Lauren Justice
Barbara Vedder (right) takes notes during a meeting with other disabled advocates to discuss the shortage of care workers, with Karen Foxgrover (left) and Fayth Kail.
Barbara Vedder doesn’t let her disability slow her down.
A car accident more than 30 years ago left her paralyzed from the chest down — a “devastating” blow for the young mother, who at the time was living in France with her husband and son. She uses a wheelchair to get around and depends on personal care workers to help with virtually all aspects of her daily routine.
Despite her injury, Vedder is active in the community. She’s been a Madison alder, a Dane County supervisor and an energetic political activist — particularly for disability rights. But in recent years, her life has been disrupted by increasing struggles to find caregivers to provide the in-home assistance she needs. She’s gone nine months without being fully staffed, and for the last four months she’s been unable to find a caregiver to help her in the mornings.
“It’s really a very, very disturbing thing that’s going on right now,” Vedder says. “There’s a real crisis going on for people like me.”
A May 3 study by a coalition of Wisconsin’s long-term care advocacy groups highlights the extent of the caregiver shortage throughout the state. The survey, which is believed to be the largest of its kind ever completed, surveyed almost 700 Wisconsin care facilities and found that there are nearly 11,500 vacant caregiver positions.
“People bandy about the word ‘crisis,’ but what we’re seeing, in a documented way, is without debate — there is a workforce crisis in our field,” says John Sauer, executive director of LeadingAge Wisconsin, a membership organization of nonprofits that provide care for the elderly and disabled and one of the groups behind the study. “It’s a troubling trend.”
Just as elderly and disabled people are struggling to find caregivers, the agencies tasked with providing the workers are struggling to recruit and retain personal care workers. Nearly 50% of providers surveyed reported that they had no applicants to fill the open positions; about 70% said there were no qualified applicants. Between 2012 and 2015, the number of people applying for Certified Nursing Assistant (CNA) certification dropped by 24%. Meanwhile, as the population ages, the need for personal care workers in Wisconsin is projected to increase by more than 26% by 2022.
“There are just fewer people coming into our field at a time when there is a growing need,” Sauer says.
Vedder was shocked to learn the extent of the shortage. She gets home care via a local agency called Community Living Alliance, but when she saw her caregiver hours being cut, she reached out to other nonprofits to fill the gap. None were accepting new clients.
“They didn’t have enough workers to go out in the field and help people,” she says. “It’s the same situation across the board.”
Kathy Talaat, CLA’s director of human resources, quality and development, says the personal care industry is an attractive field for individuals who are “compassionate, caring and desire flexibility in their work.” But the pay for such positions does not keep pace with what other industries can offer to attract and retain talent. Statewide, the median wage is $10.75 an hour for personal caregivers, compared to $12 for local, non-health care employers seeking unskilled, entry-level workers, according to the study. In Dane County, personal care workers under contract make a “living wage” of $11.66.
A major factor in the pay shortage is the reliance on Medicaid to fund caregiver provider agencies, Talaat says. While the costs to home care agencies for salaries and benefits has increased with time, the Medicaid reimbursement rate has gone up just $0.24 over the past 14 years, with no increase at all since July 2008. A study published in May from the American Health Care Association suggests Wisconsin has the worst Medicaid reimbursement rate in the nation for nursing homes.
“We hope the state Legislature will support a reimbursement rate increase in the next biennium,” Talaat says.
Personal care providers and advocates are concerned about a number of legislative proposals that will affect the industry, including a forthcoming independent assessment model for Medicaid recipients and additional changes to Family Care and IRIS, two other Medicaid programs for long-term care.
The independent assessment model, slated to begin in August, will give a private company the power to decide how many hours of care a client will receive. Currently, nurses decide how much each client needs. Proponents of the change say it will save money and eliminate fraud, but critics argue that the alleged fraud is nonexistent and that the new model will hurt vulnerable individuals who rely on personal care workers.
Kim Turner, executive director of Options in Community Living, says personal care agencies are preparing for the change by “taking a hardline stance” on how they assess and interpret client needs. But she says enforcing a standardized time allotment for tasks like helping someone bathe or use the bathroom is “essentially impossible.”
“People’s lives aren’t like that; the human body isn’t like that,” she says. “[This change] will make things worse.”
A proposal to shift Wisconsin’s Family Care and IRIS programs from a nonprofit to a for-profit model has been sitting before the Legislature’s Joint Finance Committee since April 1. Lawmakers have been gathering more information about the program, but Gov. Scott Walker’s administration has said Family Care/IRIS 2.0 will be in place by the beginning of 2018, at the earliest. The plan is projected to save taxpayers $300 million over the first six years. But Turner says the change will make things worse for individuals who are already struggling.
“They’re promising to serve more people magically with less money,” she says. “They only way to do that is for people to get less support.”
