At-home caregiver shortage weighs on Upper Valley families, loved ones

  • Nick Nikolaidis helps his wife Heidi Nikolaidis into bed at their home in Bethel, Vt., on Thursday, Oct. 21, 2021. Nick has been Heidi's full-time caregiver since she had a stroke six years ago, and though Vermont’s Choices for Care program would cover paid help for 30 hours a week, Nick has struggled to find enough people to cover those hours. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to Valley News / Report For America — Alex Driehaus

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    Nick Nikolaidis, left, and Heidi Nikolaidis look through photo albums at their home in Bethel, Vt., on Thursday, Oct. 21, 2021. Heidi likes to look through old photos, especially those that show her travels to places like China, India and Thailand. "Someday we're going to go there again," Nick said to Heidi as they flipped through the pages. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to Valley News / Report for America — Alex Driehaus

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    A photo of Heidi Nikolaidis, left, and Nick Nikolaidis as a young couple in New York is kept in a photo album at their home in Bethel, Vt., on Thursday, Oct. 21, 2021. Nick says that when they got married they promised to care for one another for better or for worse and he takes that vow seriously. "Now maybe we're going through some hard times," he said, "but better ones will come." (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to

Valley News Staff Writer
Published: 10/23/2021 9:45:48 PM
Modified: 10/24/2021 6:15:15 PM

BETHEL — For decades, Nick and Heidi Nikolaidis, he originally from Greece and she from Germany, ran the Black Forest Cafe on Main Street.

But they had to close the business in downtown Bethel about six years ago after Heidi Nikolaidis had a stroke, which left her unable to speak and without the use of her right side. Since then, Nick has been her full-time caregiver.

“My job is 24/7 here,” Nick said.

The 76-year-old former restaurateur helps his wife — his elder by 35 days — get out of bed, use the bathroom, dress and bathe. He makes their meals, does the shopping and takes her to appointments. Their son Peter, who now lives in the Boston area and works in cybersecurity for Dartmouth-Hitchcock, gave them an Amazon Alexa smart speaker, communicates with them daily and helps as he can.

Through Vermont’s Choices for Care Medicaid program, the couple has paid help come to their home about eight hours each week, but that’s nowhere near the hours that the program would cover if Nick could find someone. The caregiver they have gets $20 an hour.

“I could have at least people for 30 hours a week, which would be a blessing, but I can’t find anybody,” he said.

They are not alone. Challenges finding help at home have become more acute in recent months amid a workforce shortage across industries in the Twin States and beyond. It’s not yet clear what these challenges may mean as a growing number of people need care and fewer workers are available to provide it.

There are several factors contributing to the home-care challenge, including the region’s aging population, said Angela Smith-Dieng, the director of the Adult Services Division for the Vermont Department of Disabilities, Aging and Independent Living, which includes the Choices for Care program. In addition, the work is difficult and the pay is relatively low, though the Legislature did increase Medicaid rates 3% for home-based services earlier this year, Smith-Dieng said.

“People are really working hard to try to make it work and to meet needs,” she said. “It’s just a really challenging time.”

Due to difficulty finding workers, care managers at home-care agencies and area agencies on aging try to triage the situation, ensuring that families get their most critical needs met, such as assistance with bathing and toileting, Smith-Dieng said. At the same time, agencies aim to help families sort out which relatives or neighbors might be able to help with the grocery shopping or the laundry.

“Typically we would be supporting having caregivers go in and do all of those things,” she said.

It’s not yet clear what the consequence of the workforce crunch will be, Smith-Dieng said. The department is monitoring whether more people, such as the 3,100 like Heidi Nikolaidis whom the Choices for Care program supports to stay at home, may have to move into long-term care facilities as a result of being unable to find caregivers. Officials also are wary of the effect the workforce problems may have on emergency department visits or on caregiver burnout for family members.

Concern about such burnout is “one of the reasons why we’re trying to put more supports in place for family caregivers because they’re shouldering a heavy burden right now,” she said.

Officials are turning to area agencies’ networks of volunteers to see if they might be trained to perform more caregiving responsibilities, she said. In addition, state officials are exploring ways that technology might be employed to help people perform daily tasks such as meal preparation or getting around their home when a human caregiver may be unavailable.

“I don’t think there’s going to be one wholesale solution to this,” Smith-Dieng said.

Unfortunately, there is no end in sight to the workforce issues, she said.

We “need to adapt our systems and our workforce to address that,” she said.

Some families are thinking creatively to get their needs met.

Liza Deignan, president of the board of the Thompson Senior Center in Woodstock, unexpectedly found herself seeking caregivers to help her husband, Dan Bellmore, after he fell and suffered a traumatic brain injury this spring, she said during a panel discussion at the Thompson and online last week about finding a caregiver.

After home health agencies told her they would have no workers available when Bellmore would be arriving home, Deignan noticed a Listserv post from a family that was offering a hospital bed.

As it turned out, “someone not very far away had passed away” and the workers providing round-the-clock care to that person were suddenly out of work, Deignan said in a recording of the event.

Even after finding people able to provide the necessary care, it was a puzzle to sort out which responsibilities she and her family could handle and which they needed hired help to provide. Another factor was what type of help her husband was willing to accept, she said.

“I had to think of myself as one person pitching in to a team,” she said.

The hired caregivers came from varied locations across the region, including Enfield, Claremont and West Rutland, Vt.

“The caregivers also themselves have very complicated lives, they really do,” she said. There was “lots of flexibility required.”

For his part, Nick Nikolaidis is doing the best he can. Heidi will go to a nursing home “over my dead body,” he said.

The “good thing is that she’s still here,” Nick said. There are “good people taking good care of her when they’re here.”

To get more help, he’s tried advertising online and in the newspaper to no avail, he said. He’s also tried calling the Thompson and word of mouth.

“I don’t know where else to look,” he said. “I’m resigned to the idea that it will take some time to find other people. That’s all I can do.”

Heidi sleeps for much of the day, but she enjoys occasional outings such as summer trips to Ice Cream Fore-U in West Lebanon for a serving of rum raisin, her favorite flavor. She also watches television and particularly favors a musical program on the Brigham Young University station on Sunday mornings, Music and the Spoken Word.

If Nick needs to run a short errand, he has a former caregiver with back problems who he can call on to stay with Heidi, he said.

Nick experiments with different meals, trying to find the right match for her changing tastes. While she can’t use words to tell him when he gets it right, he can tell.

“I can see the approval in her eyes,” he said.

Nora Doyle-Burr can be reached at or 603-727-3213.

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