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Hard work, huge need: Florida sees shortage of home health aides; low pay a big factor

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Nancy Pye knows she’s fortunate to have someone by her side to help her with daily living tasks she can’t do on her own anymore.

An outfit and jewelry are selected each night. A steadier hand than her own helps with her lipstick in the morning. Doors are opened so she can keep a good grip on her walker.

Best of all, there’s the camaraderie she and her home health aide, Maybelle McDonnough, have when they sing a Patsy Cline song in the dining room of Pye’s independent living community for seniors in Naples.

McDonnough is a rare breed working in the home health care business for 30 years, especially since the COVID- 19 pandemic caused worsening vacancies in an industry notorious for low pay, Home health agencies can't find workers who left the industry during the pandemic and found better paying jobs elsewhere, industry officials say.

Frail seniors are losing the option of staying independent in their homes or staying home safely if they can’t access home care services. There are ripple effects where senior injuries will increase and they will require hospital stays and some may be forced into nursing homes or assisted living earlier than necessary.

“Home health aides are really the building block that keeps people in their own home,” said Maureen Albertson, a volunteer board member of the Home Care Association of Florida, the trade association for the industry.

Florida will have a projected 101,000 openings for home health aides by 2029 due to an aging population and more people moving into the state, according to the Florida Department of Economic Opportunity.

That’s more than double the 73,000 individuals in 2020 working as home health aides across a variety of healthcare settings.

Health issues derailed plans

Pye, 76, has lived in the independent living side of Aston Gardens, a senior community in North Naples, since April 2021. Aston Gardens also has assisted living and a memory care program.

She relocated to Naples from northern Virginia with her daughter, Debra Keenan, who had retired and moved to Bonita Springs.

A stroke at the age of 60 derailed Pye’s plans to travel with her husband, which led her to developing vascular dementia and her vision became impaired.

Chemotherapy from cancer caused nerve damage and now she uses a walker. Her husband was her primary caregiver until his death in 2017.

“I am trying to keep her in independent living with caregiver support as long as I can,” said Keenan, 58, who was an executive in northern Virginia with VITAS Healthcare, a hospice organization, before retiring.

McDonnough, who works for Discovery at Home, an agency based in Bonita Springs, comes to Pye’s apartment five days a week, two hours in the morning and two hours in the evening.

They have a rapport that leans more toward friendship than client and caregiver. They tease each other and giggle often.

“I don’t know what I would do without her,” Pye said.

McDonnough, 73, helps her get ready for breakfast and escorts her the short distance to the dining room and back to her apartment. On Friday, she helps Pye in the shower.

“If I start to make my bed, she starts yelling at me. She doesn’t want me to fall,” Pye said.

McDonnough returns late afternoon and goes with Pye to dinner at 4:30 p.m., where the two occasionally start singing and others nearby join in, she said.

“We are really liking the companionship,” Keenan said. “I feel better knowing Maybelle is here during dinner and helps her get ready for bed.”

Home health care: ‘It is hard work’

Roughly 350,000 seniors in Florida use home care agencies, where 90% say they want to stay independent as long as possible, according to the home care association.

Home health aides provide assistance to people with activities of daily living, like dressing and bathing, but typically not medical care, said Dan Cundiff, president of Discovery at Home.

“It is hard work,” Cundiff said. “People who do this work have a calling. They likely relate to the seniors. They had some experience in their lives and they feel a connection to help seniors.”

The bulk of home health care is an out of pocket expense for families for their elderly loved ones, he said.

The average hourly wage for a home health aide is $12.22, data from the state Department of Economic Opportunity shows.

Besides the need for more home health aides, the state will need nearly 90,000 more certified nursing assistants by 2029, a different classification of workers who can provide medical care and a step above home health aides.

The COVID-19 pandemic caused many home health aides to leave their jobs due to exposure risk or other factors and have changed the type of work they do, said Albertson, the board member of the home care association.

Many found they can earn more at Target and other big-box stores.

“Home health aides are the lowest on the wage scale,” she said.

McDonnough, the home health aide for Pye at Aston Gardens, acknowledges she could earn more at Target.

“I have a grandson who works at Target and makes more than I do,” she said.

Still, she has no plans to leave the profession.

“I just love my people,” McDonnough said.

Without home health aides, people cannot age in their homes as desired and may have to be placed in a setting, Albertson said.

“People do best in their home, they age best in their home,” she said.

Right now, agencies are not able to accept new clients for home care because they can’t find the workers, or they have to shorten the hours, she said.

That means they cannot provide the two to four hour blocks of time during the day that was typical before the pandemic, she said. Cundiff, of Discovery at Home, said the industry faced an “almost two year drought” of workers due to the pandemic but he’s now seeing positive signs people are becoming available.

“Very few are full time,” he said. “They want flexible hours.”

“It is hard work. People who do this work have a calling. They likely relate to the seniors. They had some experience in their lives and they feel a connection to help seniors.”

Dan Cundiff

President of Discovery at Home