Ohio's home care industry asks for a lifeline in COVID-19 pandemic to boost worker wages
Is Ohio leaving more than a billion dollars of home care funding on the table?
Titus Wu
Changing diapers, checking vitals, administering meds for frail patients in their homes is a tough job that only pays about $12 an hour – a wage so low that the home health care industry is struggling to hire and retain workers.
The home care sector's capability to serve more than 105,000 Ohioans is worsening as the staffing crisis and high costs have been exacerbated by the COVID-19 pandemic.
Some help is on the way. In response to the pandemic, Congress put in a financial incentive for states to build out historically underfunded home care services in the American Rescue Plan Act, or ARPA.
The Ohio Medicaid Department submitted a spending proposal late October to the federal government, detailing how an additional $964 million would boost the industry and in turn, expand availability of home care for Ohioans.
But the state could have made a pitch for more than $2.1 billion.
So at a time when providers are seeking every penny and when more Ohioans are seeking home care services, why didn't the state ask for more?
Responding to a crisis
It is far cheaper and safer to age at home, and that became even more clear when nursing homes became COVID-19 hotspots.
Receiving in-home services averages $1,225 a month compared with $6,361 on average for nursing home care, according to the Ohio Association of Area Agencies on Aging.
Home care is becoming more popular for those on Medicaid, state and federally funded health insurance for 3 million low-income and/or disabled people in Ohio. It pays for the bulk of long-term care.
But the pandemic is straining the system. Staffing shortages plague the industry. Direct care workers make on average $12 an hour. And the pandemic prompted more workers to leave, making it more difficult for people to find home care services.
Since the beginning of 2020, roughly half of at-home nurses have left, according to Lisa Von Lehmden Zidek of the Visiting Nurse Association of Ohio, leaving just 700 visiting nurses.
Patricia Carson, a Brunswick resident, told the Columbus Dispatch that she hasn't been able to find someone to take care of her 84-year-old mother on evenings and the weekends for almost a year.
“Most of them don’t want to spend the time and even come out,” Carson said. “On average, it takes me 14 calls just to get one agency to follow through and send someone out, and even then, you don’t have a solid deal."
That doesn't surprise Zidek, who said there have been times when 15 agencies are called to provide services. The requests are declined, leaving the patient without care or taken to a nursing home, she said.
Agencies are turning away three out of every four referrals, according to the Ohio Council for Home Care and Hospice.
With the pandemic, Congress saw the benefits of home care but also how under-invested it was. Through ARPA, it temporarily beefed up the federal share of Medicaid for home and community-based services.
From last April to March 2022, Ohio is expected to receive an extra $562 million for home care as a result, a much anticipated boost. The extra money, which must supplement and not supplant current funding, must be used by March 2024.
Higher rates or systemic improvements?
Ohio faces choices on how to spend the $562 million: temporarily boost reimbursement rates paid for services, invest it in long-term projects or a combination.
Home health care providers want Ohio Medicaid to use the cash to temporarily boost reimbursement rates. Higher rates means they could increase wages to attract and retain workers.
Per Medicaid's complicated rules, spending it that way before March would allow Ohio to draw down even more federal money on top of the $562 million – at least an additional $1.69 billion.
Spending it on long-term improvements, such as technology upgrades, wouldn't draw down as much.
Ohio's current plan earmarks $164 million to temporarily increase rates. Most of the rest is dedicated for long-term improvements. Overall, Ohio is using its $562 million to get just $401 million more for home care. View the plan below.
Some are scratching their heads why more money isn't being put toward reimbursement rates to help increase wages.
"Our preference would be for them to fully leverage the opportunity that the enhanced (match) provides the state of Ohio," said Joe Russell, head of the Ohio Council for Home Care and Hospice. "That is by far our No. 1 need. We're in a crisis state right now."
Others questioned using one-time money for long-term investments.
"There isn't a lot there that really shows how they're going to maintain a lot of these initiatives in the long term," said Jordan Ballinger, policy director for Disability Rights Ohio. "Although a lot of [them] could and probably will be very good... what happens when this money is gone?"
But using all the one-time money to help home care providers increase wages is not sustainable, Ohio Medicaid Director Maureen Corcoran said in an interview. Even with an influx of cash, the industry would be up against the labor shortage, she said.
"There are not people to hire. We could give them every dime of this (for increasing reimbursement rates). They wouldn't be able to hire people," said Corcoran.
On the other hand, the ARPA boost represents a one-time opportunity for these long-term investments that Ohio normally wouldn't fund on its own, said Corcoran.
She also noted that nothing is decided yet. Talks between the governor's administration and state lawmakers are ongoing, and the federal government has to approve the final plan.
In the end, for most home care providers, any additional money is better than nothing.
"Just the total amount of money that's going to be going into the system is really hopeful," said Ballinger.
Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.