Decked out in a matching pink shirt and hat with layers of bracelets and necklaces, Clara Hatcher’s dialysis appointment doubles as a fashion event.
She spends three and a half hours, three mornings a week, receiving the treatment, so the 77-year-old likes to dress up for the occasion. Having been a dialysis patient for 12 years, she also shares her expertise with newer patients about how to handle the procedure.
“I like to warn people how tired it can make you feel and what to expect,” Hatcher said.
While she likes helping others prepare for it, she receives help of her own through her caregiver Pat Martin and nurse Belinda Hensley.
The trio reflected on how healthcare “takes a village” as they helped her slowly walk back into her ranch-style Henrico County home after an appointment.
Hatcher’s home health workers help her age in place in the house she bought to do just that.
Much of Martin’s work involves making sure Hatcher sticks to her medication schedule, handling light housekeeping, ensuring she gets to medical appointments and assisting with tasks like dressing or cooking.
“She likes to cook but her hands have tremors and I need to make sure she doesn’t fall,” Martin said.
Hensley makes occasional visits to check in, as nurse supervision is required by Medicaid.
As a nurse and a caregiver, Hensley and Martin are part of an evolving home healthcare landscape. As more people choose to age in place longer or avoid nursing homes altogether, demand for services is growing.
Staffing organizations are innovating to hire and retain workers while coping with low Medicaid reimbursement rates at a time where the state-federal program is bracing for funding losses. That’s why two Richmond-area nonprofits hope that a grant-funded pilot program they participated in could become a model for other parts of the state.
Supported staff, supported clients
With $700,000 in funding from the Richmond Memorial Health Foundation and the Bob and Anna Lou Schaberg Foundation, Family Lifeline and Jewish Family Services were able to grow their staff numbers by 69% and 43%, respectively. They also raised caregivers’ starting wages to $15 an hour, predating the benchmark that state legislators passed this year.
“This is a workforce where the wages have historically been very low,” Family Lifeline CEO Jennifer Case said.
Raising pay was important for both attracting and retaining staff. The funding also helped the organizations modernize technology to make paperwork easier for nurses and caregivers, improve professional development training and assist workers facing transportation issues.
Case emphasized that many caregivers do not have cars and rely on public transportation to get to work.
If a client lives along a bus route, that may not be a problem, she said. But when clients live deeper into Henrico or Chesterfield counties, transportation can become a challenge.
Even within Richmond city limits, Southside resident Regina Carter said what would normally be a short drive to the East End can sometimes take her more than an hour because she relies on the bus.
“Sometimes the bus will not even come, so I have to wait for a whole other one,” she said. “And that’s almost like I don’t want to say an hour, but it’s an hour.”
In recent years, the city and surrounding counties have expanded bus routes, but building that infrastructure takes time.
For caregivers whose clients live farther out, the pilot program helped offset some Lyft and Uber costs for workers who needed it.
Wendy Kreuter, CEO of Jewish Family Services, said both organizations continue supporting workers with transportation needs and plan to advocate on the issue with state and local governments while exploring public-private partnerships.
Transportation barriers have long been an issue in healthcare, particularly in rural communities. State lawmakers have backed a pilot program providing Medicaid coverage for non-emergency transportation to help rural patients reach appointments. But challenges getting workers into patients’ homes have not yet been addressed.
“This is something we should explore,” said Del. Rodney Willett, D-Henrico, who chairs the House Health and Human Services Committee, where healthcare legislation is reviewed each year.
Medicaid issues
Another longstanding issue has been Medicaid reimbursement rates. For Family Lifeline and Jewish Family Services, that means both organizations have had to rely on other funding sources to support staff.
Generally, reimbursement rates range from $20 to $23 per hour. But Kreuter and Case said the “village” includes more than direct care workers. Administrative staff are also needed to coordinate scheduling and transportation for clients.
“I think it’s just going to get harder,” Hensley said of a reconciliation bill Congress passed last summer that puts thousands of Virginians at risk of losing Medicaid coverage.
A KFF survey released earlier this year found that 41 states have reported home health agency closures, though Virginia was not among them.
Case and Kreuter said their organizations seek private philanthropy of all sizes to continue supporting workers and clients.
Though the reconciliation bill could affect Medicaid coverage and services across Virginia, federal lawmakers also negotiated the Rural Health Transformation Fund as an opportunity to address longstanding challenges.
Outgoing Gov. Glenn Youngkin secured $189 million from the fund, which Gov. Abigail Spanberger’s administration is now responsible for administering.
LeadingAge Virginia, which represents organizations like Kreuter’s and Case’s, has applied for the funding.
Betsy Archer, director of the association’s PositiveAge branch, said the charitable pilot offers a strong blueprint.
“We definitely see it as a replication or a replicable pilot that we think can be strengthened,” she said.
