Mass. facing shortages of home health aides and doctors for people with Alzheimer's

Massachusetts will need to find another 30,000 home health aides and personal care aides to support the increase in Alzheimer’s patients expected by the end of the decade, according to the latest yearly report from the Alzheimer’s Association released Wednesday.

The latest data show there are about 110,000 home health aides and personal care aides in the state, and about twice as many unpaid caregivers supporting this growing population. Jim Wessler, the CEO for the Massachusetts/New Hampshire chapter of the Alzheimer's Association, said that almost 30% increased need for aides by 2030 comes on top of a current staffing shortage exacerbated by the COVID-19 pandemic, when a number of long-term care workers left the profession.

“Some of them just decided, ‘I'm not going to do this anymore,’ because it was just too overwhelming, and they have their own families they have to take care of,” Wessler said. “So we have critical shortages today in nursing homes and assisted living. And we see that with hospitals having patients backed up that they can't place in long-term care facilities because long-term care facilities don't have beds, because they don't have enough staffing.”

The report also projects that by 2050, Massachusetts will need 1,042 geriatricians — primary care doctors with additional specialized training to treat older patients — to serve 30% of its residents who will be 65 and older, regardless of whether they have dementia or not. At last count in 2021, there were only 214 geriatricians in the state.

Wessler added that, right now, Massachusetts is facing “a really dramatic shortage of specialists like neurologists and geriatricians in particular.”

Anastasia Canell, a doctoral candidate in counseling psychology with a focus in geriatrics at Lehigh University who is doing her residency in Massachusetts, recognizes the need for more specialists from her own experiences. Her grandmother had risk factors for vascular dementia but was not diagnosed until after the family noticed behavioral changes and contacted a neurologist. Now she wants to normalize the process for other families.

“I honestly think about that every time before I go into a room with the family,” said Canell, who also does legislative advocacy work with the Alzheimer’s Association in the state. “I think about what would my family have needed in this moment? What would my family have benefited from? What kind of person would make this experience more comfortable?”

Wessler said addressing the doctor shortage is particularly urgent with the recent accelerated approval by the FDA in January of lecanemab, only the second drug the agency has approved to treat Alzheimer’s. If the medication is approved for Medicare coverage, doctors anticipate a rush in demand. Wessler said the Massachusetts/New Hampshire chapter of the Alzheimer’s Association has a medical scientific advisory committee of specialists, including geriatricians, neurologists, neuropsychologists, from most of the major teaching hospitals in the state who have been meeting to prepare.

“How are they going to handle what they anticipate will be an influx of demand for people to know if they're eligible for the treatment?” Wessler said. “And then another part of that is, how are we making sure that there is equity involved with this so that underserved communities are also getting access to the latest in treatment?”

Wessler said equity is deeply embedded in diagnosis, treatment and outcomes with regard to Alzheimer’s. He said national statistics show that African American people are twice as likely to get Alzheimer's and dementia as white people, and that Latino people are about one and a half times more likely to be diagnosed. He added that some of that increased risk is correlated to the disproportionate impact of heart disease in those communities.

In Massachusetts, Wessler said his organization is working with several Community Health Centers to increase access to specialists, care aides and treatment for people of color and those with lower incomes.

Equity is also an issue when it comes to meeting the projected needed increase of tens of thousands of care aides in Massachusetts.

Marlishia Aho is the regional communications manager of 1199SEIU United Healthcare Workers East, a union representing over 80,000 health care and home care workers in the state. She echoed Wessler’s perspective on the effects of the pandemic on the shortage of care workers

“It has only exacerbated the shortage,” Aho said. “Prior to the pandemic, we have seen that certified nursing aides were leaving the field because they were — as majority women, and women of color and immigrants who weren't paid fairly — seen as essential, but their wages and benefits didn’t mirror that.”

Aho said, as of April 1, 58,000 personal care attendants they represent who are paid through MassHealth, the state’s Medicaid program, will be making $18 an hour, which works out to less than $38,000 a year. And she said, with the healthcare industry “just churning through workers,” she’s skeptical that finding another 30,000 care aides to enter the field by 2030 is a reachable goal.

“Is it feasible? Not where we are currently,” Aho said. “Not with the wages we are providing to caregivers, but if we continue to invest in caregivers and listen to them, ensure they have a seat at the table, I think it is doable. But we have to value these roles because they are essential.”

Aho added that recruiting and retaining care aides for those with dementia has a multiplying effect.

“They allow other work to happen. So if I have someone caring for my elderly father, I am able to go out into the world and work. And so we have to think about it makes other work possible.”