'Worse For Care': Low Pay, Tough Work And Turnover Bedevil Vermont's Eldercare Workforce

Dec 4, 2019

Like many Vermont eldercare homes, EastView at Middlebury was struggling to keep enough 'round-the-clock staff in early 2015. The nonprofit's 34 elderly residents were falling down more often as a result, a confidential complainant alleged February 3 of that year to Vermont's Department of Disabilities, Aging and Independent Living. The home was interviewing caregiver candidates almost daily and leaning on temp agencies to cover gaps, state records show.

Jessica Badger, a 30-year-old caregiver, was working there at the time. She had pleaded guilty January 26 to forging a check and received a deferred sentence. Badger continued to care for seniors at EastView after that, despite a state rule that bars eldercare facilities from employing anyone convicted of theft-related crimes.

By July, the son of a 91-year-old EastView resident had spotted dozens of fraudulent charges on his mother's credit card, court records show. Authorities confronted Badger that August at the Williston Walmart, where she'd been using the card to buy pet food and T-shirts. She was arrested and charged with exploiting a vulnerable adult, a felony.

Regardless, Badger was able to land new positions at other eldercare homes. She would go on to steal thousands of dollars from another elderly charge.

Caregiving is a people business, and the quality of care seniors receive, whether at home, in residential settings or at nursing facilities, depends on the people providing it. Personal care aides must be trained and attentive. Nurses and nursing assistants must be knowledgeable. Managers must be diligent.

But low pay, difficult working conditions and a state workforce shortage have combined to make it tough for eldercare homes across Vermont to employ enough qualified people. As a result, residents are put at greater risk of accidents, injury and exploitation.

A Seven Days and Vermont Public Radio investigation found dozens of instances in which residents at state-regulated homes have been harmed or mistreated by staff who were poorly trained, overwhelmed or made terrible decisions.

Particularly ill-suited staffers have diverted drugs, stolen residents' money and assaulted them. One caregiver, working alone at the tiny Waterford Group Home, beat a cognitively impaired resident with a hairbrush hard enough that bristle-shaped marks were visible on the resident's body the following day, according to a 2016 state inspection report. Waterford fired the caregiver and reported the incident to state officials.

Another, at Brookwood Residential Care Home in North Springfield, was found to have thrown briefs at an incontinent resident and yelled for a second resident to "get the f--k up!" after a fall. The "bad apple" was fired and reported to the state, owner Jen Silva said.

Facilities are required to screen prospective employees through background and elder-abuse registry checks. But 43 homes have been caught without them, including the nonprofit Lincoln House in Barre, which was cited in 2014, 2016 and 2018.

The home's executive administrator, Brenda Scalabrini, told Seven Days that she hadn't run the checks "in a timely manner" when the 27-bed home faced urgent staffing shortages — which occurs when even one employee leaves. Scalabrini said she's worked 12-hour days for 12 days straight just to keep the kitchen going.

"It's hard to get good help," she said. "I think long and hard before I fire someone, and I think long and hard before I hire someone."

More from Worse For CareWhen Elder Homes Stumble, Frail Vermonters Get Hurt

Caregivers are in high demand as more Vermonters reach old age; the state's population is on pace to become one of the very oldest in the country. There aren't nearly enough people who want to care for the elderly.

Vermont is forecast to add 220 personal care aide positions annually through 2026, according to state Department of Labor estimates; the occupation will surpass cashier as the most common job. Residential care settings and nursing homes will need to add 300 registered nurses over the next decade, according to estimates in a 2017 state-commissioned report on health care workforce demands.

"The workforce shortage we are facing across long-term care in Vermont is rapidly approaching crisis levels," said Ruby Baker, executive director of the advocacy group Community of Vermont Elders.

Nurses must oversee the care at most licensed residential settings, but much of the direct service falls to assistants or unlicensed aides. A supervising nurse isn't necessarily always on-site.

These caregiving jobs are demanding, with long hours and low pay: Personal care aides earn average hourly wages of just over $13, according to state labor data.

A recent survey of 45 long-term care homes by the industry's trade organization, the Vermont Health Care Association, revealed extremely high employee turnover. More than half of unlicensed caregivers leave their jobs each year.

"They are not paid a livable wage," former DAIL commissioner Susan Wehry said, noting that caregiving jobs often fall to women and people of color who must work second or third jobs to get by.

"Nobody can work three jobs and not be stressed, irritable, frustrated with people under their care who are difficult," she said.

Nor do caregivers always receive the training that eldercare homes are required to provide. More than half of the 133 facilities have been cited since 2014 because their employees didn't complete state-mandated training, the news organizations' analysis found. Many of those have been cited multiple times.

More than 20 have been caught operating with dangerously few caregivers on duty. Pillsbury Manor South, in South Burlington, once relied on a new caregiver who hadn't finished orientation to conduct nighttime safety checks for an entire wing of the 64-resident building, state inspectors found. A routine 11 p.m. safety check for a 95-year-old resident wasn't done. At 1:50 a.m., the staffer discovered that the woman had gotten her head wedged between her mattress and a bed railing, state inspectors learned. The medical examiner determined that the woman had suffocated to death.

The 2016 incident, which occurred before Pillsbury was sold to a Texas private equity fund, led to a $230,000 wrongful death settlement with the woman's family, according to court records.

Paying up

Vermont's aging labor pool and the cost of getting professional licenses contribute to the workforce shortage, according to a draft report by a legislature-commissioned task force on health care services. A lobbyist for the Vermont Health Care Association, which represents eldercare facilities, led the subcommittee that drafted the report.

Eldercare homes that participate in state Medicaid programs can be constrained financially by the daily rates the state pays for care. The base rate of $42.25 per resident doesn't cover the actual cost of care.

The rate "is still not enough to maintain the kind of staffing that they need to and want to," DAIL Commissioner Monica Hutt said.

Bradford Oasis, an 11-bed residential care home, was financially foundering when Teresa Hemingway agreed to take over management in 2018 from her aunt, who owns the facility, Hemingway said. Inspectors had visited a dozen times in the previous three years, citing more than 60 problems and issuing a rare fine.

Hemingway said Bradford Oasis' struggles were rooted in its finances, which were tied to Medicaid reimbursements. She cut employees' hourly wages from $15 to $13 and said she paid herself the state minimum wage in order to balance the books.

"It's been rough to get us to this point here," she said, adding that she's written to state officials about the home's predicament. "They wonder why little homes like this are closing. It's because we don't have the funding."

In addition to cutting wages, Hemingway said, she's begun taking on residents with higher needs. Seniors eligible for nursing homes can instead opt to live in a residential care home through the state's Choices for Care program. Bradford Oasis gets an extra $55 to $70 per day for each participating resident. The home must provide them with additional services, but Hemingway said it pencils out more favorably.

At the other end of the industry spectrum, Massachusetts-based LCB Senior Living uses a variety of incentives to attract and keep caregivers at its three private-pay homes in Chittenden and Addison counties, spokesperson Ted Doyle said. Its facilities, the Residences at Shelburne Bay, Quarry Hill and Otter Creek, together house more than 300 seniors at rents that can approach $10,000 per month. The company offers $2,000 sign-on bonuses to unlicensed caregivers and an educational assistance program for those who want to pursue professional licensure.

"One of the advantages we can offer is the opportunity for a career," Doyle said.

Turnover is still high, he said, but the company can call substitute workers from one of its other homes to fill in. He declined to disclose starting wages for caregivers.

Exploit me twice

Until 2015, Vermont eldercare facilities had to request a waiver from DAIL to employ anyone with a criminal record. Since then, regulators have let managers make those calls, licensing chief Pam Cota said.

That may be one reason why Badger, the EastView at Middlebury caregiver, was able to get another caregiving job after she was charged with stealing from an EastView resident. (Asked about Badger, EastView wrote in an email that it "acted immediately, followed regulatory protocol, notified appropriate agencies, and followed legal requirements of the State of Vermont.")

State records indicate that Badger began working at Living Well Residence, the Bristol location of the nonprofit Living Well Group, in August 2015, just weeks after her arrest for the stolen credit card. It's not clear when the nonprofit learned of her criminal charges, including her May 2016 conviction in the EastView case, but at some point it did, according to inspection reports.

Regardless, Badger transferred to Living Well's Burlington facility, Ethan Allen Residence, in January 2017. The following summer, a resident reported $7,200 missing from her purse. The home's manager told police she suspected Badger because the caregiver had recently posted pictures online from a trip to Jay Peak with her family. Badger was making just $12 an hour, according to a police affidavit.

Badger admitted to buying an $800 weekend trip with her kids but said she'd used the rest of the stolen money to pay overdue bills, police said. She was convicted last year.

In a statement, current Living Well Group administrator Mark Tapper declined to comment on Badger's case, which predated his management. He wrote that the organization today has "robust" systems to vet all employees, including yearly background checks.

State inspectors returned to Ethan Allen Residence this past July. They cited the home for having too few caregivers on the night shift; those who were on duty weren't logging resident checks. The facility's response? It was interviewing for additional help.

VPR's Emily Corwin contributed reporting, and Seven Days' Andrea Suozzo contributed data reporting.

Resources

“Worse for Care” is a joint investigation by Vermont Public Radio and Seven Days into assisted living and residential care homes for the elderly. In addition to publishing stories over four weeks, we’ve launched the Vermont Elder Care Navigator, a searchable database at eldercare.sevendaysvt.com.

It was produced by: at VPR — Emily Corwin, reporter; Mark Davis, editor; and at Seven Days — Derek Brouwer, reporter; Andrea Suozzo, data editor; Matthew Roy and Candace Page, editors; and James Buck, photographer.