The coronavirus pandemic has changed the way some older people and their relatives think about long-term care for those who cannot live independently, moving towards at-home care rather than nursing homes and other senior care facilities. But staffing shortages continue to afflict the home care industry across Maryland and the nation, as well as developmental disability care organizations.
Medicaid has been the nation’s largest funder of long-term care, and in recent years, the federal program spent more on home- and community-based long-term care rather than institutional care, according to the National Conference of State Legislatures.
The pandemic caused “significant fluctuations” in long-term care services, as nursing facilities across the state saw a significant decrease in service while home care increased, Steven Schuh, the deputy secretary for health care financing and the Medicaid director for Maryland Department of Health, told the legislature’s Joint Committee on Children, Youth, and Families on Wednesday.
More specifically, there were 760 more individuals participating in a Medicaid program that allows adults with physical or age-related disabilities to live in their own homes now than before the pandemic, Schuh said.
However, staff shortages in the direct care workforce, including nursing home and home care staff, continue to plague the industry.
A recent survey by the National Center for Assisted Living found that 99% of nursing homes and 96% of assisted living providers are facing staffing shortages, said Allison Roenigk Ciborowski, president and chief executive officer of LeadingAge Maryland, an association of nonprofits dedicated to expanding services for the aging.
“We see that here in Maryland. You can talk to any home and community based provider, any hospice organization, and they are struggling to find enough staff,” she said. Nearly every facility is asking its staff to work overtime or take on extra shifts, straining the existing workforce, Ciborowski continued.
More than 70% of nursing homes and assisted living providers say they are concerned that workforce challenges or the lack of qualified employees could force them to close, according to the same survey.
Ascension Living St. Joseph’s Place in Frederick County is slated to close next month. The western part of the state is especially impacted by the long-care workforce shortages, Ciborowski said.
Even raising wages does not solve the problem because jobs such as housekeeping are very competitive and some employers offer large sign-on bonuses that the home care industry cannot afford, she continued. “Our field is not an easy place to work. You really have to be passionate, you really have to care, you have to want to do it because there are easier places to work,” she said. Some organizations within LeadingAge Maryland have offered scholarship opportunities and help pay off student debt to entice more people to join the workforce, she said.
To address the workforce shortages, the Maryland Department of Health provided temporary flexibility such as paying “legally responsible individuals” for personal assistance services and relaxing provider hiring and training requirements.
Other states have also offered flexibility to allow more home-care services. For instance, Alaska allowed providers to hire family caregivers as direct service workers, including for in-home support. Colorado lowered the age limit from 18 to 16 for in-home direct care workers and Washington expanded locations where home-care services can be provided to include hotels and churches.
Although these provide temporary flexibility during the pandemic, some states are considering making the policies permanent, said Samantha Scotti, senior policy specialist for the National Conference of State Legislatures.
This year, the General Assembly passed a bill that established a direct care workforce grant program under the Maryland Department of Labor to help bolster the number of direct care workers across the state. During the 2020 legislative session, a bill that would have required the Maryland Department of Health to conduct a cost-benefit analysis on expanding access to home and community based services did not pass.
The federal American Rescue Plan Act raises the federal share of state’s spending on home and community based services by 10% for one year.
The majority of elder care staff are women, who may also care for their own older family members or children, so expanding access to affordable child care and adult daycare could help reduce the strain, Ciborowski said. There are some organizations that are interested in opening childcare spaces as a part of their retirement communities, for instance, but they often face regulatory barriers, she continued.
Sen. Nancy King (D-Montgomery) said that lawmakers have looked into partnerships between nursing homes and childcare but the “barrier” is lowering standards for the people taking care of the children.
Even so, some organizations are moving forward with multi-generational care settings.
Del. Ariana Kelly (D-Montgomery) said that she recently spoke with a hospital that is looking into opening a childcare center on its campus because of similar staff shortage issues. And Sen. Adelaide Eckardt (R-Middle Shore) said that Delmarva Community Services is about to open its Intergenerational Center that includes a daycare, senior center and a developmental disabilities center.
Staff shortages are also plaguing care centers for people with developmental disabilities, according to Laura Howell, executive director of Maryland Association for Community Services.
“Many of our provider leaders…have spent their entire careers working in this field and they all say the same thing, which is that they’ve never seen anything this bad,” she said. In a May survey, the Maryland Association for Community Services found that one in three providers reported a direct support vacancy rate between 30% and 58%. “Those are perilous numbers,” she said.
As the pandemic increased people’s reliance on virtual support options, what families want and need from care facilities have changed and how providers need to shift remains a mystery. “We don’t know where that end place is going to be for us,” Howell said.
“Time will tell,” she said.