Demand was already on the rise — then COVID-19 hit
HALFMOON — Charlotte Kennedy knew she didn’t want her husband to enter a rehabilitation facility after his week-long hospital stay.
It was late June, and visitation restrictions at nursing homes and other health care facilities were still in full force due to the coronavirus pandemic. In the time James Kennedy had been at St. Peter’s Hospital in Albany, Charlotte could only visit him during a four-hour window, and spent the rest of the day wondering what tests he was getting, how he was feeling, and whether he was confused by everything happening to him.
The 80-year-old has dementia and congestive heart failure, and after a feverish night last month developed blood clots in his lung that impacted his ability to walk, talk and move.
Then there was the matter of nursing homes and the deadly devastation they had endured from coronavirus. Rehabilitation centers are often co-located with nursing homes, and congregate settings of any kind made Charlotte nervous.
“They really wanted us to send him to rehab,” she said of her husband's medical team. “I said, ‘No, I’d rather take him home.’ I’m not going to send him to a rehab with all this COVID-19 going around.”
So Charlotte and her daughter arranged in-home care for James through The Eddy Visiting Nurse and Rehab Association, and soon a nurse, nurse’s aide, physical therapist and occupational therapist were visiting their Halfmoon home twice a week. A speech therapist visited once a week.
The family set James up in the living room near the sliding door, where he could see the cardinals at his bird feeder and the garage, where he had spent endless hours tinkering with his classic ’53 Mercury.
Proximity to the garage “really facilitated him to do more,” Charlotte said, noting how religiously he devoted himself to therapy. “He wanted to get back out there.”
James has improved considerably since, she said. He’s able to move around with the assistance of a walker, and he’s talking and eating regular food again.
Home care boom
The Kennedys were not alone in opting out of congregate care for a loved one during the pandemic.
A recent survey of just six New York home care agencies found that 20,000 elderly, at-risk and disabled New Yorkers were kept out of nursing homes and hospitals thanks to in-home health care. Agencies say they are fielding increased inquiries and demand for home care in recent months, and believe the fear of contagion and isolation at nursing homes caused by the pandemic is to blame.
“People have always been reluctant to put their parents in a nursing home,” said Jim Hurley, franchise owner of Home Instead Senior Care, a home care agency based in Schenectady. “Now they’re scared to death of it.”
The rush to flee or avoid congregate settings altogether has impacted health care across the board. Hospital admissions fell significantly and are only now returning to normal. Families pulled loved ones out of nursing homes, and put off moves into assisted living. Others arranged for home-based hospice care, physical therapy, occupational therapy and speech therapy. There’s even an increase in people considering home births.
The first thing Hurley noticed during the pandemic was an increase in people seeking at-home hospice care, which is provided near the end of life.
“We definitely early on got an uptick from hospice,” he said. “People were in a facility and families couldn’t go visit them, and they knew they weren’t going to make it to the other side of this when visitation opens back up. So they brought them home.”
He also noticed a surge in general inquiries from the public — people calling to find out what services his agency provides and whether they might be the right fit for mom or dad.
“Those were up probably 50 percent,” he said. “So it looks like that wave is coming.”
Lisa Lemery, a director with the Eddy Visiting Nurse and Rehab Association, said there was an initial dip in home care demand when the pandemic began as elective surgeries were postponed and fewer people required post-acute follow-up care.
Demand picked back up, however, and now appears to be exceeding what it was prior to the pandemic, she said.
“People don’t want to go to rehab because their loved ones can’t visit them and there’s that potential exposure to other people,” she said. “It’s definitely a more secure feeling for the patient to get that care at home.”
The same scenario has played out for family with loved ones in nursing homes, she said.
“We’re seeing patients go from nursing homes back to the home setting — which we don’t typically see, because usually the nursing home is someone’s last stop,” she said. “But because the loved ones can’t go visit the nursing homes and see their relatives, they’re saying, ‘You know what? It’s not worth it. I’m taking them home.’”
Many, like the Kennedys, are also finding the psychological benefits of in-home care too large to ignore.
“Sometimes the factor that’s not really adequately incorporated into the equation is the psychological toll it can take on somebody when their lives are upheaved,” said John McCooey, president of Belvedere Home Care in Albany. “It can have effects on their physical well-being.”
In particular, he thought of seniors who may be struggling with Alzheimer’s or dementia and suddenly find themselves thrust into a new environment. The abrupt change can be disorienting, and impact their eating and sleep patterns.
“It’s still massively shocking to me when you are with (a dementia patient) in a nursing home and they say, ‘I want to go home,’” he said. “What they mean is, ‘I know I’m not home. I know this isn’t home. I know this isn’t right.’ It breaks your heart.”
A strained workforce
The shift to in-home care was already happening when COVID-19 hit, driven by an aging population of Baby Boomers and policies designed to encourage what many consider to be cheaper, more efficient care.
The state Department of Labor predicted in 2018 that the home health aide occupation in New York would see a 66 percent rise in employment over the next 10 years — the second-highest projected increase in the state behind solar photovoltaic installers.
But home care leaders say the pandemic helped speed up this already high demand.
“Family dynamics during this time have changed quite a bit,” said Hurley. “Adult children are home more, interacting with their parents more and noticing, you know, ‘Hey, I think they might need some help."
The flexibility of working from home has also freed some up to coordinate or supervise care for loved ones who they maybe previously didn’t have time for, Lemery said.
The rise in demand, however, is expected to exacerbate what were already widespread staffing shortages in the industry.
Home health aides are paid starting wages at or near minimum wage, and turnover is high. Wages in the Capital Region are lower than elsewhere, Lemery said, and many agencies wind up competing for the same skilled labor pool.
The result is a lot of overtime. McCooey said almost one out of every three hours worked for his agency is an overtime hour — something he is actively trying to change, he said.
Belvedere, which currently employs 215 direct-care aides, announced this month that it’s looking to add another 100 direct-care positions to its roster. McCooey said his organization is technically always hiring, but said the mass unemployment caused by the pandemic may spur interest it doesn’t typically see.
“It would allow us to de-stress the organization,” he said of the possibility of taking on the new workers.
“We haven’t been able to change the dynamics since at least 2016, because the economy had been growing and growing and more and more people were employed,” he added. “We couldn’t keep up with Walmart in terms of what they pay, and it’s easier to stock shelves or flip burgers than provide home care. But the current situation leaves a very different dynamic.”
Assuring aides they will be safe on the job will be critical to retaining staff, Lemery said. Fear of contagion inside other people's homes and early roadblocks to attaining personal protective equipment caused some in the field to leave or retire early, she said.
"It was tough," she said. "But people are committed when they’re in this field and want to do everything they can for people and their patients. So we're seeing that, as well."