INDIANAPOLIS — Thousands of disabled Hoosiers need home help. And with hundreds of thousands of baby boomers set to reach retirement age in 2030, when more and more people will start needing the same intensive care, Indiana doesn’t have the infrastructure to handle it.
In 2019, Indiana spent 35% of its long-term Medicaid services and supports funding for home and community services — which would cover home health aides — well below the national average of 59% and the second lowest in the nation.
According to Alzheimer Association 2022 report, Indiana had approximately 43,460 nursing aides and home health aides in 2018, also known as direct care staff. By 2028, Indiana will need 59,990, an increase of 37.5%.
During the COVID-19 pandemic, elderly Hoosiers seeking to avoid nursing homes, which were particularly vulnerable to the virus, realized they had few options for aging in place due to shortages of providers and care. ’employees. Additionally, advocates have found that complications from COVID-19, or long-haul COVID-19, have increased the number of younger populations in need of in-home assistance.
“When the pandemic arrived, it really highlighted the need to really reform the system,” said Dr. Dan Rusyniakthe director of the Indiana Family and Social Services Administration. “If we (don’t) have a workforce that (is) in the communities, as this population of Medicaid recipients ages, it’s going to be hard to keep people at home if we’re not able to to provide services.”
Recognizing this, the Family and Social Services Administration urge him General assembly to pay for a fundamental change in the way the state delivers services. Currently, Indiana operates on a fee-for-service model, which means states pay providers for each covered service. Starting in 2024, the agency would like to switch to a managed care model, which they believe will save the state money in the long run.
In managed care, the state pays an insurance company to oversee an individual’s care – which Indiana already uses for government insurance programs like the Healthy Indiana Plan or Hoosier Healthwise. Opponents say the cost savings will be the result of fewer approved services for customers.
Stakeholders knew this change was coming, but struggled to overcome the built-in challenges. Indiana has long relied on and invested in institutional care, such as nursing homes, even though the vast majority of Hoosiers prefer home care.
Low wages and benefits stifle the workforce
A brief from 2017 from L’Arc de Indianawhich advocates for Hoosiers with intellectual and developmental disabilities, analyzed Indiana service labor force and reported that low wages in the industry lead to turnover of up to 45%. The average worker was 38 years old but had only three years of experience in the field.
“No one is satisfied with the current situation of multiple and frequently changing caregivers and the compromised quality of care resulting from the inconsistency of the current (direct service provider) workforce,” the brief states.
Rusyniak said the state’s ombudsman system investigates and responds to reports of abuse or neglect by state health care providers. But to improve the system, Rusyniak stressed the will of the state Direct Services Workforce Advisory Council and Direct Service Workforce Plan, which calls for investments to build a “well-trained, reliable and stable” workforce.
In particular, the $130 million in the Workforce Investment Grants, launched in November, are rewarded to tackle low industry wages, which fall below the state living wage, and inadequate benefits. At least 95% of funding must go directly to workers. In the future, the FSSA will review its pricing.
But Rusyniak noted that provider training varied widely between agencies and needed to be more comparable.
“If you’re a direct service worker, the training is vendor-specific, which means you go and get hired by a specific vendor and they deliver the training,” Rusyniak said. “So one of the strategies we’re looking at is how do we develop more portable training and certification for people who are direct service workers so everyone gets the same type of training.”
Advanced training would allow these workers to specialize in types of caregiving, such as caring for people with dementia or intellectual disabilities.
FSSA thinks managed care would help Hoosiers navigate resources
Rusyniak urged Hoosiers to contact 211, which has pivoted during the pandemic to respond to more than 1.3 million calls about COVID-19 vaccinations and testing resources. But the resource is designed to do much more, including help with housing or utilities.
“Health care in general – and it’s not specific to Indiana, it’s at all levels – it’s complicated. And then when you mix not only healthcare and health-related services, but also social services and so on, it gets even more complicated,” Rusyniak said. “But (the resources are) all sort of disconnected.
Changes to increase the workforce – and overall home and community services – would benefit the thousands of Hoosiers who [think they] would not need home help until [they were] much older.
