It took 23 phone calls to find home health care for MJ Falango’s father.
A series of falls and infections had brought Joseph Falango, 87, to the hospital. Now, his doctors were refusing to discharge him without assurance he had someone to monitor his health at his Melbourne home.
At first Falango, who lived 90 miles away in Deland, wanted a vaccinated home health aide for her father, contacting national agencies and local companies with her request.
“Several times, people laughed,” she recalled. “They said, ‘We have too few employees as it is — if we make that a condition of employment we wouldn’t have anybody.’”
She lowered her standards. It didn’t matter.
None of the agencies had staff available, regardless of vaccination status, for at least three weeks. Two put her on waiting lists — it was the end of June, and she’s yet to hear back from either, she said.
Finally, a local agency in Melbourne had an aide to care for her father. Joseph Falango returned home.
But the home health employee was a no-show on her first and second days of work.
When no one came the third day, Falango finally heard from the agency — the staffer’s daughter had been sent home from school with a possible COVID-19 infection.
Defeated, Falango moved her father into an assisted living facility by the end of July.
“It truly has been a nightmare,” she said.
Home care is more popular — and more difficult to find — than ever in Florida.
About 90 percent of Americans want to age at home rather than in a long-term care facility, and home health leaders say the demand has only increased amid a pandemic that has been especially deadly for long-term care residents.
At the same time, the global emergency has ushered in an unprecedented shortage of home health aides in the state, leaving older adults and people with disabilities with limited options to stay in their own homes when they need care.
“We’re trying to recruit new people weekly,” said Andrew Burke, president of Granny Nannies, a home health agency that serves older adults in Hillsborough, Pinellas, Pasco, Sarasota and Manatee counties. “It’s always net zero — we bring on five, but we lose five.”
The local Granny Nannies franchise has lost between 150 and 200 home health aides since the pandemic began, Burke said.
The agency recently put out a call for a caregiver to work with Alzheimer’s patients during 12-hour shifts — the preferred shift schedule for many home care workers. The job paid $18 an hour.
“No one took it,” Burke said. “I’ve never been at a point in my business where I’ve had to say no, we can’t help you.”
Several area companies reported raising wages to attract staffers, but said they still struggle to get candidates to pick up shifts or show up for interviews.
“We’re seeing it at our agency and really throughout the state of Florida,” said Denise Bellville, a Home Care Association of Florida board member and vice president of operations at Comprehensive Home Care in Palm Harbor, an agency that serves seniors in the Tampa Bay area.
The number of home health aide jobs in the state has grown by 60 percent in the last decade, according to a data analysis by PHI, a nonprofit that researches the direct care workforce, which is predominately made up of immigrant women of color. At the same time, wages have remained relatively stagnant.
While many agencies are increasing pay amid the pandemic, the analysis found that when adjusting for inflation, the median pay in 2020 for a home health aide was $11.61 an hour, compared to $11.39 in 2010.
“We covet these paraprofessionals,” Bellville said. “But they could work at a fast food location and earn more per hour than they can in a patient’s home being a caregiver — which is a menial job, I’ll just say it.”
It’s hard to truly measure the scope of staffing shortages in the home health industry in Florida — people pay for care at home through a mix of private and public means.
A look at one program for some of the state’s most at-risk seniors suggests demand for home care services may be increasing.
Many low-income people rely on Medicaid to pay for home health caregivers. Most Medicaid recipients in Florida are enrolled in the Statewide Medicaid Managed Care program, which has a specific division for long-term care services — including home health care, which is designed to help adults who qualify for nursing home placement stay in their homes.
The long-term care program had about 57,000 people on its waitlist in 2019, according to data obtained by a public records request. Last year, the waitlist rose to roughly 59,300 people. At the end of the 2021 fiscal year in June, the number of people waiting for care through the program sat at 59,004.
In an emailed statement, Rebecca Roberts, spokesperson for the Department of Elder Affairs, which determines eligibility and level of need for the program, said it’s “not uncommon” for people on the waitlist to be receiving other services that “can extend their ability to remain independent and in their own home.”
Why are there shortages?
Worker shortages plagued the industry long before the pandemic, according to Stephen McCall, data and policy analyst at PHI.
But the pandemic exacerbated existing challenges in recruitment and retention — dually increasing demand for these services while leading many employees to retreat from a physically taxing, low-wage job that demands close contact with others indoors.
“Demand for these workers is extremely high,” McCall said. “However, because of the historical undervaluing of this workforce and the high reliance on public funding to shape their job quality, compensation for these workers really hasn’t kept up with that demand.”
Home health agencies are also limited in how much they can raise wages, agency owners and industry experts said, by predetermined Medicaid reimbursement rates.
As people get older, they’re expected to pay out-of-pocket for many health care services. When a senior’s resources deplete to the point of poverty, they become eligible for Medicaid to continue receiving essential services like home care.
According to McCall, approximately two-thirds of the home health industry’s revenue nationwide comes from public payers, most often Medicaid — which depends on joint funding from the state and federal government.
“While industries like fast food and retail could adjust their prices and dip into profits to increase wages, home care employers have really struggled to do the same,” McCall said. “They have to go to the legislature every year to fight tooth and nail for even basic levels of investment in this workforce — so they just haven’t been able to keep up.”
Gov. Ron DeSantis’ administration has requested an additional $1.1 billion in federal Medicaid dollars to boost access to home and community-based services over the next two years, including $266 million to recruit and retain workers.
On Oct. 11, a top state health official reported that the federal government has given Florida “conditional approval” of these funds. How the state plans to distribute this money remains to be seen.
An aging population
The problem of increased demand colliding with limited supply is expected to balloon in the home health industry in coming decades.
One in five Americans will be 65 or older by 2030, according to U.S. Census Bureau projections.
Florida’s aging workforce may nevertheless present opportunities for the home health business, McCall said. The flexible schedule and nontraditional hours may be appealing to older adults looking for an “encore career.”
Home health aides take work as-needed — meaning they accept opportunities on a job-by-job basis.
Dalia Torres, at 68, is partially retired and works two hours a week as a home health aide.
She likes her ability to set her own schedule — it means she gets to care for her own mother as-needed and keep her weekends free.
“If I don’t want to work, I don’t work anymore,” she said.
Torres still keeps in touch with former clients — she plays bingo with a Holocaust survivor in Gulfport, and will attend a 90th birthday party next month.
“A lot of agencies don’t pay the girls enough,” she said. “It’s not fair, because it’s not easy to take care of people.”