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In-home care shortage afflicts eastern oregon seniors

This story originally appeared in the East Oregonian in August 2018. Click here to see it.

By Brittany Norton

Katherine Hodge dashes around the June Partin’s house, washing dishes, cleaning counters and sweeping. Every time the phone rings, Partin glances over at Hodge, who then answers it.

Hodge is there to assist Partin in many of the household chores that have become difficult for her as she gets older. 

Partin is one of the many older citizens who use aging-in-place services from the Community Action Program of East Central Oregon. CAPECO provides her with an allowance that helps her remain in her home. 

However, she is one of the lucky ones because there are more people on CAPECO’s waiting list than the organization is able to serve.

In 2017, CAPECO served 37 people in Umatilla and Morrow counties through Oregon Project Independence, a state-funded program known as OPI that assists people over the age of 60 with funds for hiring in-home caregivers. But there are 49 people on the waiting list. 

The program allows older citizens to age in the comfort of their own home, rather than transferring to an expensive care facility. However, many people aren’t receiving the amount of care that they need, leaving family members to pick up extra costs.

Partin lives alone at her home in Milton-Freewater. She has arthritis and a herniated disc in her back that limits her mobility. She can’t do household chores like sweeping and mopping, so Hodge takes care of that when she comes two hours a day Monday through Friday. And Partin doesn’t own a car, so she relies on other people for transportation. 

The 83-year-old insists she still gets down on her hands and knees to do gardening in her front yard. Yet even that is becoming a precarious activity. Two or three years ago, she fell down in the street outside her house and had to yell for help until a passerby came to her aid, she said. Partin got a walker shortly after: “If I have my walker up against a wall, I can get up,” she said. 

There are still struggles. Last week she spilled hot stew on her leg and had to seek medical care. 

As the Baby Boomer generation ages, they enlist more senior services. But these services will continue to stretch thin unless something changes. According to the United States Census Bureau, the number of people aged 65 and older grew from 35 million in 2000 to 49.2 million in 2016. And two-thirds of the nation’s counties had an increase in median age in 2016. The Census Bureau estimates that 15.2 percent of Umatilla County’s population and 16.1 percent of Morrow County’s population is 65 and older.

“Typically, as we know in the aging population, it usually doesn’t get better,” said Paula Hall, CAPECO’s chief executive officer. “Things seem to get worse, unless it was an accident or an injury or so forth.”

Hall said there is a “dignity” to a person staying in his or her home — in addition to the cost savings that come along with it.

State Sen. Bill Hansell said a combination of resources share the responsibility of helping citizens age in place, including individual investments and savings, federal dollars and state resources.

“I know parts of our population, for whatever reason, aren’t able to provide for the services they need,” he said.

But determining who should pay is a difficult discussion to have, according to Hall.

“I’ve never found it easy to engage with conversations about aging and the responsibility that we as a society should hold,” she said.

“My personal opinion is that if you’re in a healthy environment in your own home then you’re going to thrive,” she said. “And we know that when you go into a care facility, if you have any savings, it’s going to be more than likely minimal and it’s going to be used up within a year — and then what happens? You’re on Medicare and it costs a lot of money for Medicaid to then offset that cost.”

CAPECO provides Partin funding to cover four hours of home care services per week. 

“That’s not very much, but we make it,” Partin said.

Part of the reason Partin can continue living at home is because her granddaughter, Shauna Partin-McAlester, pays the remaining cost for the services. Hodge works for Partin 10 hours per week — or 40 hours per month. Partin-McAlester pays what CAPECO doesn’t cover, which is the additional 24 hours per month and comes out to about $300, said Partin-McAlester.

“She did a lot for me growing up,” she said. “I just want to make her comfortable and happy until she does have to go to a retirement home, because eventually she’ll need full-time assistance.”

Fortunately, Partin has a strong network of support — including her granddaughter and a cousin who lives nearby and comes to check on her throughout the week. Altruistic friends and family members are who CAPECO relies on to provide services to as many people as possible. Caseworkers do periodic reassessments of clients to determine if they need an increase in services or if it’s possible to decrease.

“What we do try to do is go in and say, ‘You needed this many hours, you daughter is moving back in town, could she do some of this?’ So our intention isn’t to reduce, but it’s to try to reach as many Oregonians and as many people in our two counties that we currently serve with appropriate services,” Hall said.

Hall didn’t know how long people are typically on the waiting list, but said it’s too long. 

“It’s always sad at the end of the day that how many of the 49 people are going to end up in a care facility when we could have provided some preventative services,” she said. 

CAPECO received $191,403 to cover two years of funding in Umatilla and Morrow counties. Hall said CAPECO isn’t allowed to lobby, but it can “advocate” for funding on certain issues. For example, she said the organization can advocate for a 10 to 30 percent increase in funding for homeless services — and because this issue is a priority for Gov. Kate Brown, Hall said funding is easier to secure. In the past, CAPECO has advocated just to maintain the current level of funding for aging-in-place services. 

“OPI is a state program and Medicaid is not. So you have to say, ‘Yes, it’s costing the state this amount of money, but it is preventing this additional debt and additional cost on the federal side,’” Hall said. 

But when there are other issues to address in the state, aging-in-place services can often fall to the bottom of the priority list. 

“Do you invest in schools? Do you invest in law enforcement? Or do you invest in aging-in-place and senior services? It’s just kind of a hard sell,” Hall said. “We have to really have some legislators pick it up. Pick this up as a personal challenge, I guess.”

Hansell said it’s challenging to distribute a limited amount of resources. Oregon has to tackle issues such as education funding, law enforcement, combating opioids and rising Public Employee Retirement System costs, as well as aging.

“You have more demands than you have resources available to fill,” he said.

Finding home care workers is also a challenge. Clients are responsible for finding their own workers who are employed through the state. CAPECO currently serves Umatilla and Morrow counties, but starting Oct. 1 will be expanding into Gilliam, Wheeler, Sherman, Wasco and Hood River counties.

“Pendleton is rural, but we have parts of our service area that we call frontier — so no services. And I think that’s what we’re going to find when we expand our services, especially to the Gilliam, Wheeler and Sherman counties. The home care worker component is going to be difficult,” Hall said.

According to U.S. Census Bureau data estimates, 34 percent of Wheeler County’s population is aged 65 or older, the highest percentage of any county in Oregon. But it’s also the state’s least populous county. 

“And we know in those counties, those frontier counties, the aging population is growing yet the workforce is not there — especially for home care workers,” she said.

In situations where home care workers are unavailable, CAPECO tries to enlist the help from volunteers in the form of family members, friends and neighbors. And if a person is unable to receive services through OPI, there are other paths available to them. OPI is one program under an umbrella of senior care services. When someone can’t immediately access OPI they receive options counseling, but this mainly involves information and referrals. There are also nutritional services that deliver meals to a person’s home. 

CAPECO will conduct community forums to determine what the highest needs are for the area. The responses it receives will drive the future direction of the organization. If senior services are high on the community’s priority list, then CAPECO will have to explore different approaches to providing those services. 

“It is our responsibility as a community action agency that if we get a lot of feedback saying this should be your priority,” said Hall, “then we have to say, ‘OK, OPI is not filling the gaps, so we have to look at other ways.’”