Throughout the winter and into the spring, The Senior Connection in Hailey has gotten around two calls per week inquiring about in-home care services. But since last fall, it can only offer an assessment and a place on the waiting list.
With COVID-19 restrictions limiting access to homes—and staffing already strained by a shortage of available caregivers—the organization stopped taking new clients in October for its in-home care services.
The nonprofit is the only in-home care provider in Blaine County contracted with Medicaid. As of mid-April, it provided 32 clients with in-home services. Half of those clients are insured by state Medicaid funding or the federally funded Office on Aging. The other 50% are “private pay,” which usually means they are subsidized by The Senior Connection.
Senior Connection Associate Executive Director Jovita Pina is in charge of the home care services program there.
“We are honest about our current status in not accepting clients because of the current re-open stage,” Pina said. “Also, the individual may be in need of services beyond our scope.”
Pina said existing clients don’t always receive the number of hours each month recommended by The Senior Connection for private care clients and Medicaid and Office on Aging clients.
“We can’t always accommodate all the hours they need,” Pina said. “We accommodate who we can with the caregivers that we have.”
The Senior Connection’s home care services help keep elders in their homes by assisting with activities of daily living such as eating, bathing, dressing, mobility assistance, toileting and continence. Homemaking services include light housekeeping, laundry, grocery shopping and errands, personal transportation to medical appointments, pet care, and cooking.
Pina said keeping seniors at home is ultimately more cost-effective than moving them to eldercare facilities, but that a shortage of home-care professionals is putting a crimp on the model.
“We need more Medicaid providers for in-home care services in Blaine County,” said Senior Connection Executive Director Teresa Beahen Lipman.
With few available, the organization has been recommending that seniors seek help from family members and church communities.
When Idaho goes to Stage 4 COVID restrictions Lipman hopes to start taking new clients—a process that requires an in-home visit and assessment, which can’t be completed under Stage 3. She said senior care organizations and private in-home care providers around the country have been challenged by COVID restrictions.
Meanwhile, demand for in-home care services has outstripped expectations, Lipman said. About $204,000 was budgeted for in-home care last year. Total expenses reached $250,000. She said $35,000 was spent on in-home care “scholarships” for private pay clients. (Around 90% of private pay clients get some kind of scholarship, she said, though everyone is required to pay something for the service.)
The Senior Connection charges $27-$30 per hour to private-pay clients, depending on where they are located, Lipman said. Medicaid and Office on Aging clients are not charged for services. Those agencies reimburse the Senior Connection about $15 per hour for in-home care. A caregiver’s starting pay rate is also $15 per hour—and, for Medicaid clients, they’re forbidden by statute from getting any more.
Lipman said the usual budget for the in-home care services program typically anticipates that 70% of clients will be private pay with the remaining 30% Medicaid or Office on Aging-insured, reimbursed at the lower rate. But the number of private pay clients decreased during the pandemic as families took over responsibilities from outside agencies to protect family members from the coronavirus. At the same time, the number of Medicaid-insured client hours increased because they were allotted more hours by the Department of Health and Welfare.
Now, the Senior Connection is looking at a 50-50 split between private-pay and federally funded clients, which means less money coming in to cover costs. Lipman expects the program deficit to reach around $56,000 by year’s end. A local family foundation makes up the difference, passionate about in-home care services because of a “personal experience” in their family, she said.
“If it were not for the generosity of our community, this would not be possible,” she said.
Lipman said there are many independent in-home care workers in the Wood River Valley serving families who have the means to spend more than a Medicaid-trained worker earns, making it hard to find caregivers to take on those clients.
“Some people have end-of-life private care around the clock, or staff on salaries who are readily available,” Lipman said. “They are fortunate to have that.”
For those less fortunate, Lipman said the Senior Connection usually provides a backstop. She said the organization became Medicaid eligible several years ago after a series of trainings were undertaken to meet federal criteria for top level services. While that has been a boon for many clients, it may also be a handcuff on hiring. The law caps certified caregiver pay, meaning Medicaid-certified providers cannot be reimbursed more than $15 per hour for a Medicaid client, Lipman said, which does little to incentivize certification.
“Our board made a decision to not turn people away,” she said. “But any in-home care worker in the valley could become a Medicaid provider. I just don’t know of any who have done so.”
The caregiving industry will continue to seek more workers—especially in Blaine County, where the population has a higher than average number of senior citizens. (The average age in Blaine County is 43.2. In Twin Falls County, it’s 33.3.)
“There is more demand than there is supply of caregivers,” Lipman said. “We know that from inquires. We have two full time positions open to fill, but it has been difficult to recruit and retain staff.”
The Senior Connection will pay prospective caregivers to train at the College of Southern Idaho for the positions and provides a competitive standard of pay, with good benefits, Lipman told the Mountain Express.
“You would have a job for a lifetime in this industry,” she said.
Another option for helping seniors in the valley is to sign up for the Adopt a Senior Program, currently on hold pending a lifting of COVID restrictions. She said these volunteers spend time once or twice each week with a senior who could use some companionship or help around the home or take them for a drive.
“We are excited to restart that program,” Lipman said. “One silver lining in the pandemic is that western culture has started to pay more attention to its senior populations.”