Aug. 28—Keith Williams maneuvers his motorized wheelchair to his breakfast nook as Michaelene Kulig peers into his refrigerator.
"What do you want for lunch today?" she asks.
"How about salad. Do I have any tuna open?" he replies.
Kulig spoons the tuna and slices cherry tomatoes into a bowl of salad greens, then sticks a fork into the mixture and carefully guides it into Williams' mouth.
She is one of several personal care aides who perform daily life tasks that Williams, 62, cannot do on his own because he was born with a neuromuscular disorder that deformed his arms and hands. The aides, he said, are the lifeline that allows him to remain at home and work full time for the Center for Independent Living in Scranton.
Maintaining independence has become increasingly challenging for him and others who rely on at-home care because of a critical workforce shortage facing the home health care industry locally and statewide.
"Right now, we have 33 people waiting for personal care because we can't find direct care workers," said Jason Kavulich, director of the Lackawanna County Area Agency on Aging.
That's left families struggling to meet their loved ones' needs and keep them out of an institutional setting, such as a nursing home or personal care home.
"I can't tell you how many calls I get from people looking for help," said Tracy Hunt, assistant vice president of in-home services for Allied Services Integrated Health System, which provides in-home personal care and health services to thousands of people in northeastern Pennsylvania. "They don't know where to turn."
Statewide, there were 107,829 elderly and physically disabled people receiving home-based services through the state's Community Health Choices program as of March, according to the latest data available from the state Department of Human Services.
That's an 8.4% increase since January 2020, according to DHS. As that need grows, the labor force has not kept up with demand. The federal Bureau of Labor Statistics projects that by 2030, there will be nearly 600,000 open positions nationwide, or a 32.6% increase from 2020, including nearly 40,000 in Pennsylvania.
Unable to walk, lift his arms or grasp objects, Williams has always relied on his aides to feed, dress, bathe and assist him with bathroom breaks.
He's always had enough help, but he had a close call late last year after two aides quit within a two-week period. He found replacements at the last minute, but the experience left him with a "very, very uneasy feeling."
"I have family in the area who have helped me out many times over the years with emergencies," he said. "Not being able to find somebody is scarier. It's not a scattershot, occasional instance."
Providers say the low pay and nature of the physically and emotionally demanding job creates significant barriers in attracting and retaining staff.
The average annual wage for home health and personal care aides in Pennsylvania was $27,870, or about $13.40 an hour, as of May 2021, according to the latest data available from the Bureau of Labor Statistics. In the Scranton-Wilkes-Barre area, the average worker earned $26,360 a year, or $12.67 an hour.
Providers, most of whom rely heavily on Medicaid funding, say they can't compete with other industries that pay more for far less demanding work.
"You go to work at any of the Amazons and Chewys of the world or fast food restaurants, you're there for eight hours ... and you go home versus the healthcare world, which isn't always that cut and dry," said Michael Zeshonski, staffing manager for Interim HealthCare in Scranton.
In January, Pennsylvania used American Rescue Plan Act funds to provide an 8% increase in service rates to home health agencies. The increase helped, but did not go far enough, said Teri Henning, executive director of the Pennsylvania Homecare Association (PHA), a Lemoyne-based industry trade group.
"That only supports an hourly wage in the $12 to $13 range," Henning said. "We think we need at least another 8% to get closer to $15 an hour just to be competitive."
While compensation remains a challenge, providers and social service agencies say they are taking additional steps to entice people to the field.
The Lackawanna County Area Agency on Aging is developing a pilot program with two area home health care agencies to allow their employees to qualify for tuition reimbursement at Lackawanna College, Kavulich said. He expects to release further details shortly on that long-term solution.
For those who need help now, Williams points to the Medicaid waiver and other state-run programs that allow people needing home-based care to hire their own caregivers, including family members in some instances.
DHS administers multiple programs, each with its own eligibility requirements. Williams receives help under the Act 150 program, which charges a sliding scale fee for services for people who earn too much to qualify for the waiver program.
That's how he pays Kulig, 21, of South Abington Twp., a student at the University of Scranton studying to be an occupational therapist. She's worked with him for about four years, supplementing aides Williams uses from a home health care agency.
"It's a great option that I think a lot of people don't know about it," Williams said.
Henning said she's hopeful the state will consider additional increases to Medicaid funding for home health care so it can recruit and retain workers, otherwise the situation promises to worsen.
In a recent survey, 98% of PHA members said they declined referrals in the last year because of staffing shortages. That results in more people having to go to nursing homes or personal care facilities — a far more costly alternative for the state, Henning said.
The real cost, Henning said, is measured not in dollars, but the toll on families and clients denied care because there was no one to send.
"I don't want to lose sight of the fact this is about people," Henning said. "It's really about fundamental care and about dignity for people who need care to stay in their home."
Contact the writer: firstname.lastname@example.org; 570-348-9137; @tmbeseckerTT on Twitter.