To make ends meet, Helen O’Gorman, a full-time certified nursing assistant with Springfield-based O’Connell Care at Home, also picks up private home-care clients and runs a cleaning business, logging between 60 and 70 hours of labor among the three jobs each week.
On any given day, she’s addressing complicated medical issues, comforting anxious family members, preparing meals, picking up prescriptions, shopping for groceries, helping with personal tasks like showering — and cleaning houses.
It can be difficult and stressful, but O’Gorman, 57, of Buckland, said she likes working with people in need.
If CNAs relied on just one job, “we’d all be broke,” O’Gorman said one recent day, sitting on a sunny deck with Georgene Zimmerman, 89, of Greenfield. Zimmerman receives 24-hour care through O’Connell Care at Home.
With them was Ella Arial, 62, of Gill, another CNA. The two caregivers paused between their shifts with Zimmerman to talk about their jobs.
“You have to do a bartending job or a waitressing job to be a CNA. It’s never going to make you financially independent,” O’Gorman said. “And you need to worry about burnout, too.”
Arial said that she works about 60 hours each week, exclusively caring for Zimmerman, to earn a living wage.
“Honestly, you cannot live on a 40-hour week salary doing this job,” she said. “There’s a lot of turnover. A lot of people who go into this work find out they don’t have the heart for it. If you don’t have the heart, you won’t stay.”
An industry in trouble Home-care business operators say they are not able to pay higher wages because most of their funding comes from Medicare, with inflexible rates set by the government. At the same time, they face a rapidly increasing demand for services driven by an aging population. That spells trouble for the industry, said Susan Pratt, director of the Tripp Memorial Foundation, a nonprofit advocacy organization for health care workers she started in 2001.
“The public at large is really ignorant of the crisis we’re facing,” she said.
To help raise awareness, her foundation runs Giving Circle Thrift Shop on North Main Street in South Deerfield as a way to help caregivers by offering them donations and discounts.
On average, home caregivers earn between $11 and $14 an hour, according to data from the Bureau of Labor and Statistics. The Paraprofessional Healthcare Institute, an advocacy organization, documented a 5 percent reduction in average hourly wages over the past decade, with a median income of $15,200 across the state’s caregiving industry.
According to 23-year-old Mary Wetzel, who works for Barton’s Angels, direct-care workers visit between one to four clients each day, aren’t guaranteed a specific number of shifts per week and are not paid for travel time. If a client has a medical appointment, or for some other reason doesn’t need a visit, the care worker is not paid, Pratt said.
The job is also physically demanding. In 2016, the Bureau of Labor and Statistics reported that home health care workers were injured on the job at a rate of 4.7 injuries per 100 workers. Comparatively, construction workers reported 3 injuries for every 100 laborers.
Combined with those issues, the industry’s structure, which is built around unchanging payment rates by the state and federal government, makes recruitment difficult, Pratt said. To compensate for resulting staff shortages, she said, caregivers across all sectors (including those in nursing homes), work long and sometimes uncompensated hours.
She does not see relief in sight.
The ‘gray wave’ As a whole, direct-care needs are projected to mushroom as the baby-boom generation — those born between 1946 and 1964 — gets older (known in the health community as the “gray wave”). Since 2010, the percentage of people over 65 in the state has increased from around 13 percent to 16 percent. Looking ahead, Pratt predicts that 10,000 people each day will turn 65 over the next 15 to 20 years, based on her own research.
In correlation, the home care industry is expected to grow by 38 percent between 2014 and 2024, continuing a trend. Based on data from the Bureau of Labor Statistics, Massachusetts’ home health aide industry has expanded by about a third over the past decade. In 2006, the bureau documented there were 16,750 aides working in the state. By 2016, that number had climbed to 27,020.
“There’s massive demand for these workers,” said Hayley Gleason, interim executive director of the Home Care Aide Council, a Watertown-based nonprofit association of home care agencies. “That’s a good thing. There’s huge growth. But on the flip side, we’re really struggling with recruitment of people into this field. When the economy is better, oftentimes the low wage industries struggle because there’s more competition.”
Already, Gleason noted, the industry isn’t gaining new workers fast enough to compensate for the growing demand because of high turnover. A study completed by the aide council last fall, with funding from Tufts Health Plan Foundation, found that 58 agencies statewide over three months, on average, lost 15 workers for every 18 new employees hired. Additionally, 47 percent of the 656 individual home care aides who responded to the survey said they had at least one other job, nearly 50 percent said they were born outside the United States, 48.4 percent were MassHealth recipients, and about 40 percent reported they lived in households with an annual income of less than $20,000.
Money struggles While there are many clients who pay out of pocket for in-home services, about 75 percent of home care is paid at the set Medicare rates, according to Gleason.
“In any other industry, if there was demand, prices would increase, and that would be passed on to the workforce. But because of how health care, as a system, is built, in that it’s structured on the government as a payer, it doesn’t have that ability,” she said. “Unfortunately, it’s going to get much, much worse.”
Medicare pays a flat rate of $6.10 for every 15 minutes a home health aid spends with a client. This is based on a payment scale from the Massachusetts Executive Office of Health and Human Services and doesn’t take into account state-required overtime or holiday pay, Pratt said.
Repeated phone calls to the Executive Office of Health and Human Services to clarify how those rates are set were not returned before press time.
The money is distributed to 26 Aging Service Access Points statewide, including nonprofit organizations like Greenfield-based LifePath and Highland Valley Elder Services in Florence, which in turn contract businesses like O’Connell Care at Home or Barton’s Angels in Northampton to send direct care workers to clients’ homes, Pratt said. The workers receive a portion of the payments, and the rest pays the middle-organizations’ expenses.
If something doesn’t change, said Nancy B. Whitley, owner of Barton’s Angels, many home care agencies could go out of business, making the problem worse. Right now, she said, her agency is breaking even, but weighed down by increasing demands, “at some point, the math doesn’t work.”
The loss of home care agencies could mean more people landing in nursing homes, Gleason said.
‘Basically our charity’ Some home caregivers, however, faced with the choice of working unpaid hours or leaving their clients’ needs unmet, will choose the former, Wetzel said. “It’s basically our charity.”
Wetzel was recently caring for John Powlesland, 62, of Hadley, and paused from sweeping the floor to pet Powlesland’s cat, Ghost. The cat stretched its legs and purred. From his arm chair, Powlesland smiled at the interaction.
Powlesland, who is homebound, was diagnosed with cancer last year, and attributes his improved health these days to Wetzel and other caregivers who alerted doctors to his deteriorating symptoms, and repeatedly followed up to make sure he received treatment.
“If I didn’t have Mary and Justin (another caregiver), I would have died. And I’m not being overly dramatic,” Powlesland said.
Over three years of visits, Wetzel has built a trusting relationship with Powlesland.
“When I first started here, John’s idea of fun was to play dead,” Wetzel said, remembering how he’d lie still with a sheet pulled over his head when she came for weekly home visits. “Eventually, I’d hear a little giggle, and I’d get so mad.”
At times, Wetzel said the home care industry’s instability can be difficult to manage. Recently, she was denied a home loan, initially, because the lender didn’t perceive home care as steady work, even though she consistently logs 40 hours per week. On top of that, it can be stressful, she said.
“There are days when it feels like your heart is going to break. And then you go home, and you have to do it again the next day,” Wetzel said.
But despite the challenges, Wetzel is quick to note that she loves her job, because “I have compassion for the human condition.”
Ultimately, direct care workers like Wetzel will continue to do the work regardless of the salary, Gleason said. For years, the industry has relied on this benevolence, she said, but rising demand for the work could tip the scales.
“We have to talk about wages. We need to be increasing the reimbursement rate to agencies, so they can increase the wages for their workers,” Gleason said. And, she added, the importance of direct care should be recognized.
“For a long time, they’ve been seen as glorified babysitters. They’re not seen as a part of the health care system,” she said.
Whitley noted that caregiving has traditionally been ascribed to women, adding that she thinks caregivers are undervalued “partially because women are not as valued.” The industry comprises about 85 percent women, according to data from the Paraprofessional Healthcare Institute.
Meanwhile, Pratt, who had a career advocating for caregivers before opening the Giving Circle Thrift Shop in March, is hoping the second-hand store — where both O’Gorman and Arial said they sometimes go — will help money-strapped direct care workers by providing them with an inexpensive shopping alternative, and simultaneously raise public awareness about the working conditions faced by caregivers.
“It would be great, if, when we saw someone in scrubs, we went up to them and said ‘Thank you for your service,’” Pratt said.
Andy Castillo can be reached at acastillo@ gazettenet.com.