After decades of low funding, will workforce that provides help to seniors get a boost?


A Darke County business is among those that could get a boost from Biden proposal.

A large senior care service in Greenville this month added 27 people to their wait list for home care and gave notice to another 19 that they will soon be unable to continue services for them.

“In a small town, it’s pretty heartbreaking to turn anyone away,” said Kara Allread, chief administrative officer with Brethren Retirement Community and Brethren HomeCare. “We’re talking about hardships for people and families where all of us live together, work together and worship beside each other, each and every day.”

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Brethren and other local aging services providers are advocating in support of the Biden administration’s American Jobs plan’s proposal for $400 billion for home and community-based care and services for older adults and disabled people.

These providers are urging their services and workforce need to be treated as essential as any other infrastructure, and say more funding is needed to pay better wages and support more older people.

In Ohio, the median wage for home health aides is about $11.50 and for STNAs just above $14 an hour on average. These lower wage jobs -- which became particularly strenuous work during the pandemic -- are disproportionately staffed by women of color.

A less visible army of unpaid family caregivers -- also disproportionately women -- also fill gaps. In Ohio, AARP estimates about 1.5 million family caregivers provided an estimated 1.27 billion hours of care to their parents, spouses, partners, and friends in 2017.

It’s cheaper to receive home and community based services than to live in a facility like a nursing home, but there can be wait lists for these services. About 69,000 Ohioans were on a wait list as of 2018. Some middle class families might not qualify for coverage of these services but still have difficulty footing the bill, and Medicare does not cover long-term care.

“An unacceptable number of older Americans can’t access the care they need to deal with the changes and challenges of aging,” said Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services. “More and more of us try to fill the gap by stepping in as caregivers to parents, grandparents, spouses or other loved ones, and we’re increasingly stressed, stretched and in unsustainable situations.”

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The details are still coming together of what that $400 billion would pay for. The AP reported a summary of Biden’s plan says the money would go to expand home and community-based services so more people could get care. A major goal would be to raise pay and benefits for workers, nearly all of whom are women, many from minority and immigrant communities. The proposal would also permanently reauthorize a program within Medicaid that helps people move out of nursing homes and back into their communities.

Republicans have in other contexts supported home and community base services, but this particular package has received pushback from some, including some lawmakers who have criticized the Biden administration of lumping a wish list of services that don’t fit the definition of infrastructure.

Brethren cares for about 500 older adults and have about 325 employees, which makes them among the largest employers in the Darke County community.

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Allread said several times a week she drives past a billboard advertising jobs at a warehouse in the Darke County area and the starting wage is now up to $17.50 per hour. She said under the current amount they are reimbursed, Brethren can’t compete with other wages.

“We had a recent recruiting event with a local high school, where there was zero interest from any of those graduating high school seniors to speak with any of the health care providers that were going to be there that day,” she said. “And I think that that they simply just know that we cannot compete with the fellow wages from the other industries that were represented there.”

By the numbers: Caregivers

The U.S. direct care workforce grew within a decade from 3 million workers caring for older adults and people with disabilities in 2009 to almost 4.6 million in 2019.

68,644: Ohioans waitlisted for home-based services as of 2018

$11.50: Median Ohio home health and personal care aide wage for 2020

91,910: Ohioans working as home health or personal care aides in 2020

Source: LeadingAge, Kaiser Family Foundation, BLS