About the SeniorAdvisor.com 2014 In-Home Innovation Scholarship: We started the scholarship program to bring awareness of the unique benefits and challenges of in-home caregiving for seniors to younger generations. The questions posed by the scholarship encouraged our nation’s future caregivers to present solutions for improving home care in the United States. College-aged students were required to answer one of the three essay topics below and provide a short bio as part of their scholarship application. Read the winning essays here.
What is the top challenge facing in-home care in your city, and what is your proposed solution?
Essay response by Abigail Ivaldi, Indiana University Purdue University
The greatest challenge to in-home care in the greater Indianapolis area is a shortage of available services. Given the high number of medical providers, post-graduate schools, and not-for-profit foundations catering to seniors, one would suspect in-home care would be taken care of thoroughly. The reality, however, is that a gap exists. It stems from a few interrelated root causes. The field is not retaining enough qualified workers to provide direct care at a sustainable cost. Also, government funding, especially Medicare, has been cut in recent years making it harder to navigate the system and get paid. The aging population, spurred on by retiring Baby Boomers, has accelerated the demand for in-home senior care. And finally, the 2012 economic downturn created unemployment, loss of benefits, mortgage defaults, and made care-giving by the more highly qualified professionals like LPNs and RNs unfeasible for even more patients. As an undergraduate working for an employee-owned provider of in-home care, I have observed and discussed these factors with peers regularly. In fact, the degree to which the root causes are solved over the next few years will strongly influence my own, and my peers’ own, decisions to remain in the field. It is unlikely government funding will turn around in the short term given the broader challenges of Obamacare, increased retirement, and modest economic recovery. It is also unlikely that we will see a sharp upturn in families who can afford LPN or RN providers. With that, the best near-term solution will be to incubate and nurture private foundations utilizing students and part-time employees to fill the gap.
The in-home field is not attracting enough qualified candidates. Ironically, even though many LPNs and RNs prefer the in-home setting, the cost of care exceeds clients’ income provisions, especially those who have lost employment or can only secure part-time employment without medical benefits. Demand is exceeding supply. There are few programs available focusing on training young students and non-nursing professionals to become in-home caregivers. Students courting the healthcare field generally have ambitions beyond direct caregiving, especially because universities have more to gain in terms of attracting new students and alumni contributions by emphasizing the high incomes and flexibility of LPN, RN and Physician’s Assistant careers. An aging population faced with health and economic challenges greatly increases the foreclosure rate, the retirement rate and consequently the reliance on Medicare. Numerous families have no choice but to enter assisted living or nursing homes, and to a certain degree this draws resources away from in-home care. At the same time reductions in the Medicare system itself choke funding for essential services, and those providers who do rely on government funding have to be even more resourceful and clever to sustain income.
The best near-term solution is to empower a different tier of providers. Students like me can sustain a lifestyle working in the $10 to $12 per hour range while attending school. We can address a wider in-home client base since the cost is lower than registered nurses. Of course, by virtue of inexperience there are limits to what can be provided initially. Students can provide supervision, activities, meals and a limited amount of medical, therapy, and emergency services. Medical treatment and clinical therapies would still require nurse qualifications, but the patient population requiring those services is smaller. Even at this low-cost level, student providers have to remain frugal because often times they are not paid for incidental expenses such as driving clients on errands and appointments. Some firms are employee-owned, and can offer 401k and stock options once students turn 21. But for the most part, students are part-time employees relying on their parents’ benefits. Those limitations tend to prevent more students from participating. Part of the solution could come from the colleges and universities themselves. Grant appropriations, student reimbursements for expenses, and credit hours similar to what are used for intern and co-op programs could greatly increase student incentive to participate. Finally, as more students become exposed to the rewards and gratification of in-home care-giving, the retention rate in the field will certainly increase. The shortage will therefore be more effectively filled as a higher number of newly-graduated professionals are retained.
Abigail Ivaldi is a 3rd year undergraduate student majoring in Occupational Therapy/Physical Therapy at Indiana University Purdue University of Indianapolis (IUPUI).