Perhaps no part of the health care system in Southwestern Pennsylvania faced greater challenges during Sunday’s snowstorm than already understaffed home care agencies.
Their task was monumental: Keep hundreds of group homes and thousands more personal residences in the region staffed with caregivers, even as much of their workforce got snowed in.
“We said it multiple times this weekend: It’s all hands on deck,” said Robert Smail, a community living specialist with Achieva’s office in Westmoreland County. “Anybody who can be at work, we needed you at work.”
Achieva saw around 20 call-offs Sunday across its 18 community living facilities in the county, which each offer supportive housing to one to four people with disabilities.
Smail has never seen so many absent workers in his 15 years with the nonprofit.
Staffing issues lingered well into this week for many local agencies as side streets remained encased in a foot or more of snow and public transit struggled to get back on schedule. It was a precarious situation for the sector, one that could play out during any serious snowfall.
Hospitals and long-term care facilities have also faced snow-related challenges. But they have dozens if not hundreds of staff members on site and can adapt to mass call-offs by tweaking patient-to-staff ratios or shuffling people between departments.
The stakes can be higher in home care, where services are often provided in a one-on-one setting. And if that sole caregiver doesn’t show up, chronically understaffed agencies have precious few workers to take their place.
“In other parts of the health care system … you’ve got backup,” said Mia Haney, CEO of the Pennsylvania Homecare Association. “In home care, people literally go without the care.”
Waiting for relief
Home care is used by older adults and people with disabilities for a wide range of reasons. In some cases, individuals simply need companionship or light assistance around the house.
But others rely on these professionals for medical care or help with fundamental tasks, like getting out of bed. That’s where disruptions in home care become more than just an inconvenience.
Chris Bender, who directs non-medical assistance at BAYADA Home Health Care’s office in North Versailles, sorts clients into three buckets: safe to be alone, try-to-covers and must-covers.
“If you’re on a must-cover case, you can’t leave until your relief arrives,” she said.
Steve Riddle, 68, of Oakdale is one of those cases. A decade removed from a devastating spinal cord injury, he’s able to get around with a walker, but requires assistance with grooming, meals and keeping his house in order.
Sunday’s storm left one of his caregivers stranded there for 34 hours. Riddle and his aide passed the time by chatting and bingeing shows on Netflix.
“We hunkered down for the storm,” Riddle said.
Bender’s agency keeps backup plans for clients who need around-the-clock care if a worker can’t make it. Those contingencies usually involve a predetermined friend, neighbor or relative stepping in.
If that backup contact falls through, BAYADA may be forced to call emergency services to check on the client.
The agency did not have to activate these plans during or after the storm, though some of its more independent clients who would have preferred help went without it for a day or two.
“Fortunately, clients and families are typically very understanding in cases like this,” Bender said.
Rough commutes
Only about 10% of caregivers under Bender’s watch have personal vehicles.
And none of them, she found out in preparation for the storm, are four-wheel drive.
The rest of the staff relies on rides from family members, ride-sharing services and — above all else — public transit. The snow quickly overwhelmed transit agencies and sent their systems sputtering.
Pittsburgh Regional Transit Service was suspended Sunday evening into Monday morning. Delays lingered into Thursday as the last of the bus routes were cleared of snow. Westmoreland Transit Authority was also forced to briefly pull its drivers off the roads.
Call-offs at Southwestern Pennsylvania home care agencies peaked at around 30% to 40% of staff — mainly because of transportation issues — though some of them were mutually agreed upon by workers and clients.
These limited transportation options are an artifact of the industry’s low wages, Bender said. For many, hourly pay rates in the low-to-mid teens are hardly enough to cover car payments and insurance costs.
Stress test
Home care agencies in Pennsylvania have been drawing attention to the issue of measly pay for years, claiming they’ve wrung out internal inefficiencies and still can’t raise wages to competitive levels.
The culprit, they say, is inadequate state reimbursements for government home care programs.
As state budget talks dragged on last year, the industry sought action from distracted lawmakers, who were mainly focused on plugging gaping holes in public transit funding.
In the end, the sector scored a small win: $21 million to help the vast minority of non-medical caregivers who are hired directly by the people they serve. The funding raised hourly wages from $13.51 to more than $15.
The move was cheered by Service Employees International Union Healthcare Pennsylvania, which represents many of these participant-hired workers. But the Pennsylvania Homecare Association, representing agencies, said its members were hung out to dry.
Because of trouble attracting workers, the home care industry struggles to meet its obligations, even without extreme weather. About 112,000 non-medical care shifts go unfilled every month, according to the Pennsylvania Homecare Association.
“Snowstorms expose system gaps — where we have workforce shortages, where we have public transit that’s unreliable, where we still have interruptions in care that could be addressed if we shored up the program in good times,” the association’s Haney said. “Really, a snowstorm is like a stress test.”
‘Time doesn’t stop’
Rosanne Warman’s son, Derek, has a caregiver with him 24/7 at a Lifesteps, group home for people with intellectual disabilities in Bridgeville. He also has several physical health challenges, including a seizure disorder and cerebral palsy, further necessitating constant care.
Ahead of the storm, his support professionals packed their bags and planned to stay overnight.
Warman, 67, of Whitehall, said she can no longer meet all of her son’s needs on her own; sending him to her wasn’t an option.
When winter weather makes getting to and from work challenging, his caregivers adjust “without blinking an eye,” Warman said. It’s an example to her of their dedication and reliability.
“For the disability world, time doesn’t stop,” she said. “You provide the same services that you did the day before.”