Shortage of Home Care Nurses on Horizon

Home healthcare agencies say Medicaid reimbursements have not kept pace and, as a result, it’s tough to recruit private duty nurses

It’s a typical Monday night for 22-year-old Lili Kaplan and her private duty nurse. Cartoons are on the TV while nurse Barbara Gibney performs one of the day’s many required tracheostomy cleanings. It’s just a small portion of the long list of medical services she provides.

“Sometimes I work a 15-hour shift here, so we do that in the morning, and we do it in the afternoon. Her feedings are three times a day; they run for an hour and a half to an hour and 45 minutes,” said Gibney.

Gibney and a team of six other private duty nurses are responsible for Lili’s round-the-clock care — tending to her congenital heart and lung disease that requires medically complex treatments, overseeing her therapies, and understanding the needs of someone who is both cognitively impaired and nonverbal.

“We’ve been doing this for 20 years and we’ve gone through phases where we haven’t had enough nursing,” said Lili’s mom Emma Kaplan. “I’m a single parent, I work full time, so if I don’t have my nursing in place all the time, I can’t go to work. And if I can’t go to work, then I cannot support my household.”

Home healthcare agencies say a shortage of PDNs, or private duty nurses, is on the horizon. PDNs give individualized care on a continuous and non-intermittent basis to certain patients in a home setting. They’re licensed as either a registered nurse or a licensed practical nurse, or LPN. The difference is in training and education requirements. But private duty nurses are paid through Medicaid reimbursements, and those who work in the field say that makes it tough to compete.

Problem: attracting, recruiting, retaining

“Our biggest obstacle right now is trying to attract, and recruit, and then retain quality nurses,” said Marlana Follet, division director for BAYADA Home Health Care.

The last Medicaid reimbursement increase was in 2008. Since then, Follet says more and more nurses are being recruited to big-name hospitals right out of school with the shiny salary and benefit packages that go with that. Meanwhile, home healthcare agencies like BAYADA, which employs Lili’s nursing team, say pay rates for home care reimbursement is significantly lower. It’s $38 an hour for an LPN or $50 an hour for a registered nurse.

“Out of that amount that we get for the nurse, that has to cover the nurse’s salary, their benefits, PTO. It also has to cover supplies,” said Follet.

BAYADA conducted an internal study and found that because of reimbursement rates, the home healthcare industry is only able to attract roughly 40 percent of LPNs like Barbara and 17 percent of registered nurses.

“A lot of children are going without a nurse, parents are stressed,” Gibney said.

Sen. Loretta Weinberg introduced a bill to increase the hourly Medicaid reimbursement rate by $10, up to $60 an hour for an RN and $48 for an LPN — this as the home health field is expected to boom. The United States spent an estimated $103 billion on home healthcare last year. That is predicted to jump another $70 billion by 2026, according to the Centers for Medicare and Medicaid Services.

For the Kaplan family and many others, these private duty nurses are a lifeline.

“It’s always a concern in the back of my mind, what would happen if my job one day said, ‘you can’t keep missing this many days,’” said Kaplan.

She’s hoping she’ll never have to find out.