Samantha Brown knows there is a need for more home care workers.
She has been a certified home care provider for more than 15 years, and, in that time, she has learned that it takes a special level of compassion and sacrifice to do this kind of work.
"With Mrs. Jean, it's 24/7, so I'm here a lot," she said about one of her oldest clients, 91-year-old Mount Pleasant resident Jean Wier.
Back in 2003, the U.S. Department of Health and Human Services estimated that the number of people using all forms of long-term care services would double from 15 million in 2000 to 27 million in 2050. The department cited the increasing demands of an aging baby boomer generation as one of the main causes.
But patients who require home care aren't limited to the elderly. Millions of children with complex medical needs and adults with various disabilities also rely on trained professionals to care for them in their homes. And shortages of these skilled workers have created a supply-and-demand problem.
BAYADA Home Health Care, a national home care provider agency, has found that only 10 percent of registered nurses and 25 percent of licensed practical nurses in South Carolina are interested in home care. And in 2016, the Centers for Disease Control and Prevention reported that in five areas of long-term care, more than 8 million people were receiving services from over 65,000 providers. That's one provider for about every 123 patients in need.
Brown said providers have to become accustomed to lengthy schedules.
"You have to have patience," she said.
Brown decided to branch off and create her own home care company, Faithful Companion Home Care, in May. Her motivation behind doing it, she said, was that she felt like the companies she had worked with didn't have the same drive that she had.
"They weren't as passionate," she said. "I was like, 'I can do this myself.'"
Though now she works with patients with private insurance, Brown is currently applying to care for Medicaid and Medicare patients, too. She hopes it will allow her to expand her business to reach patients of all ages with disabilities, an area that is in need of more providers in South Carolina.
The hardest part
On the other side of the Lowcountry, Summerville resident Stefanie Rough and her family have been struggling to secure home care for her 18-month-old son Mason.
"He needs 24-hour care," Rough said.
Mason was born with a rare genetic disorder called Chromosome 7 deletion. He struggles with paralysis of the vocal cords. He also requires the use of a trach to breath and a gastrostomy tube (G-tube) for nutrition.
Because of this, Mason cannot enroll in an regular daycare. He requires special care. When he was born, Rough said she had to take five additional months off work. She also applied for registered nursing services through the Medicaid Medically Complex Children's waiver.
“I honestly thought the hardest part would just be getting him qualified for it," she said.
Mason qualifies for 100 hours of nursing services through the waiver per week, but the most they've been able to secure in a week since Mason was born was 60 hours. Lately, it's been 20 hours a week, she said.
“And we need 50 (hours) so my husband and I can still work," she said.
Anytime she takes Mason to a medical appointment, there has to be an additional person in the car with her caring for Mason. He also gets six tube feeds for his G-tube.
The main issue for them with getting the needed service hours is securing a nurse who is willing to take lower pay than he or she would get at a hospital or facility setting. Most of the nurses that they do get connected with leave for higher paying positions.
“Some nurses we’ve only had for two weeks," she said.
Melissa Allman, the director of government affairs for BAYADA Home Health Care, said in South Carolina the Medicaid reimbursement rates for home health agencies haven't been raised in more than a decade. Nurses can typically make more working in other locations like schools, hospitals and doctor's offices.
“The cost of living wasn’t as high in 2008," Allman said. "We’re not able to cover all the authorized hours.”
The hope now, Allman said, is that a rate increase would attract more nurses and providers into the much-needed career field.
"It is a very big need," Brown said.
The S.C. Department of Health and Human Services, the entity that oversees the states Medicaid program, has been currently reviewing Medicaid reimbursement rates for a variety of services.
"As a result of the review, SCDHHS believes a rate increase for private duty nursing services is warranted and has proposed a rate increase in its annual budget request," said Colleen Mullis, a spokeswoman for the department.
'That's what we're here for'
Brown has worked with elderly patients since she was a 12-year-old girl sitting with residents in her neighborhood. She has specifically worked with her client Wier since January after Wier's children reached out to her about being her home care provider since they didn't live in the city.
Since then, Brown has worked with Wier as a 24/7 care companion.
If Brown isn't there, one of Brown's employees is there with Wier. She helps her with medication, mobility and getting lunch and dinner. She takes her to her hair appointment every Thursday. She does puzzles with her and helps her with physical therapy.
During the hurricane season this year, Wier even stayed with Brown at her home for a week so that she could help her during the storm.
She also plans on spending Christmas with Wier.
"That's what we're here for," she said.
Ultimately, her goal with Faithful Companion Home Care is to make sure that the people they serve have a companion and are not just sitting somewhere alone. That's 80 percent of what they do, she said.
In her experience, the job can be very demanding and requires a lot of compassion. When people are interested in doing this type of work, she tries to emphasize to them that schedule flexibility is a little difficult when dealing with someone who needs consistent care.
"We do everything that her kids are not able to do," Brown said.