“A lifetime bond” – Home health care advocates ask for better pay for providers

DOVER, Del. – Private duty nurses and home health care aides make all the difference for individuals living with disabilities. However, stagnant wages are putting a strain on the amount of helping hands to go around, leaving many disabled individuals without vital care.

Meet Benjamin Shrader

Benjamin Shrader loves his family, and advocating for those living with disabilities. He’s also lived with cerebral palsy his whole life. Benjamin depends on his home health care aide, Alexis, to make sure his medical needs are met every single day.

“We think of independence as self sufficiency. But, the truth is that our main goal should be autonomy. And, I can’t be autonomous if Alexis doesn’t show to get me out of bed in the morning,” said Benjamin.

In addition to providing crucial care, Alexis also provides Benjamin with friendship, and the pair share frequent laughs.

“I know it’s the right fit when I hear Alexis show up in the morning, and they immediately begin their banter,” said Benjamin’s mother, Carol Shrader. “The relationship is beautiful and unique, and when it works right, it’s a mutual respect… She’s in tune to what he needs, and she gives him the autonomy to choose. But, I also know she guides him a little bit.”

While it’s a “best case scenario” with Benjamin and Alexis, the Shraders say it’s not the same for everyone who relies on that type of care.

“The backup plan can’t always be a parent. We need to make sure that we value the position enough to provide enough salary,” said Carol. “Home care means that Benjamin is where he is loved, it is where he is able to be a contributing member of society.”

“[My mom] has her own schedule and things to do, and I don’t think it’s best for either of us for my schedule to be blended into that. But, [without Alexis] it often is if I don’t have an aide there,” added Benjamin.

Stagnant Wages Strain Home Health Care

Medicaid reimbursements help provide private duty nurses’ and aides’ income.

In Delaware, however, aides’ rates are just $27.85 an hour. The aides pull in a portion of that as their income, but the reimbursement rates cover all costs of providing care. What the aides end up taking home is about the same as what can be made in entry-level positions in the retail and hospitality sectors. Registered nurses’ rates are $63.66 and hour, and licensed practical nurses’ are $57.04 an hour.

Those numbers are making it harder for non-profit home health care providers, like BAYADA, to compete with others.

“We compete with a lot of other companies when we are not able to pay our care givers that reasonable salary that they can live off of,” said Director of BAYADA’s Delaware State Program Office, Rachael Ali-Permell. “[Previous increases haven’t] been significant enough to justify increasing wages for our health care providers.”

Ali-Permell says allowing individuals living with disabilities to do so independently only improves their quality of life. And, those providing the care that makes that possible, deserve better pay, says Ali-Permell.

“If we don’t have the tools, and the financial ability to do so, we’re not able to meet their needs. And, that’s the biggest part of it,” said Ali-Permell. “We don’t have the skilled individuals, because those individuals don’t want to work for minimum wage. They want to be able to get a decent salary that they can live off of.”

Asking For an Increase

Home care advocates are asking for an increase in Medicaid reimbursements for workers and nurses to get them up to speed. Under the request, aides would make $34.31 an hour, a 23.2% increase; registered nurses and licensed practical nurses are asking for increases to $57.04 an hour and $59.98, respectively; a 5.2% increase.

“[Increases] directly impacted our retention rates. It directly impacted us being able to recruit more credible nurses, more experienced nurses,” said Clinical Manager for Delaware Pediatrics, Tykisha Church Brown. “We could do more training to bring in more nurses that may not already be pediatric specialized. That increase not only goes for increasing the nurses’ pay rate. It also goes to maintaining the [simulation] lab, making sure that we have everything we need in order to train. And, it also goes into their benefits.”

The combined requests would cost the state about $9.8 million in total, estimate home care advocates. However, Executive Director of the Delaware Association for Home and Community Care, Sue Getman, says the investment would only return to the state.

“Inpatient care in hospitals is six times more expensive than home care. For example, you can spend 64 days, or over two months, in the hospital, and that cost is the same as one year of nursing services provided in the home,” said Getman. “This is cost savings for the state, as well as what the people of the state want.”

More Than Aides and Nurses; Family

The request for increases comes not just as a way to provide home health care providers’ a living wage; advocates say it would also help ensure a better quality of life for those who rely on them.

“The people who go into homes as either personal care workers or nurses definitely become part of the family,” said Getman. “They also provide companionship, and concern, and a love that comes from their commitment to doing this work… It keeps our people living at home, where they’re safe, and where they’re with the people they want to be with.”

Getman personally knows the impact that home health care providers have on their clients; her husband suffered a stroke about a decade ago, and has since made a full recovery. “We relied on people coming into our home to provide care that enabled him to heal, and now live a full life,” she said.

Church Brown worked in the field before she became the Clinical Manager for Delaware Pediatrics. She stayed with the same family for more than 20 years; spending almost every moment of every day with her pediatric client, sharing memories, and eventually becoming his god mother.

“Without having me as his nurse, he would not have been able to go to school, he would not have gotten the quality of life he got,” said Church Brown. “It is a lot of work. But, it is a labor of love… To this day, I go back to visit them. So, it’s a lifetime bond.”

And for Benjamin, Alexis is more than family. “This is a daily personal relationship that’s key to autonomy, which is a unique thing,” he said. “This is not a handout. This is an instrument of liberation.”