caring for adults with disabilities.
Lisa Green’s 26-year-old son, Patrick, requires 24-hour care. He has autism and a seizure disorder.
Green, who is a single mom in her 50s and works full-time as assistant property manager for Emerson Place Apartments in Lebanon, sought a part-time person to help care for Patrick for more than a year, from early 2017 until January.
“It’s just been really hard,” she said.
When Patrick first graduated out of the school-based support system for youth with disabilities at 21, it was easier to hire people to fill one full-time spot and another 18-hour spot to help her, Green said. But it’s gotten harder in recent years.
“We have a very special community here,” Green said. “It’s a beautiful place to live.”
But, she said, the region’s cost of living makes it difficult for a person earning $14 per hour to live near the Greens’ home in Lebanon, where the median home value is $240,000, according to the 2016 American Community Survey.
Instead of hiring the part-time aide herself, Green went through PathWays of the River Valley, a nonprofit agency that serves people with disabilities in Sullivan and lower Grafton counties.
Kim Henning, senior director of human resources for PathWays, pointed to the low rate of pay — usually between $10 and $13 per hour — as the primary challenge in recruiting employees to care for adults with disabilities at home.
“It’s definitely gotten more challenging in the last year and a half,” she said.
For Pathways, the challenge is daily, Henning said. Either a good candidate finds a job elsewhere, or a current employee puts in their notice, she said.
While Green sought to fill the vacant 18-hour per week position, friends and neighbors helped.
“In general the community is very supportive,” she said. “In my case, people are afraid of the seizure part. It’s just a little scary.”
Naomi Gariepy, 22, started in January and having her on board has been a big relief for Green.
In addition to keeping an eye out for a seizure, Gariepy drives Patrick to various activities and helps him stay on task at his job at Omer and Bob’s sports shop in Lebanon.
Gariepy, who has an uncle with a seizure disorder, didn’t need to have special training before she started, Lisa Green said. Instead, Green said she looks “for someone who’s patient, very kind, who’s not going to be aggressive with him and who’s fun.”
In part because of her experience with her uncle, who lives in a group home in Massachusetts and has intellectual as well as physical disabilities, Gariepy said she was drawn to helping people. The job is working out well, she said.
“I feel like I did get really, really lucky with getting Pat as the person I’m working with,” she said.
Gariepy, who lives in Bradford, Vt., also teaches yoga and is interested in herbalism. She’s happy to work with Patrick Green for now, but isn’t sure what her long-term future holds.
“I don’t know if I would make a career out of it per se,” she said.
Now that she has Patrick’s current needs being met, with help from the state’s Medicaid waiver program, which pays for the care, Green is eyeing the future. As she approaches her 60s, she said she’d like to have a plan for her son that doesn’t rely on her ability to care for him, but allows him to live as independently as possible.
In the future, Green said she’s hopeful she will be able to find a place for Patrick in a supported home for people with developmental disabilities that the Enfield-based nonprofit Visions for Creative Housing Solutions aims to establish in Lebanon.
“A lot of us we see that that’s probably the best option for us right now,” she said.
Access Issues
Access to help at home is varied and somewhat related to income. Those whose income and assets are low to qualify for Medicaid sometimes have better luck.
Betty Paton, 78, like Payne, lives in the Montebello Hill development and participates in the Oxbow adult day program. She has Parkinson’s disease and has both Medicare and Medicaid.
Paton worked a variety of jobs after dropping out of school in the eighth grade, including 18 years putting together wooden panels at Bradford (Vt.) Veneer & Panel Co. She married young and has three sons.
Medicaid pays an agency to send a woman to Paton’s apartment once a week to clean the bedroom and bathroom and help with laundry. An adult son, Francis, who lives in North Haverhill, spends weekend days with her. Due to a 2009 spinal surgery, she can’t drive. Her son takes her grocery shopping.
For now, Paton is able to shower on her own, but she doesn’t know what the future holds.
“Maybe down the line (I’ll) need help,” she said.
Though Paton has the help she needs and the ability to pay for it through Medicaid, there is a high turnover in the agency that provides the service. Half the time the cleaning aide doesn’t come at the appointed time. In that case, Paton says she has to call a caseworker to get the agency to send someone else.
“She’ll get ahold of them,” she said.
Thomas Slavin, 56, struggles with a seizure disorder and bipolar depression. The resident of the Gile Hill development in Hanover qualifies for four hours of housekeeping assistance per week through Medicaid, but has been unable to find anyone to provide that assistance recently.
Partly because he often has trouble sleeping, Slavin said staring at a sink full of dirty dishes can be overwhelming.
“It becomes something it’s not,” he said. But, “What I’ve come to realize (is) that there isn’t going to be any help coming in.”
One day last month, Slavin slept from 1 a.m. to 5 a.m. and then forced himself to get up and put away his canned goods.
“I finished the dishes,” he said. “That made me feel really good. That is an accomplishment.”
There are some tasks, however, that Slavin — even on a good day — cannot perform on his own. Due to chronic obstructive pulmonary disease, Slavin said he cannot carry his trash to the dumpster.
That day in March, a visiting nurse who had come for Slavin’s weekly 20-minute visit carried the trash out for him. She also checked his medication, lungs, blood pressure, temperature, pulse and looked for swelling in his extremities.
For the time being, Payne, who is a “smidge of money” away from qualifying for Medicaid — which could help in her search for at-home help — is also getting by. She gives herself sponge baths on the weekends, knowing she’ll get a good shower at the adult day program come Monday. Standing to cook also is difficult because of her muscle spasms, and her arm movement is limited.
When she’s home, she doesn’t eat much, maybe a cup of coffee, a cereal bar or a bowl of cereal. But, she knows she’ll get a good breakfast and lunch at the day program during the week.
“I get along the best I can,” she said.
Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
