Michigan’s work mannequin of residence nursing for essentially the most susceptible is damaged into {dollars} and cents


On the Sunday morning after Thanksgiving, an M&M Home Care Inc. HR coordinator sent an urgent email to its 145 employees.

“We need immediate coverage for our Livonia customer, ASAP. $$$ 50 $$$ bonus for last minute quick pickup,” she wrote.

Four days later, she was looking for two supervisors to fill five days of shifts the following week and looking after a new client in West Bloomfield. The payment was not advertised.

On the same day, another HR coordinator for the Livonia-based home care company was looking for someone to work a 12-hour shift for $ 16 an hour in Clarkston.

I get these emails every few days from the managers at M&M Home Care because I have a part-time job that I wish I never had – taking care of my disabled brother Brian when my parents weren’t may or they are small caregivers, which is very common.

Some of those emails are desperate and sent at any time of the day or night as the company’s managers struggle to fill shifts because a caregiver is sick, their children are sick, their car won’t start and they find a better paid one Jobs with more predictable hours – or they just quit on a dime.

Inclusion on this email list gave me some insight into the difficulty of finding workers for people whose functioning ranges from an Alzheimer’s patient who needs help around the house to someone like my brother who cannot walk . talk, bathe or feed yourself.

Since 2004 I have seen a revolving door of direct caregivers from seven different agencies come in and out of my family home in Chelsea. I guess in the last 16 years there have been 150 people looking after Brian somewhere in the stadium.

I asked my mother to write down the names that she could remember. She came up with a list of 17 women and five men. Only last year it was 10.

Nancy, one of Brian’s current supervisors, has been with us for eight years. She is Saint Nancy in my book.

A woman named Brenda looked after him for three years. A close friend named Angie was his caregiver for 18 months well over a decade ago. The rest of it took a few months, weeks, days and even hours.

Some quit in the middle of the shift after realizing the difficulty of lifting a 6-foot-1,220-pound man in and out of bed and chairs for $ 12 an hour.

According to Home Care Pulse, an Idaho-based research firm, the turnover rate for the direct care worker industry was 64 percent in 2019.

This is mainly due to the low wages for a level of work that, in my brother’s case, is more difficult, physically and emotionally, than washing cars or beating up a turkey tom at Jimmy John – jobs that typically pay more in this job market.

My mom and I fill in if necessary and it is certainly a love job for us.

Because Brian sustained a brain injury in an unusual electric shock accident, he has a Medicaid insurance program for the elderly and disabled that is limited to 64.25 hours per week. These hours are spread over all seven days a week to give my parents the time they need to run their small business and enjoy life a little.

In normal years, I spend a couple of weekends taking care of Brian while my parents take a well-deserved vacation and Nancy stays with him during the week. My parents pay out of their own pocket for 24/7 coverage.

You have the means. Not everyone does.

Medicaid’s wages for this work are set by the government. The crisis this industry is facing in retaining passionate and caring workers is primarily due to state and federal government reimbursements to suppliers.

The math is pretty simple: the patients with the lowest reimbursement rates are the hardest to staff consistently.

The Area Agency on Aging 1-B, a Southfield-based nonprofit that manages Medicaid’s home care for my brother, pays M&M Home Care about $ 17 an hour for patient care (the equivalent of $ 1,092 per week and $ 56,797 per year).

After an hourly wage, the HR company has overheads, wage taxes, and liability insurance to get that $ 17 an hour out.

“As soon as I pay more than $ 12 an hour, I lose money,” said Michael Malecki, President and CEO of M&M Home Care.

Malecki, a former Detroit medic who has worked in the healthcare sector since 1995, said if Brian were a private contractor he would be charging $ 27.50 an hour.

If Brian was in a car accident, Malecki said the hourly rate would be $ 35 an hour – his highest rate for a patient with high visual acuity, such as a quadriplegic or someone who ventilates at home. These nursing workers make nearly $ 17 an hour plus health insurance, vacation and retirement benefits, Malecki said.

“The refunds are day and night,” he said.

Malecki’s company “inherited” the program my brother participates in through the acquisition of a Milford-based company, Hearts and Hands Home Care, which often struggled to fill shifts to cover Brian’s daily care on Fridays and Saturdays.

“They were essentially driven out of business because they relied far too much on (Medicaid patients) and couldn’t keep it up,” Malecki said.

M&M Home Care offers a mix of home care patients with Medicaid, Private Wage and Personal Injury Protection (PIP) through their auto insurance, which extends to more than 150,000 patient care hours that they are expected to log this year, Malecki said.

Like any Medicaid provider, Malecki has tried to convince the Area Agency on Aging 1-B that providers desperately need an increase in their reimbursements to keep wages competitive with other low-skilled jobs.

He said if the hourly rate were increased to $ 21 an hour, he could raise direct nurse wages to $ 13.50 and still make a 5 percent profit for his company.

That is still not a living wage. According to the Michigan Association of United Ways’ annual ALICE report, this is less than half the full-time wage of $ 30.64 an hour needed to survive a family of four in Michigan.

And it would still lag behind big healthcare employers like the Henry Ford Health System, Mercy Health, and the Saint Joseph Mercy Health System, which raised their minimum wage to $ 15 an hour in October.

“Valet parkers get $ 15 an hour plus car parking tips,” Malecki said in hospitals. “It’s a broken system.”

The coronavirus pandemic has only added to the strain on this industry as direct caregivers quit their jobs to teach children how to study from home or to protect themselves from infection of a loved one.

At the same time, families like mine are downright afraid of sending our loved ones to care facilities where the virus has devastated residents and their daily carers.

The $ 2 an hour COVID hazard payment for some home health workers that Congress has appropriated through the CARES Act expires later this month.

It could have served as temporary relief to a labor crisis that will only worsen as our state ages and more people want to spend their days at home.

Brian is 36 years old. His ability to live full and meaningful lives was painfully diminished at the age of 20.

We have perhaps decades ahead of us to administer his day-to-day care – a grueling challenge that is unfathomable given all the work problems my parents have faced for 16 years.

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