High gas prices crimping rural health care

Bigfork area especially hard-hit in the Flathead

By ALEX STRICKLAND / Bigfork Eagle

In a line of work that practically requires a big heart as a prerequisite, there's an increasing demand for another quality for in-home health care workers: a big wallet.

With fuel prices hovering around $4 per gallon in the Flathead Valley, area health care providers are reporting a dwindling staff and shrinking coverage as employees are driven to find higher paying work.

"Health care workers are going into different fields with more money and less travel," said A Plus Health Care Branch Director Michelle Christensen. "What are we doing? What are we saying to these people? You subsidize the government."

The subsidy Christensen is referring to is the Medicaid reimbursement her company gets for health care assistants' mileage: 25 cents per mile. That rate, not even half of the new federal mileage rate of 58.5 cents per mile, is low enough that workers are paying out of their pocket to fill their tanks when shuttling clients to and from doctors appointments or trips to the grocery store.

"Who suffers? The people who just want to stay home and be independent," Christensen said, adding that keeping people at home rather than in hospitals or nursing homes is actually cheaper for the system overall.

For A Plus Health Care, based in Kalispell, it's much easier to serve clients in town because employees don't have to go far to reach them. But for clients in outlying communities, just the commute to reach a client's home can be daunting.

"The best thing is to find a caregiver in that community," Christensen said. "But Bigfork in particular has been really hard to find people."

Kim Nelson, a nurse supervisor at Personal Touch, another Kalispell-based health care provider, agreed.

"It's been dramatic over the last few months," she said of the falloff in caregivers.

"It's constantly an ebb and flow of caregivers and that takes a toll on a client," she said.

In-home health care workers provide all kinds of services for clients that are in good enough health to live alone, but not quite spry enough to take care of everything.

Duties range from helping people dress and bathe to preparing meals and taking them to doctors appointments.

"We are always trying to market for caregivers," Nelson said. "And there are some benefits, but most of the people who do this have a big heart. There are a lot of rewards in that regard."

But warm fuzzies don't pay the rent, and with wages at less than $10 per hour, caregivers have to scrimp to get by in the Flathead.

Christensen said in-home health care workers with her company make $9.35 an hour, not enough to survive in this valley according to one group.

The Northwest Federation of Community Organizers, a Seattle-based nonprofit, puts out an annual publication for Montana, Idaho, Oregon and Washington called the "Job Gap Report" that puts the minimum livable wage in Flathead County at $10.44 an hour in their most recent publication.

That disparity, compounded by the high cost of gas, led Christensen to write a letter to Richard Rough, the regional contact for the Montana Department of Public Health and Human Services' Senior and Long Term Care Services division in Kalispell.

"Barring a startling change in our current economic realities, we are on the verge of finding ourselves unable to care for our community members," she wrote in the letter dated June 18, 2008.

Speaking with the Eagle, Rough conceded that there is a great strain placed on caregivers by the escalating fuel prices, and that he is constantly working with people in his office to keep them apprised of the situation.

"It is pretty severe in Northwest Montana," he said.

Christensen said she has sent out pleas to area churches asking them to post notices on bulletin boards or forward e-mails in an attempt to find local people willing to take on a caregiver position.

"It's people caring for people," she said. "This really is a plea for help."

DPHHS Public Information Officer John Ebelt said that the state office is very clear about the concern stemming from the low mileage rate and the difficulties incurred by it.

"With rising costs of everything there are concerns all over the place, especially in rural parts of the state," he said. "Certainly our department is concerned about the rate, but no decisions have been made."

Until things change, local health care providers will continue to advertise for open positions and try to court community members who wouldn't have to travel to tend to a local client's needs.

"We're very dependent on the reimbursement rate," Nelson said. "There are lots of things in this business that are not reimbursed."

The DPHHS did institute a 2-cent raise, up from 23 cents per mile, on July 1 of this year.

"Caregivers, who have less money than anybody, get a raise of 2 cents," Nelson said. "A lot of caregivers can't afford to go to the doctor. There are a lot of ironies here."