Associate Editor

RICHMOND – Aging senior citizens who prefer to stay at home face tough decisions, including choosing to move, downsizing or hiring a personal caregiver.

James Stowe directs the Adult and Aging Services Program in Kansas City. The program is under the Mid-America Regional Council, which manages Ray, Cass, Clay and Platte counties. For two years, he has been immersed in the challenges senior citizens face.

In 2017, the state budget changed the rating scale that determined who would be eligible for Home and Community-Based Services through Medicaid. Nearly 8,000 people lost their eligibility.

“It was a tumultuous issue,” Stowe said. “We had to look at what it would mean for those on Medicaid who were receiving home and community-based services.”

Medicaid rates a person’s need as if they were in a skilled nursing facility, Stowe said.

“The change meant people who received Medicaid-paid services could be terminated from those services or the services would be downgraded,” he said.

Stowe had to tell seniors they would no longer receive those services.

“They were distraught,” he said. “People had to make choices about services they received.”

Finances are complex under the home and community-based services program. When the budget is tight, the state pays more than if the person is in a skilled nursing facility, he said. The federal government pays a larger share when a person is in a skilled nursing facility.

“There are not enough facilities for people who need skilled nursing care,” Stowe said.

Even more critical is the lack of staff, he said.

“Right now, I turn away people who need services because I do not have the staff to meet the demand,” Stowe said. “I have the money to pay staff, but there just are not enough employees.”

Even if companies built enough facilities, there are too few people to meet staffing needs. The Bureau of Labor Statistics found the need for personal care attendants and home health aides is expected to grow by 41 percent.

“One of the driving factors is the lack of consolidation among care agencies,” Stowe said. “So, people will leave one employer and go to another. These jobs are some of the lowest paying and the hardest working.”

Bobbee Karguth from Home Instead Senior Care, St. Joseph, tries to find employees in 13 counties in Missouri and six in Kansas.

“Mr. Stowe is absolutely correct about not being able to find employees,” she said. “We know these are not the highest-paying jobs. People can make more money at Walmart and not have to be personally involved.”

Karguth said they need about eight employees right now, including some for Richmond and Lexington.

“Some may only be for a few hours,” she said. “I did get a call where I need someone to fill a 24-hour situation.”

Underlying the workforce shortage is how communities engage and connect with senior citizens.

One factor is families are different than they were 10 to 15 years ago, Stowe said.

“There are divorced and blended families,” he said. “Families do not stay in the same place, and the family structure is different.”

Stowe said communities may view senior-focused living opportunities as the preferred way to manage their senior citizen population.

“There are assisted living facilities, memory care and skilled nursing facilities,” he said. “The danger is we are taking people out of their communities and segregating them from others. Then they become someone else’s responsibility.”

Karguth sees situations where families move mom or dad to a facility, and over time they withdraw.

“Sometimes, the family may have been assisting mom or dad,” she said. “Then life happens, maybe they have their own health issues or issues with children and grandchildren. Pretty soon, the visits become less frequent.”

Seniors who lose in-home care services may be forced to move into a skilled-nursing facility, when they prefer to stay at home, Stowe said.

“People are resilient,” he said. “They will find resources, perhaps paying for more expensive care so they can stay at home.”

Karguth said neighbors used to help neighbors.

“Now, we keep to ourselves and we are just houses,” she said. “People used to mow a little old lady’s yard or shovel a sidewalk, but we don’t see that much now.”

Stowe said the issue of senior care is a “silent crisis.”

None of it happens all at once, he said.

“There is the issue of what to do when seniors face a new diagnosis that affects their ability to stay at home,” he said. “Do they want to commit to aging in place?”

Perhaps the situation calls for downsizing or moving where there is better access to medical care, he said.

Stowe would like to see policies that bolster the personal care workforce and hopes people will speak up and advocate for innovative programs that allow seniors to receive care from those they want.

“We need to take a hard look at how we segregate seniors from their communities,” Stowe said.

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