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June this year looks different from last year, especially for older adults most affected by COVID-19. Despite the higher rate of infection for individuals below age 65, those 65 and older had the greatest number of deaths due to COVID-19. While the threat of the virus may have somewhat subsided as about 75% of those 65 and older are fully vaccinated in the nation, other pre-pandemic issues continue to pose concerns for the aging population. 

Even before the pandemic, those in the caregiving professions knew a shortage in workers would occur. The pandemic only exacerbated the problem, said Homewatch CareGivers of Tucson president Margie Lannon. 

“We are also taking care of the baby boomers, and there are a lot more baby boomers and we knew a long time ago that this was going to happen,” said Lannon. “Granted the pandemic and the pay rates have made things a little bit more difficult with the surplus money that they’ve been getting for staying home, but it’s also the generational gap that we have right now.”

The pandemic only caused a greater shortage as individuals felt fear of contracting COVID-19 or infecting someone else. Particularly in Green Valley, where many of Lannon’s in-home care workers are retirees, she said many of them resigned during the pandemic and about half have returned. 

Like Lannon, Pima Council on Aging President W. Mark Clark said they knew long before the pandemic that they faced problems with that workforce. While there is a general labor shortage in the nation, he admits direct care work “tends to be challenging, and doesn’t pay very well.”

Clark said part of the problem is balancing the workers’ wages with the costs to people who need the in-home care services. He said the only public support for that non-medical in-home care is the state Medicaid program, AHCCCS, which offers the Arizona Long-Term Care System for individuals who are age 65 or older, or who have a disability, and require nursing facility level of care. Here's a list of local resources.

“Some people think Medicaid pays for long term care, it does not. It pays for a limited amount of skilled rehab care, but not what we call non-medical in-home care. It does pay for long-term like skilled care or residential assisted living or those sorts of things,” said Clark. “So people are having to pay for much of that care out of pocket and so as we see significant wage pressure, which we know we’re going to see.”

With a shortage of workers and some workers getting sick, Lannon implemented what she calls the “caregiver shuffle.”

“An employee would get exposed to somebody with COVID, so then they couldn’t work for 14 days. So that caregiver might have taken care of five different clients that week, but I had to find another caregiver that could go in and take care of her five clients for two weeks,” said Lannon. “It’s not like we can plan ahead for a vacation...This was you know like five people calling and saying, ‘I’ve got exposed.’” 

At the start of the pandemic Lannon had about 20 clients who went on hold because they were not receiving services they deemed necessary. 

“We were just helping make their lives a little bit easier by grocery shopping and things like that,” said Lannon. “The people who didn’t feel it was a necessity, they did stop as soon as the pandemic really hit, and all of those people are now back, I think, except for one.”

During the pandemic, Lannon notes demand for their in-home care services fluctuated from month-to-month. 

“One month I would have a ton of people who needed help, and then the next month it was quiet as a bee. I mean, there was really no rhyme or reason, I couldn’t make any sense of it,” said Lannon. 

Prior to the pandemic, Lannon said they traditionally ran at about 125 employees and have about 91 caregivers at the moment. 

As the number of workers climbs back up, Lannon faces increased demand and finds herself having to refer clients to other agencies, turning away and sending about 10 clients to other agencies in the last two weeks. 

“It breaks my heart when people are calling and I can’t help them. It’s probably the worst feeling in the whole wide world,” said Lannon. 

According to Clark, the Pima Council on Aging has about 180 people on a waiting list that they have approved for services, but their 13 providers are unable to find a person to work in those people’s homes.

“They’re not waiting for what we would call authorization or service approval. It’s now just a matter of trying to figure out how one of our providers can find somebody to actually go in their house, help them with bathing, help them with laundry, light housekeeping, linen changes. The kind of really important caring work, those direct care workers do on a regular basis,” said Clark.

Lannon had not necessarily prepared for the shortage, but made it her motto to always care for her employees. 

“Yes, I own the company. Yes, I’m the administrator but the person who really is my company is my employees that are out there with their faces,” said Lannon. 

When Lannon opened her company about 13 years ago, she conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with all the other companies in town and found no one was offering employee health care benefits.  

“I made that my personal goal to be able to do that and at this point right now, I pay 75% of my employees health care benefits to try to make it even more affordable for them because I want this to be a career for them. I don’t want this just to be a stepping stone,” said Lannon. 

For the Pima Council on Aging, facing the shortage meant investing in those training the next generation of caregivers. 

Last April, the Pima Council on Aging integrated the CareGiver Training Institute (CGTI) into their family of nonprofit companies as a subsidiary organization to keep it afloat. For more than 20 years, CGTI has provided certified nursing assistant, certified caregiver, and assisted living manager training. 

“Those workers do not tend to be the folks doing that non-medical, in-home direct care work, but they’re the next rung up the ladder,” said Clark. “Part of the way I think you get people to do the direct care work is by talking with them about how that work will allow them to move into higher level, better paying healthcare careers.”

However, CGTI also faced a decrease in students after they had to pause their programs in March for about three months as they planned their students’ return to a safer environment and changed their training to better prepare their students for their current

reality. 

They not only provided remote learning, but also created 40 hours of clinical simulation for students approved by the Board of Nursing, as their clinical sites were no longer accepting nursing assistant students. This meant investing in PPE and more equipment, like mannequins to provide them that experience.  

“Knowing that one of the reasons that people leave the healthcare industry in general, especially within the first year of employment, is that they didn’t feel prepared going into it. They faced circumstances and encounters that they didn’t feel that their training had prepared them for,” said PCOA Vice President of Population Health Initiatives Rebekah McGee. “We not only wanted to address that moving forward, and training on Caregiver Training Institute has always done a really great job at providing quality training to students, but during this time we wanted to make sure that we were able to do that, especially considering the needs of healthcare workers in a pandemic. “

Once they opened back up, McGee said many students declined enrollment due to personal issues brought on by the pandemic. 

“Job training programs saw a steep decline in student enrollment because priorities had to change. Meeting their basic needs and taking care of kids being at home and lack of transportation, lack of childcare, lack of any other income made people have to reevaluate, which is completely understandable,” said McGee. 

Since then, enrollment has increased with CGTI offering full classes, with waiting lists for would-be students. One of the benefits that McGee thinks draws students to enroll in CGTI is that they provide help overcoming barriers to enroll and also connect them with employers through their industry partner program. Those in training may go on to work for Casa de la Luz or other partners that provide care services for older adults.

“The people that are doing this work are just wonderful. They have such big hearts, and they continue to do it during the pandemic just kind of talks about who they are,” said Lannon. “My office never shut down because of the pandemic, we were always there, we were always still working.

While the shortage continues and Clark says they have a lot of work to do, he is reminded of the resilience of older adults. When checking in with their 75 and older clients, about 600 of them, nearly 40%, had already gotten vaccinated. 

“They’d figured out how to find a friend who can navigate the registration system, the transportation system, all of that stuff,” said Clark. “So that resilience, I think, is very important to remember, because sometimes we lose track of that.”

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