MN Faces Looming Workforce Crisis for Long-Term Home Health Care

Updated: 04/25/2013 11:23 PM By: Scott Theisen

Minnesota is facing a looming workforce crisis when it comes to long-term home health care.

Baby Boomers are aging, and the projected need for personal care assistants in the next decade far exceeds the number of people entering the field.

Health care advocates say it's difficult to attract and retain quality workers due to low wages and a lack of benefits.

KSTP investigated just how this so called "care gap" is already creating problems statewide.

Every day from 8 a.m to 4 p.m., Becky Pollack tends to Sharon Bramhall's most intimate needs.

Once a nurse herself, a botched sinus surgery led to an ongoing series of medical problems for Bramhall, and she ended up with a spinal fluid leak.

And if Becky weren't here, she wouldn't be at home. "At this point, (I'd probably be) dead," said Bramhall.

In 2011, nearly 27,000 people in Minnesota were deemed eligible for PCA benefits. That's more than double the number of recipients the program served in 2002.

The 2011 spending topped $422 million in state and federal dollars.

Christine Maxwell of Atfirst Nursing Service and Home Health Care said, "The senior population is growing, booming, exploding you might say. We call it the silver tsunami."

In the next 20 years, the number of Minnesotans 65 and older is projected to grow by 80 percent to over a million people.

There are currently 574 agencies that employ more than 88,000 PCAs. But this recent study estimates the state will need as many as 50,000 additional home health care workers in the next decade alone.

Education Director for the Minnesota Home Care Association Paulette Sorenson said it's very hard to find the right people. Perhaps it's because pay isn't increasing. Adjusted for inflation, wages for PCAs have declined as much as 12 percent over the last decade.

Currently the median earnings for in-home health care workers are $10.88 an hour. On average, PCAs will work part time and make about $12,000 a year.

Pollack has been a PCA since the early '90s. Her pay? She said it's just a hair over $10 an hour.

And sometimes, with low wages, you get poor service. Before she had Pollack, Bramhall endured a string of PCA horrors.

"Some of them were just not qualified and some of them were not good," said Bramhall.

One would often show up drunk, or not at all. Another actually stole one of her prescription medicines and then overdosed on it.

"We found her under the couch and she was in respiratory arrest," said Bramhall. She survived, but only after Bramhall performed CPR on her. Because PCAs are largely unsupervised, the risks of neglect and abuse are amplified.

Officials want to raise the training, the education and the pay, but with Minnesota currently more than a billion dollars in debt, they say it has a huge fiscal impact.

Now, a new bill in the state legislature aims to give home health care workers the right to form a union and set up standards across the board.

To become a Personal Care Assistant, you have to pass a background check and a basic training course. But there are no set standards for the training statewide, or enforcement protocols. And the agencies that employ PCAs aren't required to be licensed; they simply re-enroll with the state once a year.

In order to qualify for PCA services, you must be eligible for, or receiving Medical Assistance benefits, Minnesota'a Medicaid program, or the Alternative Care program for qualifying seniors. You must be assessed by your county as having a need for PCA services. You must have a doctor's statement of need every year.

Between October 2012 and October 2013 the state received 1,984 complaints related to long term care involving adults. Although the majority of those were related to nursing homes, state ombudsman Deb Holtz believes the number of PCA complaints is grossly underestimated because the system isn't adequately designed to track those complaints, and most consumers don't know who or where to call.

Questions, concerns and complaints about Personal Care Assistants and long-term care can be directed to the Office of Long-term Care Ombudsman at 800-657-3591.

The MN Dept. of Human Services administers the Personal Care Assistance program and can be reached at 651-296-3971.

The Minnesota Home Care Association, which represents 250 home health care agency members, can be reached at 651-635-0607 or