Becky Bryant: Bridging the Elder Care Gap and Ensuring Dignified Aging at Home

Becky Bryant, LRCS President and CEO

While climate change and its concurrent risks receive public and political attention on a daily basis, there’s another threat to our society that has profound consequences on our well-being and is much more immediate. It’s a crisis that’s not getting the public attention it deserves.

It’s well known that the share of older residents in our state’s population is increasing. And we all want to age with dignity and in safety.

Unfortunately, however, our idyllic vision of dignified aging at home is marred by a harsh reality — a dire shortage of elder care workers to support us in doing that. This is not a looming problem with dire consequences fifty years in the future. It’s one that’s already upon us.

Nonprofit agencies like ours, entrusted with providing essential in-home services to low-income New Hampshire seniors, are grappling with a severe lack of staff, creating a ripple effect that reverberates through the aging community. The consequences are profound and deeply unsettling.

The essence of the continuum of community-based elder care lies in providing holistic support to help seniors live at home for as long as possible until they medically need to transition to assisted living or nursing home care.

In the beginning this usually only requires “light-touch” services, ranging from light housekeeping to grocery shopping, food preparation and laundry. These are simple tasks that most of us at some point will no longer be able to do for ourselves as we age.

An elder may require only five to 10 hours per week of outside help spread over a few days in order to continue to live at home — usually when they are no longer able to drive and are becoming increasingly frail.

In the case of nonprofit agencies like ours these services for low-income seniors are paid for by Medicaid and other public funding sources.

Low-income elders may have worked their whole lives but many now live on just their Social Security benefits. In order to qualify for Medicaid in-home services a senior must receive less than $928 per month in income. It’s hard to believe someone can live on that little money, but many do.

And sadly, for every Medicaid-eligible senior we are able to accept, we have to turn away two or three others because we don’t have enough staff.

As a provider of community-based services, we navigate a complex web of state and federal funding sources, each with its eligibility criteria and corresponding pay rates for staff.

Complicating matters further, the public reimbursement system is a labyrinth of different waivers and rates, making it challenging for agencies like ours to maintain a unified, competitive wage structure.

For instance, we may be able to pay a direct support employee working with people with disabilities $16 per hour, while being limited by other funding source regulations to pay a home care worker performing similar tasks as little as $12.41 up to $14 per hour depending on the funding source we pay them from.

This wage disparity not only hampers recruitment and retention efforts but realistically means we are competing against ourselves with dedicated employees leaving lower-paying homemaker jobs for higher paying direct support positions.

Fixing this convoluted system requires comprehensive reform. State and federal funding sources should re-align their reimbursement rates across the system so that agencies like ours can normalize pay rates for direct support workers across all waivers. This would create a level playing field to help us attract the skilled workforce we need to meet the growing demands of direct support and elder care.

To be clear, this is not a plea to redirect funds from nursing homes to dedicate it to in-home care. Rather, it is a call to recognize the interconnectedness of care across the spectrum.

It’s about recognizing the symbiotic relationship between nursing homes and community-based care. Both are indispensable, and the need for fair and competitive compensation for the people who provide it is urgent.

We must act quickly to bridge the gap in elder care services. Supporting individuals in their homes for as long as is possible not only preserves their independence but is also a more cost-effective approach for the state.

Fair wages for community-based elder care workers are not only an investment in the well-being of our seniors but also a commitment to the values that define us as a compassionate and caring society.

Let’s ensure that as we age, we have the support we need to stay home, surrounded by familiar comforts, and live our later years with the dignity we all deserve.