Saving a Vermont Health Care Gem

My maternal grandmother – Nana – was a central figure in my life growing up. When she was young, she was a talented seamstress who sewed wedding dresses for fancy customers. When she got married, she stayed at home and raised two daughters who were born “during the War.” Once the childrearing was done, her life was largely spent cooking and cleaning and sewing and doing laundry. She was deeply skeptical of my husband when I first brought him home and she discovered that he did all of those things for himself – and often for me too.
She dressed up and put on make-up to go out, and always wore heels until the day she fell and broke her pelvis. That was the beginning of her slow decline. Hypertension, diabetes and several falls plagued her in the last decade of her life. “Don’t get old, honey, it’s hard” was a common refrain. 
I’m starting to watch my parents and my husband’s parents go through the same cycle. All three of the parents we have left between us had falls this year. All three of them live alone. The moment any of them becomes disabled – even temporarily – they need assistance.
Vermont is a leader when it comes to caring for people as they age. Through the Choices for Care program, those people who need a nursing facility level of care and who qualify financially for long-term care Medicaid have a choice – they can receive care at home or in a nursing facility or other long-term care facility. A lot of people choose to stay home as long as possible. That’s been good for the people we serve, who keep their independence longer. It’s good for their families and loved ones – most often women – who can remain in the workforce, instead of caring for aging parents. It’s also been good for Vermont’s Medicaid budget. The Medicaid program spends about half as much on people receiving care at home than in nursing facilities.   
Unfortunately, the program is in serious trouble. For about a decade, Vermont made no new investments in the home and community-based program, except to add to the caseload, and made only modest investments in long-term care facilities. For the last few years, Choices for Care providers have seen small Medicaid rate increases to support the program, but the investments aren’t even keeping up with inflation. Long-term care providers are experiencing untenable losses providing the program. Hiring a workforce to serve our clients is getting harder. We recently surveyed members and found that the turnover rate for personal care attendants is 50 percent statewide. In a year, half of our personal care workforce turns over. The vacancy rate is 25 percent. This is partly a reflection of a larger workforce crisis across all sectors in Vermont. It’s also a reflection of Vermont’s failure to invest in the program. We’re working in close partnership with our colleagues across the long-term care spectrum on a series of policy proposals to shore up our shared workforce.
In the meantime, home health and hospice agencies have stretched to increase wages to this workforce. We estimate that the program is costing 27 percent more than agencies are getting paid to provide the services. This is a critical issue that requires immediate attention. If the individuals served by the Choices for Care program didn’t receive services at home, most counties in Vermont would need the equivalent of one new nursing facility each. One explicit goal of the Choices for Care program was to increase the proportion of older Vermonters receiving care at home instead of in facilities. As a result, there are many fewer facility beds available today than a decade ago. Care at home represents about half the entire long-term care program in Vermont. This legislative session, the VNAs of Vermont will join with other Choices for Care providers and consumer groups to urge legislators to make protecting older Vermonters a top priority.


Jill Olson
Executive Director, VNAs of Vermont

VNA Partners With