Editor’s note: This is a companion piece to a “Pandemic strains: Copley fights to recruit, retain nurses”.

A growing population of aging Vermonters and their desire to age-in-place has created a demand for at-home care and the nurses that provide it, as well as non-degreed caretakers.

This is increasing pressure on a workforce fighting to grow its ranks in a field disrupted nationwide by the ongoing COVID-19 pandemic.

While Vermont’s hospitals, including Copley Hospital, have largely avoided the intense pressure wrought by the pandemic elsewhere in the country, the dangers posed by the coronavirus, particularly to a more vulnerable older population, is causing shifts in the health care landscape.

“We are out recruiting for nurses and we’re recruiting because we’re growing, not because we’ve lost staff,” said Kathy Demars, executive director of Lamoille Home Health and Hospice.

“One thing that happened during the pandemic is I think the value of home-care nursing really came to the forefront for people because people weren’t going to the hospital, they weren’t going to doctor’s offices, so we were seeing even more people at home. It actually increased our business during the pandemic.”

Vermont and Lamoille County’s population is old and growing older. According to the Population Reference Bureau, Vermont is only ahead of Florida, West Virginia and Maine when it comes to percent of population 65 or older.

Nearly 18 percent of Lamoille County’s population falls into this category according to the U.S. Census Bureau, just slightly less than the state average of 20 percent.

A 2020 board of nursing re-licensure survey showed that while over a third of Vermont’s nurses work in nursing homes, only 7 percent work in the field of home health and less than 1 percent work in a hospice setting. Five percent work in hospitals.

“Vermont has a population that is aging and there’s a lot of desire behind older people wanting to age in place in their home and get that health care,” said Mary Val Palumbo, director of interprofessional education at the University of Vermont. “They want to have it brought to them so that they’re able to remain in their home. The lack of nurses doing home health care is going to pose a challenge to people who are trying to make that work.”

Not just nurses

A key part of the program Demars and Lamoille Home Health and Hospice are looking to grow doesn’t actually require having a nursing degree or any degree at all.

“Families now don’t have the capacity sometimes to stay home and care for their loved ones because they have to work, so our Choices for Care program, which is a state-funded program, is also growing. That’s the key nursing home level of care for people at home. So that program really keeps us busy. And we’re always looking for staffing for that,” she said.

Being a personal care attendant may not require a degree, but according to Demars, the role does demand a certain sense of community service.

“If somebody comes in and they really just want to help take care of elders, it’s kind of a calling,” Demars said. “It feels like you want to love your elders and you want to spend time with them. Those are the kinds of people that come through our door. Some of them are retired from other jobs and they want to work 10 hours a week doing something, and others work 40 hours a week. So, we’re really flexible that way trying to accommodate school schedules and personal schedules, anything to make it work for patients and for our clients and for our staff.”

According to Monica White, commissioner of the Vermont Department of Disabilities, Aging, and Independent Living, some of the federal funds flowing into the state through the American Rescue Plan Act will be put toward funding the employment of more of these kinds of workers.

“We are just now evaluating the proposals received from the public, the suggestions to map out Vermont’s spending plan to support it and anticipate that there will be a significantly positive impact on our workforce through this American Rescue Plan Act funding, and we’re still working through what those particulars will be,” White said.

She also pointed to the Older Vermonters Act passed last year that codified into law a general commitment to provide necessary services for the state’s aging residents.

“While we’re an aging state, that isn’t a doom and gloom or crisis scenario,” she said. “We’re focusing on the healthy aspects of aging. We’re working on a number of initiatives to bolster our direct care workforce.”

Filling the gaps

Though Lamoille Home Health and Hospice is hiring out of surging demand and Copley Hospital claimed they were adequately staffed with both local and traveling nurses, a shortage of health care workers in the county still needs to be addressed.

Data from the first part of 2021 from the Vermont Department of Labor shows that Lamoille County has 68 fewer health care workers than a year earlier.

Because Lamoille County has such a small number of health care employers, data that would indicate what part of the industry had lost most of these workers was not available.

Though Demars said she’s fully staffed with occupational therapists and other long-term, at-home rehabilitation specialists now, Lori Profota, chief nursing officer at Copley Hospital, noted that she was having trouble placing patients in the right rehabilitation facilities to meet their needs.

“We do have challenges finding long-term and short-term rehabilitation placements for our patients who need to be discharged from the hospital. And we stay in close communication with all our long-term care facilities across our region, our service area, region and state in trying to place our patients in the right place at the right time,” she said.

Lamoille Home Health and Hospice works closely with Copley, a partnership that Demars credits with helping the health care provider avoid staffing issues that might arise otherwise.

“We’d all like to see more nurses cycled through everywhere. Everybody needs more nurses. I mean, we’ve been lucky. We work with Copley. The nurses that do a rotation over there also come through home health into a rotation here, because we want to expose them to as many aspects of nursing as we possibly can.”

Demars would like to see more tuition reimbursement for nursing degrees, something that’s already happening at some state colleges for certain programs. She also highlighted that she’s hired two young graduate nurses to apprentice under more experienced nurses.

“It’s been nice to have some young nurses. It’s been nice to see the older, more seasoned nurses taking them under their wing and really teach them how to be really good nurses because at home, you’re by yourself. You can’t holler out the door to get some help,” she said.

Anything that can be done to bring young nurses into this branch of nursing is crucial. The same fact of aging Vermonters driving the demand for at-home care isn’t limited to only the patients.

“There’s just not enough and a lot of us are starting to age out, me included,” Demars said. “We just don’t have enough young nurses coming through at this point.”

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