Senior centers, providing in-home care to elderly, struggling amid West Virginia Medicaid troubles

Ebony Moore, 48, is a direct care worker in Charleston who helps elderly residents live independently in their homes. (Amelia Ferrell Knisely | West Virginia Watch)

Ebony Moore has been an in-home caregiver for elderly residents in Kanawha County for 17 years.

It isn’t a job that pays a lot, she said, but for her, it has always been a passion.

“It originated from me taking care of my family — my grandmother, my aunties,” said Moore, 48, who lives in Charleston. “You have to have a heart and passion for it.”

West Virginia uses state and federal money from Medicaid to reimburse county senior centers and private companies that employ direct care workers who help low-income elderly residents remain in their home. The service helps elderly people from going into a nursing home.

Direct care workers can help elderly persons with dressing, using the restroom and running errands, like shopping for groceries.

“If we don’t go and take them, then a lot of time they’re confined to the home if they don’t have family,” Moore said. “Sometimes it’s the light of their day when they see us coming.”

West Virginia’s Medicaid reimbursement rate, which is used to help pay direct care workers’ salaries, is well below other states. While the issue has been top of mind this year for many state lawmakers and officials, including Gov. Jim Justice, it still hasn’t been dealt with, continuing a direct care worker shortage for senior centers and private companies .

Caregivers currently earn around $11 an hour.

“This is the worst it’s been. We can’t get any workers when McDonald’s is right across the road and can pay more,” said Sally Mathess, who has served as director of the Gilmer County Senior Center for 15 years.

Her center serves around 80 seniors. “We could do more if we had more workers,” she said.

Lawmakers have left the Medicaid reimbursement rate decision in the hands of the state Department of Human Services. Department leaders said they’re considering an increase for Oct 1.

The agency has the money to fund it. Communications Director Whitney Wetzel said there appeared to be an “ approximately $130 million available for carryover to FY 2025” in Medicaid and Medicare funds. It is 2.6% of the original projected budget for the agency.

“Any rate increases would be covered using appropriated funds,” Wetzel said in an email.

While Justice teased a possible announcement of a rate increase later this year, the question about whether it will happen and how much it could be has continued to be a concern in one of the nation’s most elderly states .

“Without an adequate rate increase it’s going to be impossible to continue to provide these services we’re doing right now,” said Jack Tanner, executive director of the Raleigh County Commission on Aging, which serves as the senior center. “We’ve gone a long time without any additional help to maintain these services. We’re talking about a frail group of folks who desperately need our help.”

‘The challenge just increases every day.’

Senior centers in many countries are a hub of help for elderly residents — hot meal programs, transportation services and more. Many are serving more people since the COVID-19 pandemic.

“With our programs, senior centers offer a continuum of care. We put all of our funds into providing a wide range of services,” said Jennifer Brown, president of the Directors of Seniors and Community Services.

With budgets strained due to inflation, directors have struggled to find money in their own budgets to raise pay rates and retain staff who serve seniors through the Medicaid Aged and Disabled Waiver Program (ADW). They also use Medicaid dollars to help pay for federally- mandated Electronic Visit Verification , which requires technology and staff to track in-home visits by providers in an effort to combat Medicaid fraud.

“The staff in the field have a very demanding job that requires a certain set of skills, and it requires that we are able to be competitive in hiring and keeping employees,” said Tanner, who has been in his role for 23 years. His senior center, based in Beckley, employs 230 in-home caregivers.

“The turnover rate we’re expecting because of the lack of the ability to be competitive in salaries is very difficult to deal with. The rates that currently exist are not adequate,” he said. “The challenge just increases every day.”

Some senior centers have tried to raise their own rates to keep employees. Moore noted her employer in Kanawha County has always done its best to take care of her.

Brown said that state Medicaid leaders should fund the rate increase. A 2023 study — paid for by state dollars — said West Virginia needed to increase its rate of reimbursement and the worker salary range to $15.50-$18.60 per hour.

“We would love for them to have enough funding that they could raise everyone up to the rates in that study. It would provide care to everyone who needs it and better quality care,” she said.

In May, state lawmakers gave DoHS roughly $180 million in reserve funds that could be used for the Medicaid rate increase. The Senate declined to force DoHS to use the money on increase, saying the department already had the funds to do it. They’d recently learned that DoHS had spent millions of dollars that could have been used on the rate increase on things like in-home COVID-19 tests and contract nursing salaries.

Wetzel said that DoHS leadership have been in conversations with representatives from the Home Care Association of West Virginia, the state’s Directors of Senior and Community Services and others to discuss the rate increase issue.

“As a reminder, DoHS granted providers $281 million using American Rescue Plan Act (ARPA) funds and they have until March 2025 to spend those dollars,” she said.

Scott Mallery, executive director of Aging and Family Services in Mineral County, said he bumped up direct care worker pay with ARPA money.

“We hoped we could continue it into the future. Even though that money has gone away, we are still $2 higher than we were before COVID, but we’re struggling to maintain those rates,” Mallery said.

He added, “A lot of times, the senior centers feel like we’re out there by ourselves doing this thankless job and doing it without support from the state or the Legislature.”

The inaction on the Medicaid rate increase has led some private employers, grappling with profit losses, to lay off direct care workers who help elderly residents.

Direct care workers also help people with intellectual and developmental disabilities receive assistance eating, dressing and more in their homes and home-like settings. Earlier this month, the director of homes for people with disabilities in Martinsbrug announced he was closing due to the low Medicaid rates and ongoing staffing crisis. it could force some residents into state psychiatric hospitals who shouldn’t be there.

Connecting potential rate increase to worker salaries

Gaylene Miller, state director of AARP-West Virginia, felt confident that a Medicaid reimbursement rate increase would happen. She emphasized that DoHS should require senior centers and private companies to use 85% of the funds on workers’ salaries.

“I don’t know where we’re going to land, but we want to make sure there’s some type of direct care [worker] pass through,” she said.

Del. Evan Worrell, R-Cabell, owns a private company that employs direct care workers. “I am committed to passing rate increases to caregiver pay,” he said. “It is still a big struggle to find people to come into this line of work,  and it’s hard to pay them more with this rate.”

While Worrell also felt confident that DoHS would increase the rate this October, he worried about the amount.

“They have the money to do it and do it right. I am fearful they are going to give us some crumbs,” he said.

Senior center directors interviewed for this story all noted that, ultimately, the money was an investment in helping seniors stay in their homes. It would cost the state more to pay for their nursing home care, they noted.

“The people in West Virginia, the elderly, are born and raised here. They have a desire to stay in their homes,” Mallery said.

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