Lack of home nurses spells trouble for families

Lack of home nurses spells trouble for families

Kim Grant and her daughter Teagan.
Agencies push for better pay

PAWTUCKET – Every year, the Grant family of Pawtucket applies for the state’s Katie Beckett waiver allowing the reimbursement they need to keep daughter Teagan at home instead of in an institution.

Without that waiver to help pay for 84 hours of home care, Kim and Joe Grant “would have claimed bankruptcy over and over and over,” said Kim.

The nurses who work at the Grant home haven’t received a raise in a decade, and it’s becoming more and more difficult to find workers to fill the time slots needed. When shifts are missed, highlighting the worsening home nursing shortage in Rhode Island, it impacts the whole family, said Kim, causing loss of sleep, loss of productivity, and greater stress overall.

“Without these nurses, we would really be at a loss,” she told The Valley Breeze.

The Grants have been serviced through Bayada Home Health Care since Teagan’s premature birth in 2008. Still medically complex, after undergoing medical procedures at 5 months old just to eat and breathe, Teagan’s care requires extra help. She doesn’t walk or talk.

Vincent Ward, of Woonsocket-based Home Care Services of Rhode Island Inc., said the company’s reimbursement rate for a pediatric day shift nurse is $34.68 per hour, compared to the $56 an agency in Massachusetts receives.

Ward pays his nurses about $25 per hour, $11 lower than the average for nurses in all fields.

“A nurse can get paid a lot more just over the border,” he said.

The adult reimbursement rate for a private duty nurse is $31.06 per hour, a number that hasn’t changed since 2001.

Many home nurses enjoy what they do, and are committed to taking care of children, despite the enhanced demands of working on one’s own without the backup a hospital provides, said Ward. Home nurses need to deal with complex health crises.

“If you have a problem, you deal with it,” said Ward.

House bill 7670 increases the base rate for Medicaid-contracted home nurse and hospice providers by 40 percent, allowing higher hourly pay for nurses.

At a certain point, said Ward, nurses will begin wondering why they should deal with all the hazards of caring for a medically fragile child when they can earn just a few dollars more than someone working at a convenience store.

House Speaker Nicholas Mattiello told The Breeze H-7670 is under consideration as part of budget discussions, and hearings have covered the many issues regarding delivery of Medicaid services. He declined to discuss the potential for the raises coming through. The estimated increase to the budget from the proposed changes is $2 million.

Ashley Sadlier, Bayada’s director of government affairs in Rhode and New York, said she is a perpetual optimist, and believes the increases will pass. Workers in home care should no longer feel such a squeeze, she said. “I think it’s time.” Rhode Island is reaching a “breaking point,” she said, as nurses already in the field are choosing either not to work in a home-based setting, and nurses coming out of school are not seeing home care as a viable career option.

The relationship piece of home care remains the “magical” pull for many nurses, said Sadlier, but at some point even the most committed ones will decide they can’t do the work as a charity. These are professionals trained in “life or death” situations, she emphasized.

Ward said the bill submitted in February would bring Rhode Island nurses up to a matching level with Massachusetts nurses, to a $47 reimbursement, but the neighboring state has since decided to bump that rate up another $9 to $56.

Massachusetts rates are going up, said Sadlier, in part because of a strong group of parents who are speaking up about the threats they face, including losing their jobs and facing foreclosure if they can’t get enough nursing hours.

For the Grants, life as Teagan gets older is filled with more question marks. As she grows bigger and they get older, the thought of caring for her becomes more daunting. While many parents are planning savings for weddings or college, the Pawtucket couple are faced with the reality that Teagan will never get married and will always be with them. Their savings are meant for one purpose: to care for her for the rest of her life.

Grant said her family is one of the fortunate ones, as her husband has a great job and she was able to shed her full-time job while keeping a part-time one, but many aren’t in such a position. Without their nurses, the family would likely face the cruel choice of losing their jobs or placing Teagan in a facility or hospital. The Grant family recently lost one of its nurses, someone who left for a higher-paying job.

Sadlier said families such as the Grants in many cases are already finding it impossible to fill all the hours they need, many using three agencies just to fill 50 to 70 percent of the hours.

Grant said a lack of a nurse can be felt in numerous ways. While some might see having a nurse on a Saturday as a luxury, the reality for her family is that she goes to work and her husband needs those precious few hours just to get the yard work and other weekly household tasks done.

Editor’s note: Ward is the brother of Breeze Publisher Tom Ward