With home-care needs rising, professional caregivers find themselves overworked and underpaid

  • Mary Wetzel, a home-care worker with Barton's Angels, takes out the trash for John Powlesland, right, who watches television in his Hadley apartment. Powlesland, who has cancer, is homebound and cannot do basic maintenance tasks for himself. Gazette Staff/Andy Castillo

  • Mary Wetzel, left, a home healthcare worker with Barton's Angels, holds a sharps container for John Powlesland, right, who has just checked his blood sugar with a glucometer. Gazette Staff/Andy Castillo

  • Mary Wetzel, right, a home healthcare worker with Barton's Angels, makes a grocery list for John Powlesland. Powlesland, who has cancer, is home bound and cannot do basic maintenance tasks for himself. His cat, Ghost, lies in the middle. Gazette Staff/Andy Castillo

  • Mary Wetzel, left, a home healthcare worker with Barton's Angels, passes a sanitation wipe to John Powlesland, right, at his home in Hadley. Gazette Staff/Andy Castillo

  • June Guild, left, 86, writes a congratulatory card for a family member's wedding anniversary, while Wetzel, right, sorts through a box of cards at Guild's Amherst home. Wetzel keeps a calendar of important dates for Guild, and reminded her to write the letter. Gazette Staff/Andy Castillo

  • June Guild, below, 86, writes a congratulatory card for a family member's wedding anniversary, while Mary Wetzel, above, a home healthcare worker with Barton's Angels, puts in a load of laundry at Guild's Amherst home. Gazette Staff/Andy Castillo

  • Ella Arial, left, and O'Gorman, right, certified nursing assistants with O'Connell Care At Home, help Zimmerman, middle, into her Greenfield house. Gazette Staff/Andy Castillo

  • Helen O'Gorman, left, a certified nursing assistant with O'Connell Care At Home, prepares to serve lunch to Georgene Zimmerman, 89, in her Greenfield home. Gazette Staff/Andy Castillo

  • Susan Pratt sorts clothing in Giving Circle Thrift Shop in South Deerfield. Gazette Staff/Andy Castillo—

  • This graph indicates the average hourly wages earned by caregivers in Massachusetts from 2006 to 2016, using data from the Bureau of Labor Statistics, compiled by the Paraprofessional Healthcare Institute. Gazette Staff/Andy Castillo

  • This graph shows the number of home health aides working in Massachusetts from 2000 to 2017, using data from the Bureau of Labor Statistics. Gazette Staff/Andy Castillo

  • This graph indicates the average hourly wages earned by caregivers in Massachusetts from 2006 to 2016, using data from the Bureau of Labor Statistics, compiled by the Paraprofessional Healthcare Institute. Gazette Staff/Andy Castillo—

  • This graph shows the number of home health aides working in Massachusetts from 2000 to 2017, using data from the Bureau of Labor Statistics. Gazette Staff/Andy Castillo—

Published: 7/9/2018 9:16:28 PM

To make ends meet, Helen O’Gorman, a full-time certified nursing assistant at 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, says she likes working with people in need.

If CNA’s 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, says 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, 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 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 says.

The job is also physically demanding. In 2016, the Bureau of Labor and Statistics reported that home healthcare 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 says. To compensate for resulting staff shortages, she says, 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 healthcare, 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 Mass. Executive Office of Health and Human Services and doesn’t take into account state-required overtime or holiday pay, Pratt says.

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, 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 Home Health Care in Northampton to send direct care workers to clients’ homes, Pratt says. The workers receive a portion of the payments, and the rest pays the middle-organizations’ expenses.

If something doesn’t change, says Nancy B. Whitley, owner of Barton’s Angels, many home care agencies could go out of business, making the problem worse. Right now, she says, 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 says.

‘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, says Wetzel, 23, of Barton’s Angels. “It’s basically our charity.”

Wetzel was recently caring for John Powlesland, 62, of Hadley, and paused from sweeping the floor to pet Powelsland’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 says 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 says.

“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, says Gleason. For years, the industry has relied on this benevolence, she says, 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 a 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 say 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.

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