Demand has soared while number of caregivers dwindles

Published 7:04 pm Monday, September 4, 2017

ROCHESTER — Last April, Sharon Boelter fell and fractured her foot while trying to get into bed.

The incident would introduce the 73-year-old Rochester woman to an eye-opening experience. After undergoing surgery, Boelter was sent to Samaritan Bethany for rehab. That experience, as well as an earlier stint at Stewartville Care Center, awakened her to the severity of the area’s caregiver shortage.

Outfitted in a walking boot, Boelter became entirely dependent on staff. She needed them for her meals, for using the toilet and for getting in and out of bed. Every day, staff lifted her out of bed using a mechanical device called a Hoyer and settled her into a wheelchair.

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At first, it disturbed and concerned her when she would summon a caregiver by turning on her call light and have to wait 30 to 45 minutes for one to arrive. It didn’t happen every time but enough that it worried her. Another time, one caregiver was made responsible for a “whole section down to the dining” room comprising 12 to 13 rooms.

At first, the situation angered her because oftentimes she would need to use the bathroom. Waiting in bed, Boelter easily could imagine more frightening scenarios. What would have happened if a resident with a heart problem needed their meds? Or a person began choking on food? A quick response might mean the difference between life and death.

But her anger dissipated as she began to realize her experience was not so much the result of neglect or indifference as a symptom of an industrywide problem. She learned the floor above her went entirely unused because of the staffing shortage.

“My anger kind of left me,” Boelter said. “A person can’t be in two places at one time. I don’t care who you are. And they were doing the best they could.”

Sue Knutson, CEO of Samaritan Bethany, said the goal at Samaritan Bethany is for staff to respond to a call within five minutes.

“Does it happen every time? I can’t guarantee it,” Knutson said. “If you’re waiting for someone to help you, it’s a long time whether it’s five minutes or an hour. I give a lot of credit to our staff members for what they do. They work overtime when they can do it. And they pick up shifts. They help each other out, but it’s hard work.”

Nursing homes have dealt with shortages before, but nothing like this, experts say. An estimated 60,000 individuals are turning 65 every year in Minnesota until the year 2030. That’s the equivalent to the city of Lakeville’s population retiring every year. And only a fraction of people are entering the workforce.

“This is different because we don’t see on the horizon anytime soon that this is going away,” said Kerry Thurlow, senior vice president of advocacy for Leading Age Minnesota, a statewide organization of senior care providers.

Rural areas have been hit hardest by the shortage. That’s because young people tend to migrate from rural areas, while elderly residents tend to stay put.

The vacancy rates for caregivers are highest in the southeast region of the state, surveys show.

Here, vacancy rates for registered nurses (17.4 percent), licensed practical nurses (21 percent) and nursing assistants (19.9 percent) are among the highest in the state, according to Leading Age Minnesota. But the shortage affects not just caregivers. Dietitians, maintenance people and housekeepers are in high demand at nursing homes, too.

“It has one of the biggest shortages of the direct caregivers in all positions compared to the whole state,” Thurlow said. “And that’s directly because of the competition and need for all kinds of health care workers there.”

Another contributing factor: Demand for caregivers has soared as the options for seniors has expanded.

More and more elderly people now opt for care delivered in their homes, rather than at nursing homes. That has led to an explosion of home health aides. Minnesota now serves more seniors in home and community-based services than it does in nursing homes.

One consequence of that movement is that more people are needed to look after and care for the elderly. Caregivers — those who work directly with seniors — now outstrip retail, K-12 education and public safety in terms of the people employed in the U.S.

“It’s what families want, so that’s definitely a trend that will continue,” Thurlow said.

It was easier to draw people to nursing home work because the pay differential between nursing assistants and restaurant work and retail was larger. But the difference has narrowed.

In 2015, state lawmakers passed legislation to attract people to nursing home work. They changed how nursing homes are reimbursed, leading to better pay and benefits for caregivers. They made scholarships available for workers interested in advancing their education. Thurlow said anecdotal reports from nursing homes around the state indicate those changes have helped in the recruitment and retention of staff.

The average wage for nursing assistants is $13.93 per hour compared to $12.35 for retail sales and $9.64 for food service.

“I think we are making progress there. Certainly, I think we need to make more,” Thurlow said. “As we see a shrinking labor pool, the ability to recruit and attract workers is going to depend on being able to pay competitive wages.”

But others say the erosion of benefits with time has taken its toll on competitiveness. Eric Huntoon, CEO for Shoreview Senior Campus, said benefits relative to other similar jobs used to be “very good.” But during the last three or four years, that gap has “either narrowed or disintegrated.”

“It used to be a point of difference for us when we were interviewing and hiring that that was kind of a carrot that we could dangle,” Huntoon said.

The shortage in caregivers has been building for awhile.

“As stark as the numbers are, this is not news to anyone. To some extent, we’ve known that this is going to happen,” Thurlow said. “I think it is an invitation for innovation and creativity in changing how we deliver care and services.”

Some people say there needs to be a sea change in societal attitudes toward caregivers. Sue Knutson, CEO of Samaritan Bethany, praises her staff as the “best people who live here, but it’s a hard job.”

“Until society changes its views on a caregiver as a career and as someone to be looked up to instead of someone who wipes butts, until that stigma goes away in society, I don’t know if we’ll see change,” Knutson said. “I would love to.”