Now back at her assisted living apartment in Riverview, on-site staff — paid by MI Choice funds — visit in the morning, mid-day and evening, Yousif said.
They help with meals and medications, but Butler for the most part is otherwise independent, sleeping in her own bed and watching Hallmark movies and Steve Harvey and his Family Feud in her favorite blue fabric recliner.
“I love it when I stop over there and she’s in her own La-Z-Boy recliner, and her feet are kicked up, and she’s relaxed in her own space,” said Yousif.
Without MI Choice, Yousif said, “I don’t know what I’d do… I don’t want her to give up.”
The MI Choice program is available to people who qualify for Medicaid and require nursing home-level of care — a determination that is generally based on a person’s physical and cognitive abilities, as well as health issues and any behavioral needs.
And while MI Choice may not appeal to everyone — some older Michiganders, for example, don’t want outsiders in their home — “the program has been historically very popular,” said the state’s Wamsley.
‘Seen this coming’
As has been well documented, the pandemic has driven caregiving staff from nursing homes, hospitals and home healthcare jobs — with workers citing a range of concerns, from fear of bringing viruses home to their families to job stress and the need to care for loved ones .
Michigan boosted pay to direct-care workers by $2.35 an hour, but other employment sectors have boosted wages or benefits even more, noted Laura Alexander, CEO of Westland-based Compassionate Care Home Care Services, which receives Medicaid funds through the MI Choice program administered by the Area Agency on Aging of Northwest Michigan.
Dependent on Medicaid reimbursement rates, Compassionate Care and other service providers are limited by how much they can raise wages for MI Choice workers and stay in business, she said.
Even as workers leave, she said, “the margins are so incredibly thin that agency after agency” is pulling out of providing MI Choice services.
In urban areas, providers are competing against other agencies as well as nursing homes and other provider agencies for direct care staff. In rural areas, providers find it tough to recruit caregivers who can travel long distances to someone’s home for a few hours work, experts told Bridge.
Many workers have opted for jobs they can perform remotely, without the physical and emotional demands of direct-care work, while saving on fuel.
Which means agencies that supply workers can’t fill in openings that arise.
“There are times where we can’t find a worker, say on a Thursday, so (a resident enrolled in the program) goes without service for a day,” said Jonathan Mead, president & CEO of the Upper Peninsula Commission for Area Progress , or UPCAP, the aging agency coordinating services for the largely rural, 15-county Upper Peninsula.
“That’s becoming more and more prevalent,” he said.
“The pandemic was the worst possible scenario for the workers, but also for the clients,” said Michael Daeschlein of the Michigan Elder Justice Initiative, a legal and advocacy group for older Michiganders, which examined barriers to home care in its 52-page report , released in September. “It kind of exploded the issue.”
Despite the worker shortage, MI Choice offers an array of help beyond direct care workers — mobile meals, modifications to homes, disposable medical supplies and durable medical equipment, for example.
“The direct care worker is an essential component of services — there’s no getting around that,” said Andrew Dabrowski, chief program officer at The Senior Alliance, which serves residents in western Wayne County. Still, he added, “we are doing the community a great benefit by getting (residents) in this program, even if it’s going to take a little while to get them that direct-care worker.”
The situation has loomed for years, making it particularly frustrating, said the UP’s Mead, who has been with the Area Agency on Aging there for more than 46 years.
In a ten-year period, the state’s direct care workforce grew by more than 19 percent, driven in large part by Baby Boomers’ move into retirement age. With the explosive growth in home health and personal care aids, the workforce grew from about 100,000 workers in 2011 to an estimated 120,000 last year, according to PHI, a national advocacy and research organization for the nation’s direct care workforce and its clients.
“We saw this crisis coming 15 years ago, but never really tried to address this potential problem,” Mead said. “Now, we have our backs against the wall.”
A policy mismatch
MI Choice saves money, shifting state funds toward mostly part-time help and away from 24-hour nursing home care with layers of direct-care workers, nursing staff, medical services and administrators that can cost )more than $100,000 a year in Michigan.
Yet Michigan ranks 29th among states in its spending to help residents
remain at home or in the community through programs such as MI Choice, according to the 2020 AARP Long-Term Services & Supports State Scorecard.
By last count, the state spent just 31.5 percent of its long-term care budget on home-and community-based services — nearly 14 percentage points behind the nation’s average spending (45.1 percent), according to the scorecard.