Pandemic-fueled shortages of home health aides strand patients without care

The elderly are finding it harder than ever to get paid help amid acute staff shortages at home health agencies. Several trends are fueling the shortages: Hospitals and other employers are hiring away home health workers with better pay and benefits. Many aides have fallen ill or been exposed to Covid-19 during the recent surge of omicron cases and must quarantine for a time. Staffers are also burned out after working during the pandemic in difficult, anxiety-provoking circumstances.

The implications for older adults are dire. Some seniors who are ready for discharge are waiting in hospitals or rehabilitation centers for several days before home care services can be arranged. Some are returning home with less help than would be optimal. Some are experiencing cutbacks in services. Some simply can’t find care.

Everyone is experiencing shortages, particularly around nursing and home health aides, and reporting that they’re unable to admit patients. We’re seeing increasing demand on adult protective services as a result of people with dementia not being able to get services. The stress on families trying to navigate care for their loved ones is unbelievable.

Ninety-three percent of Medicare-certified home health and hospice agencies and 98% of licensed agencies said they had refused referrals during the past year. Members say they’ve never seen anything like this in terms of the number of openings and the difficulty hiring.

Another agency that provides non-medical services is giving priority for care to people who are seriously compromised and live alone. People who can turn to family or friends are often getting fewer services. Most clients don’t have backup.

This is true of older adults with serious chronic illnesses and paltry financial resources who are socially isolated. Many agencies are focusing on patients being discharged from hospitals and rehab facilities. These patients, many of whom are recovering from Covid-19, have acute needs, and agencies are paid more for serving this population under complicated Medicare reimbursement formulas..

When paid home care or help from family or friends isn’t available, vulnerable older patients may be forced to go to nursing homes, even if they don’t want to. Many nursing homes don’t have enough staffers and can’t take new patients, so people are simply going without care.

Patients with terminal illnesses seeking hospice care are being caught up in these difficulties as well. Brody is running a research study with 25 hospices, and “every single one is having staffing challenges,” he said. Without enough nurses and aides to meet the demand for care, hospices are not admitting some patients or providing fewer visits, he noted.

Before the pandemic, hospice agencies could usually guarantee a certain number of hours of help after evaluating a patient. Now, they really are not able to guarantee anything on discharge.

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