What does long term care include?
A man from Boise died last month after being burned in a bathtub of scalding water.
Benjamin Reed was 38 and had a genetic disease that left him unable to walk. His housemate blames a home-care aide for Reed’s death, saying the aide left Reed alone in a bath that was much too hot, then failed to perform first aid or call 911 after seeing the man’s burns.
Police have completed their investigation into what happened to Reed on May 16 and forwarded their findings to county prosecutors. But after the Statesman published a story on his death, local home-care agency owners and workers spoke up about a crisis in their industry.
They said it’s hard to find qualified caregivers for patients like Reed. The work is grueling, the wages are low, and there are many other ways to make a living in Idaho’s low-unemployment job market. Employers can’t pay enough, because of low Medicaid rates for the services, they said. Workers said their agencies provide minimal training — or none at all — before sending them out to a patient’s home.
‘I don’t even know how to do CPR’
One aide said her employer gave almost no training before sending her out to work alone with patients who have severe disabilities.
“I don’t even know how to do CPR,” she told the Statesman.
The aide said she worries about being unprepared if a patient stops breathing.
She asked not to be named, saying she needs to keep her job until she can find another one. Her agency pays about $10 an hour, with no benefits, she said.
Low Medicaid rates, low wages
In Idaho, Medicaid pays less than $18 an hour to bathe, feed and provide other personal care services for disabled adults.
After payroll taxes and other costs of operating a business, agencies have about $8 or $9 left for caregivers’ wages, according to Paige Bennion, who owns Boise’s Right at Home agency.
She said agencies make little to no profit on personal care services billed to Medicaid.
It’s hard to find employees willing to do the difficult work of a caregiver for just $8 or $9 an hour — and especially hard to find workers who have special training and experience caring for patients with severe disabilities, she said. That means local agencies sometimes have to turn away Medicaid clients because they don’t have enough workers.
Bennion’s agency continues to take Medicaid clients despite Medicaid’s low payments. She believes those patients need to be cared for, and should have the option to stay in their homes instead of living in a nursing home, she said. Her agency has 50 to 60 clients, and about 45 caregivers to serve them.
In talking with agency owners in other states, Bennion said she learned Idaho has “one of the lowest” Medicaid rates for personal care.
Pam Stigall, who worked as a local home-care aide in 2013, said the agency she worked for paid $10 or $11 an hour.
When she started the job, the agency gave her a booklet and had her “sign off” that she’d read it. She received a multiday training before starting the job, but then was almost never supervised or re-trained, she said. Stigall said she worked in a household with three patients, two of whom were bed-ridden, by herself.
Stigall also was a customer. Her grandson has a disability and needed personal care services.
For about four years, his caregiver came from the same agency as Reed’s. “They were OK at first,” Stigall said. “We actually had some really, really good workers. Especially one. ... She was a dream person, and she was there for like two years.”
After that, workers came and went, some lasting just a couple of days, she said.
DisAbility Rights Idaho Executive Director James Baugh said there are two schools of thought, and two different types of patients, when it comes to in-home care like what Reed was receiving. But there’s just one type of program under Medicaid for both types of patients.
There are patients who can and want to live independently, and they can hire a worker directly instead of going through an agency. A blanket licensing or training requirement might be unnecessary for their needs, and it might keep potential caregivers from going into the field, Baugh said.
For patients like Reed, though, advocates want to make sure workers are prepared for the job. Currently, it’s up to the agencies to make sure their employees are properly trained.
Baugh said higher Medicaid payment rates could help. That’s not guaranteed to translate to higher wages for caregivers, the way Medicaid is set up now, though, he said.
“It wouldn’t require the agency to hire better workers, but it would enable them to,” he said. And maybe more importantly, the ability to pay higher wages would help agencies retain those workers, he said, “so you get people who have experience who stay in the workforce; whereas now, so many other industries, the wages are climbing at a rapid rate, where the wages in home care are stagnant.”
Agency did not report Reed’s death
Agencies have limited oversight by the state. Their workers don’t need licenses or formal education.
The administrator for A Caring Hand — the agency that sent the aide to Reed’s home — declined to comment except to call Reed’s death a “tragic accident.”
Idaho Department of Health and Welfare Communications Director Kelly Petroff said there have been complaints filed about A Caring Hand in the past. But they were “the ordinary types” of complaints for health care providers, she said — nothing along the lines of a patient being fatally injured.
The agency did not report Reed’s burning and death to Health and Welfare, Petroff said. It reported only that Reed had been hospitalized. Agencies must report any change in a patient’s status.
Rebecca Black was one of Reed’s caregivers, through an agency that served Reed before A Caring Hand took over, she said.
She described him as “a sweet guy.”
Black quit her job recently, after finishing her bachelor’s degree.
“I don’t think people want to stick with the job, because $10 for heavy lifting, physically and emotionally taking care of them” isn’t a decent wage, she said.
Black started working in the industry in 2013, she said.
After years in the field, she said she believes that agencies should be required to do hands-on training.
She said patients would show her “bruises and scars of caregivers that didn’t know what they were doing.”
The first company Black worked for gave her two days of training, she said.
The next one “made me practice one transfer (between a wheelchair and seat), and that was it,” she said.
The third agency? She said it “just sent me off to clients ... just gave me the address.”