Home Health Providers to Tackle Rural Workforce Crisis in New Pilot

With home health providers nationwide facing caregiver shortages, the crisis is especially acute in rural areas. A new demonstration program is trying to come up with solutions by working with home health providers in Minnesota and Wisconsin.

This demonstration project is an opportunity to bring new interventions and experiment with possible solutions to the dramatic shortage of both home health aides and personal care attendants, Susan Misiorski, vice president of workforce innovations at PHI, a Bronx, New York-based research and consulting organization that focuses on the direct care workforce, told Home Health Care News. Misiorski began her career in nursing, specifically as a direct care worker.

“You can imagine that given the fact that we already have a shortage in non-rural communities that [it] is just magnified in rural locations where there simply aren’t as many people available to be trained and hired for these roles,” she said.


The landscape

The initiative began with a landscape study that analyzed the current home health care situation in both states. PHI released two reports last year and began searching for providers to be a part of the pilot program.

Knute Nelson
Knute Nelson employee LPN, Katti, with a home care client.

Accra, Benedictine Health System and Knute Nelson were chosen in Minnesota to be a part of the program. In Wisconsin, Community Living Alliance and Lori Knapp Companies were chosen.


The grant will go through October 2020 and there are many pieces of it, from coaching and leadership training to creating new and innovative career paths for home health care workers. It’s all mapped out, Brooke Zabel, vice president of human resources at Knute Nelson and Knute Nelson’s project lead for the PHI grant, told HHCN.

Knute Nelson is a provider of assisted living, home health care, hospice and long-term care in 21 counties in West Central Minnesota. The organization served 6,386 patients in 2017 and currently employs 553 people.

Turnover, wage and retention challenges

Part of the focus of the program is on finding solutions to problems in the sector.

“There is no reliable source of turnover data in home care. So, what we have had to do is gather the data from specific employers, and what I can report is that the turnover amongst home care workers is high in general. Most employers report turnover rates between 40% and 60%,” said Misiorski. “And that’s partly because of the overall quality of the job itself—it’s not a high paying job so we are talking about individuals that are not making high wages and they find it difficult to live on the hourly wage that they get in home care.”

For example, the hourly wage in 2016 for personal care aides in Minnesota was $11.48 and for home health aides it was $12.45. The state hourly wage for all occupations is $18.88, according to data from PHI and the State of Care, Minnesota’s Home Care Landscape report.

“Part of the challenge with the wage issue is that it is directly tied to the reimbursement system. The reimbursement rates are not high enough to support higher wages,” said Misiorski. “Home care agencies are challenged to try and offset with a variety of different income streams, like private pay clients.”

But more issues arise for a provider in rural areas because there aren’t many private pay clients to increase its income streams.

In Minnesota, people 65 and older living in rural areas with income 200% below the federal poverty line make up 46% of the population, according to Misiorski.

Another challenge is how far some workers have to travel to each patient.

“[One] of the things that may hinder home health care workers from being successful is just having access to transportation and having a reliable vehicle because really they are working out of their car,” said Zabel.

Hoping for results

With big challenges come sweeping solutions.

Zabel said that there a lot of ideas around finding new hires and looking outside of their usual staffing pipelines.

But as far as retention goes, Knute Nelson is trying to continue and improve on providing a culture where workers feel connected, she said.

“When they’re out working in the homes, they are on their own and so increasing that feeling of being connected to a bigger picture is something we work towards and strive to do each day,” said Zabel.

One of the interventions PHI focuses in on is developing mentor relationships so that newly hired staff feel connected, heard and have a person to look to for advice and support. This specific role also allows some care workers to advance in their careers by eventually becoming a peer mentor, which can include a wage increase and more responsibilities in their day-to-day.

The organizations within the program believe that most of the solutions can be applied outside of Minnesota and Wisconsin. The idea is that the pilot program can be an example for how other states can combat similar in-home health care issues, whether in rural or urban areas.

The plan is to release several reports over the next few years.

The program almost certainly can be replicated, according to Kathleen Murray, an organizational learning developer and trainer at the Benedictine Health System (BHS).

“[BHS is] in five states, [so] we want to take what we see is successful and roll it out within our community and facilities,” Laura Campbell, the director of organization learning at BHS, told HHCN.

BHS is a Catholic nonprofit health system based in Duluth, Minnesota. The system provides senior care and complete long-term care, independent living and assisted living services across five states.

For PHI, the ultimate goal is to improve recruitment and retention of health care aides and personal care attendants, and by doing so, to also increase access to services in rural locations.

“We’re going to bring a variety of interventions to try and improve the overall job quality so that it becomes a job that people want to stay in,” said Misiorski.

Written by Kaitlyn Mattson

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