WELLFLEET — A few years back, when Geovana Pinheiro worked as a certified nursing assistant (CNA) for a client in Wellfleet, she commuted down Cape from Centerville, where she lives. The trip took an hour — when traffic cooperated.
Supporting newly discharged patients, housebound seniors, and disabled residents, Pinheiro is skilled at the range of duties — from doing laundry to prepping meals to changing diapers — that make up most home health aides’ routines.
But Pinheiro no longer makes those trips down Route 6. Her expertise is in high demand close to her own home. Driving would only increase her gasoline costs, which she must shoulder herself. Plus, vacation traffic often upended her itinerary, resulting in delays and postponed appointments that in the end affected both her clients and her earnings.
Pinheiro is not the only home health aide who has turned away from the Outer Cape. The logistical hurdles she faced have discouraged agencies from dispatching aides to the area. Kathleen Catrambone, who owns TLC Home Health Care Services, told the Independent that her company was dialing back on serving the Outer Cape.
“It’s heartbreaking for us to have a son, or daughter, or spouse on the phone and tell them we can’t provide them what they need,” said Catrambone. “We just don’t have caregivers that live out that way,” she added. In the last month alone, she has turned away a dozen new clients.
The shortage of home care workers here seems unlikely to go away anytime soon, especially as the population here ages and the need for support rises.
The big picture, according to the Bureau of Labor Statistics, is this: while the nation’s aging population is projected to continue to drive up demand, some 600,000 home health aide positions per year are projected to remain unfilled between 2020 and 2030.
The Outer Cape is likely to feel this acutely. About 50 percent of Provincetown’s population is age 60 or older, said Chris Hottle, the town’s Council on Aging director. The state’s average is 23 percent. The aide shortage has already hit a “critical level” here, said Hottle.
Pay Is a problem
Pinheiro was drawn to her work after caring for her father when she lived in Brazil. He had Alzheimer’s disease. Pinheiro loves working with her clients and knows high-quality care matters, but the profession, she said, “is not highly valued or well paid.”
Most clients pay private agencies $30 to $35 per hour; of this amount, the caregiver takes home about half. Working 40 hours to bring home $400 a week after taxes isn’t practical on Cape Cod, Pinheiro said, where “rent, food, everything is so expensive.”
Some of her colleagues have left the field to take higher paying positions at places like Stop & Shop, where they can earn $17.50 an hour.
Agencies often hire CNAs part-time, so benefits and overtime are also limited. Delays and cancelations make home care schedules volatile by nature, so caregivers are often forced to work for multiple agencies at the same time to cobble together enough hours to make a living.
Often home health aides work full-time with one client. But if that client stops needing help or goes to the hospital, suddenly the worker’s schedule falls apart. Having several employers is the only way to be sure you’ll have access to assignments, said Kevin Smith, president of Home Care Aide Council, which represents home care agencies and providers across Massachusetts. “It’s the worst-kept secret in the industry,” Smith said.
The patchwork system makes it difficult for home health care workers to have stable home lives themselves, especially when it comes to raising a family, Pinheiro said.
Some agencies on the Outer Cape reported raising wages in the last year to keep up with the growing demand for their services, initiating sign-on bonuses — but while these attract workers, “they aren’t a retention tool,” Smith said.
Furthermore, to raise wages, agencies must increase fees charged to clients, which are already “incredibly expensive,” said Catrambone of TLC. Even so, she said, with insurance and overhead expenses taken into account, agencies don’t have much of a profit margin.
Filling the Gap
Partnering with eight home care agencies, Elder Services of Cape Cod and the Islands connects seniors with homemaking and personal care services. More and more, clients are facing long waits for these services, said Kim Nahas, the nonprofit’s director of clinical services.
“We have enough agencies,” she said. “It’s just they’re having a difficult time finding workers.” The organization provides services that can help fill in the gap, like meals on wheels, laundry, grocery shopping, an emergency alert button, and social programs.
As of August, Elder Services of Cape Cod and the Islands had 472 cases of people waiting for service, Kevin Smith said.
Some agencies aren’t keeping a waiting list at all, said Brianne Smith, who manages the Community Resource Navigator Program at Outer Cape Health Services. “They don’t have available staff, period,” she said.
While the shortage was increasing before the pandemic, it has now become much worse, Catrambone said, calling the current situation “a crisis.”
“The government has to step in and give grants, or whatever it may be to get more people to become certified nursing assistants,” she said.
A potential solution in development at Elder Services is to offer “consumer directed care.” Instead of working with contracted providers, clients can choose a friend, neighbor, child, or sibling to receive the necessary training and be paid an hourly wage to take on the role of a caregiver.
Steps to increase home care wages are also being taken on the federal level, Hottle said. President Joe Biden’s proposed $400 billion infusion of federal money into the nation’s “care economy” over eight years is one example. The plan could increase home care workers’ wages and benefits no matter where workers happen to live.
Meanwhile, “Sometimes, seniors have to do without,” said Linda Balch, outreach coordinator at the Wellfleet Council on Aging.
This past July, Rudelle Falkenberg, a Truro resident, returned home after having hip surgery and for two months benefited from a merry-go-round of check-ins. Twice a week, a visiting nurse took her vitals. A physical therapist swung by frequently, and from time to time an occupational therapist tagged along, surveying the bathroom for slip hazards.
But what Falkenberg wanted was help with taking a shower. She considered adding a home care aide to the mix, until she found out she’d have to schedule her shower days in advance, and that if things didn’t go seamlessly, she might need to postpone that shower for a week.
Falkenberg opted to ring up a friend to chaperone her should she need help. Hers was a fortunate case. “We serve a lot of people who are living alone and don’t necessarily have someone they can call to come over twice a week,” said Smith from Outer Cape Health Services.
Smith’s staff has been trying to fill in the gaps, helping seniors by delivering groceries and prescriptions. “But as navigators, that’s not our function,” she said. The program is meant to arrange for these services, she said, not to perform them.
