Some of the sickest children in California need round-the-clock care at home. But many aren’t receiving the help that the state promised. The NBC Bay Area Investigative Unit first exposed that home health agencies can’t find enough nurses, leaving parents to provide critical medical care for their kids.
Now a major move in Sacramento may bring some relief to struggling families.
As part of his budget package, Governor Jerry Brown proposed a 50 percent wage increase for at-home nurses who provide care to patients through Medi-Cal, the health care system for low income and disabled Californians.
Home health advocates are calling the pay hike significant. They hope it will entice more nurses to pursue home care and end what many are calling a crisis. There’s a shortage of available home health aides, and families across the state are feeling the impact.
Noah Habib’s family is one of them. Noah has cerebral palsy, can’t walk and has trouble speaking. He eats and gets medicine through tubes, and is at constant risk of choking. He’s 22 years old, and for most of his life he's needed a nurse by his side.
He’s eligible for 200 hours of nursing care each month, but for the past two years nurses could only fill about a quarter of those hours. Right now he doesn’t have any help.
“Last year we got a letter from the agency we had been using for quite some time telling us that they were very sorry but they had exhausted all their recruitment strategies and they couldn’t find us anyone,” said his mother Heidi Cartan.
Cartan quit her job to take care of Noah herself, but she’s not a nurse. Cartan says many providers just can’t afford to stay in home care jobs. Many choose to work in hospitals or other health care settings where the pay is higher.
“You can make more money where I live in Santa Cruz being a veterinary assistant than you can supporting Noah,” Cartan said. “And that’s what I’m up against.”
Payments to home health providers under Medi-Cal haven’t gone up in 18 years. Licensed vocation nurses, or LVNs, who work for home care agencies, make about $29 an hour. Now Governor Brown wants to increase pay by 50 percent for LVNs, registered nurses and other health care aides who provide care to children and adults.
The governor’s proposal comes after the Department of Health Care Services, which oversees Medi-Cal, found nursing agencies can’t always fill hours requested by patients. The department started tracking after NBC Bay Area started asking questions in 2016.
DHCS noted in a recent report that nursing agencies can only provide 71 percent of the hours needed by sick children statewide. In Santa Clara County that number is 50 percent. In Sonoma County nurses could only fill hours 29 percent of the time.
When the state can’t deliver what it promises, it puts a strain on parents. NBC Bay Area first reported that a Napa family had to move to San Diego to find nursing services for their young daughter, and a teenage girl from the North Bay has simply gone without them for four years, leaving her mother to pick up the pieces.
As president of the California Association for Health Services at Home (CAHSAH), Dean Chalios has seen parents upend their lives to get their kids help.
“It’s dire and it’s tragic,” he said. “It’s a chronic problem we deal with on a daily basis. The last thing a home health care agency wants to do is turn away a patient Medi-cal or other that we can’t find somebody to take care of them.”
For years CAHSAH has lobbied for wage increases. Chalios calls the recent development “monumental.”
“We’re very grateful to the governor and administration,” Chalios said. “We’ve worked very hard on this issue for a very long time. We’re grateful to NBC Bay Area News for your investigative work on this and helping to bring to public this important issue.”
Cartan says she’s not going to be around forever, and she needs to know there’s a system in place for Noah when she and her husband are gone. She says the wage increase is first step is to treat caregiving as a valued profession.
“This 50 percent sounds like a lot,” she said. “But to me, after 22 years of this – I feel like it’s just catching up to where it should be.”
The new rates would add $74 million a year to the state budget. The legislature has to approve the proposal by June. If lawmakers give it the green light, the big question is will the rate hike solve the problem?
Disability Rights California, an advocacy organization that launched an investigation into the availability of home health providers last year, says the state must meet its obligation to provide at-home services even if the nursing shortage persists after any wage increases take place.