As Workforce Shortage Looms, Family Caregivers Fill the Gap

Sep 18, 2018

Yolanda Ross is paid through Medicaid to take care of her son who has muscular dystrophy.
Credit Kate Thompson

Maly Moore has been taking care of her aging mother since 2010, and it’s been a struggle financially. She couldn’t hold down a job.

So she thought: what if she could get paid to take care of her mother? In Virginia that’s possible. Moore took a personal care aide class and got some skills.

“This will allow me some time to connect with her again,” Moore says, getting emotional. “I’m really excited.”

Related: Read the Rest of the Series on Home Healthcare

Nationwide, hundreds of thousands of people get paid through Medicaid to take care of a family member. And as more people with disabilities seek care at home, and as the population ages, it’s a potential solution to a looming workforce shortage in homecare.

“This is Not a Strain...This is What I Do”

In their home just outside Richmond, Yolanda Ross kneels before her son - a bible in her hand.

“Durell is healed oh God,” she prays. “From the top of his head to the soles of his feet, God.’

Durell is 27 and has muscular dystrophy. His mother is his primary caregiver. Each day they pray together. Then she bathes him, lifting his small frame in her arms and carrying him to the shower.

Years ago Ross had been working as a legal secretary, a first generation college graduate who says she had big plans. But as her son got older and things became more difficult, those plans  changed.



What was most important to us was peace. And that our children had a peace of mind.

“My husband was led by the lord, and everybody may not believe, but that’s our belief, to tell me to come off of my job, because it was frustrating for me as a mother,” Ross recalls. “What was most important to us was peace. And that our children had a peace of mind.”  

She stressed some about the loss of income, but they decided they could make it work. She quit her job and became a full-time caregiver.

Then about five years ago Ross and her husband figured out that their son qualifies for in-home care paid through Medicaid. Suddenly, they could hire someone else to do the work.

As they considered their options, they struggled to find someone they could trust.

“Some of the people that we knew, most of them were already making what we make an hour. Way beyond that,” she says.

The people they trusted, who had medical experience, would have to take a major pay cut to help them out. They asked themselves: who else was willing to care for their son for 9 dollars an hour and no benefits? The list was short.

“That’s what I think comes from a parent,” Ross says. “Versus it could be a strain for somebody else. But this is not a strain. Because this is what I do.”  

‘People are Turning More to Their Loved Ones.”  

Credit Kate Thompson

Ross, and others like her, are able to be paid caregivers through a program called consumer direction.

The consumer-directed model allows the disabled and elderly to hire and fire their own caregivers, rather than working with an agency.  

When the program began in 2005 it had just 1,500 participants. Today there are 23,000. More than half of Medicaid recipients who get in home care in Virginia opt to use consumer direction.

It’s popular, and growing.

Virginia’s Department of Medical Assistant Services doesn’t keep track of how many participants hire a family member. But there are reasons to believe the rise of consumer direction also means more family members being paid to take care of family.

In California, 70-percent of consumer direction users hire a family member. In Massachusetts only 30-percent of users report not having a personal relationship with their caregiver.


Related: The Underpaid and Overlooked Workforce that Cares for Virginia

Karen Kimsey is Chief Deputy at DMAS. She says that here in Virginia, at least anecdotally, she’s heard of more parents opting to take care of their disabled children.

She says that as the home healthcare workforce shrinks people are starting to think out of the box.  

“It could be just a natural evolution that we’re seeing and the lack of available caregivers that people are turning more to their loved ones to provide that support,” says Kimsey.

And as consumer direction has grown in Virginia, Kimsey says there’s been a corresponding decrease in long-term institutionalization, like nursing homes. For state taxpayers that translates to savings.

Not to mention better care.

“People are happier. They thrive. And they don’t just sit at home,” Kimsey says. “They work, they go to school. They participate in activities. They go to church. They’re just active vibrant members in society, and we want them to be.”


Catch up on other stories in the series here.