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Aging Boomers Face Home Health Care Dilemma
By Adam D. Krauss and Victoria Guay, Foster’s Daily Democrat
April 26, 2009
It started slowly, but over the last 15 to 20 years, Linda Arvenitis has been spending more and more time at her 101-year-old mother's home.
She isn't complaining, insisting that taking care of her frail, yet independent, mother is "the right thing to do."
But between the constant worry that her mother, Aletha Mitchell, may fall again, and the hours spent bringing her to the doctor, running errands and paying bills, the physical and mental exhaustion of this second full-time job has set in for the 56-year-old Dover reading tutor.
"It's tiring," Arvenitis said.
Aides from The Homemakers of Strafford County also visit Mitchell four days a week for a few hours each day. Without them, there's a good chance Mitchell wouldn't be able to stay in her home, Arvenitis said.
Yet there's a problem bearing down on Arvenitis and other baby boomers as they age.
Despite the state's concerted effort to shift resources away from nursing homes and toward home care, some health care and social service providers are concerned there won't be enough trained health workers to provide care in homes, forcing more home care duties onto untrained relatives.
"There are going to be more people to take care of than there are people" to provide care, said Bob McCaffrey, chief executive officer at Seacoast Hospice.
Such a scenario offers a "pretty bleak" picture for families, Arvenitis said.
By 2030, one in five Americans will be 65 or older, and by 2050, there will be 88.5 million citizens in that age group, more than doubling the current 65-and-over population. Meanwhile, the number of working-age people between ages 18 and 64 is projected to decline from 63 percent now to 57 percent in 2050, according to the U.S. Census Bureau.
New Hampshire's population of seniors age 55 to 64 will have grown from 109,659 to 206,177 from 2000 to 2010, while number of people age 65 to 74 will have gone from 78,327 to 114,304 during the period, according to the state Office of Energy and Planning.
The medical situations facing the elderly can be complex. In the last three years, Carol Gonyea, 65, of Belmont has had five knee surgeries, aortic valve surgery, and just two weeks ago, a pacemaker installed.
She isn't able to stand for long periods of time, walk very far or raise her arms above her head, and so needs help with everyday tasks such as preparing meals and cleaning as well as health care needs, including changing her bandages daily.
Her brother, Leo Gonyea, 70, of Vermont, has been staying at her mobile home since October — when his sister's aortic valve was replaced — where he has been cooking, cleaning and driving his sister to appointments.
His wife travels from Vermont from time to time to visit and help.
Carol Gonyea also has a nurse from Community Health and Hospice in Laconia visit her once a week to check her bandaged wounds and other health indicators, such as blood pressure, temperature and breathing.
"Between the nurses and Leo ... without them, I don't know where I'd be, in a nursing home probably," said Carol Gonyea, who also is anemic and recovering from a staph infection.
Kathleen Otte, director of the Bureau of Elderly and Adult Services, said her office recently presented information on the overall situation to the House Finance Committee.
"We are seeing an increase throughout the state in people who are either going into nursing homes or requesting home care services," Otte said.
The Bureau of Elderly and Adult Services only serves Medicaid patients, so the full number of people in nursing homes or getting home care is much higher, Otte said.
There are now about 2,730 Medicaid recipients who get home-care services in the state and 4,203 recipients in nursing homes. There are also 69 people with Medicaid in assisted living, a care level between home care and nursing homes.
Otte said the numbers of those with Medicaid who are in nursing homes or home care has substantially risen since 2000, when only 1,318 Medicaid patient received home care.
But that growth is expected to accelerate within the next two years, so that by 2011 the Bureau of Elderly and Adult Services projects there will be 3,188 people with Medicaid who need home care.
"The demands on the workforce is going to challenge a system that's already stretched," Otte said.
Obstacles include low wages and benefits for people in jobs such as licensed nurses aids or home health aides, Otte said.
The bureau recently surveyed licensed nurses assistants in the state and while the survey showed most LNAs like the work they do, they've considered leaving the profession because it doesn't pay enough.
The bureau last year conducted a series of listening sessions to hear what more than 355 senior citizens, their families and professional care givers had to say about health services.
Gas prices that had reached record highs was one concern home care workers raised. Some home care workers said they were looking or had taken jobs at nursing homes or hospitals so they could budget their gas money each week, Otte said.
The sessions, which were done in collaboration with the State Committee on Aging and the Institute on Disability at the University of New Hampshire, were conducted between May and July of 2008 in several communities, including Laconia, Plymouth, Dover, Portsmouth and Wolfeboro.
McCaffrey, the hospice CEO, said home health care pay is in the range of $9 to $12 an hour, a level he described as unattractive for workers.
"These jobs need the respect and dignity they deserve, and until that, the problem isn't going to be solved," he said.
Along with pay, there needs to be more training programs and a broader volunteer base for those caring for loved ones in order to offset the occupation's dwindling "population base."
"Our country isn't willing to pay for home support services, and very few insurances are willing to pay," said Rene Philpott, a Homemakers spokeswoman.
Philpott said lagging state reimbursements and other funding issues are also contributing to the staffing woes.
"At one point, we might be able to provide a person with four hours a week of homemaker services," she said. "Today, we may only be able to provide them two hours rather than the four."
Margaret Franckhauser, executive director of Community Health and Hospice of Laconia, said the organization does not have enough physical therapists or nurses to serve all the local elderly population in need.
She said currently the organization employs six physical therapists, though not all work full-time.
The organization could use two more therapists just to meet the current need, she said, adding that they need more home care nurses, too.
Community Health and Hospice has 11 full-time nurses to serve home health care patients and five or six more nurses who provide care to hospice (or end-of-life) patients as well as care to children with significant health issues.
Between all their programs, they serve 1,800 people in the Lakes Region. Most, about 1,200 people, are in the home health care program.
Franckhauser said in five years, she anticipates they'll need three to five more nurses, although technology may cut that number.
The organization already uses tele-health systems to help monitor patients' vital signs, and they've switched their records to computers, which lets nurses manage more patients, she said.
Franckhauser said that the vast majority of seniors they work with say they would prefer to stay at home.
She said some are prevented from doing so because of a lack of enough home health care workers in their area.
The current caseload for Community Health and Hospice nurses is between 25 to 30 patients, Franckhauser said.
Family members and friends need to play an active role in the care of a loved one at home, even if they are receiving some trained health care, she added.
"Family care is needed," she said. "No home care agency can do it all. Families really are the primary care givers."
John Poirier, executive director of the New Hampshire Health Care Association, an association of privately owned nursing homes, said the size of the workforce has long been a concern.
Health care has been downshifting over the years, he said.
About 20 years ago, a person in recovery from an operation or a serious injury or illness would be in a hospital; now that's done at a home or nursing home.
"We've shifted that recovery care out of the hospitals," he said. "Likewise, much of the care that was done in nursing homes years ago is now done at home by trained health care workers."
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