As 'gray wave' washes over Montana, caregivers become hard to find

With old age comes the need for more care, but Montana is short hundreds of in-home and respite caregivers while simultaneously leading the West in the silver wave.

About 20% of Montana’s population is over age 65, higher than any other western state, according to the Population Reference Bureau.

And Montanans are more inclined to age at home with every passing year. Montana AARP surveys showed that about 85% of residents would prefer to age at home while nationally about 77% of those over 50 years old preferred to age at home, according to Mike Batista with Montana AARP.

This cultural shift only intensified when COVID sent long-term care facilities into lockdown and the elderly in congregate living bore the early tragedies of the pandemic.

When Ross moved from her Reno, Nevada, home to Billings, she was living in a retirement community with memory care. But when COVID hit she couldn’t remember why her daughter, Kristi Drake, stopped visiting her. Once Ross’ caregiver was exposed to the virus, Drake made the decision to move her mother out of the facility.

Drake and Ross pooled their resources to buy a new home with a detached cottage where they both could live, but it needed renovations and Ross needed more care than Drake could provide.

“It was so much pressure. I was in a big depression for about a year and a half…it was constant guilt because I wasn’t spending enough time with her. I couldn’t do my job 100%. I felt like I wasn’t doing anything at 100%,” Drake said.

Finding a caregiver

Over the course of about 18 months, Drake tried caregiving agencies, she contacted the director of the CNA school and a professor at the MSUB College of Nursing. She asked friends, posted ads and asked doctors and nurses for advice when she went in for appointments. And still, not a single caregiver bubbled to the surface.

The agency workers were inconsistent, canceling often and rarely the same person would come to care for Ross, which was difficult with her dementia.

“I just needed somebody and it was nothing, nothing, nothing for months and months and months,” Drake said.

Finally, Drake found a caregiver on Care.com who was a perfect match for her mother. She has all the qualities needed for memory care and she quickly developed a rapport with Ross.

“She’s there all the time… I have a picture of her up on my mom’s wall…but I was almost abusing my time with this caregiver,” Drake said. So she started the search again to find a second person to work part time.

When a promising applicant came along, Drake found out during the interview process that they were not vaccinated for COVID-19.

“How can you apply for a job as a caregiver for an elderly person, the most vulnerable population, in the middle of a pandemic (and not be vaccinated)?” Drake asked.

It then occurred to Drake that she didn’t know the vaccination status of the person who had been caring for her mother for months.

When Drake got home, she found out she had wrongfully assumed her mother’s caregiver was vaccinated.

But there are no other options. With no replacement, Drake has kept her on as her mother's caregiver. But Drake often struggles to come to terms with the situation.

“I don’t have a choice. I guess the only way I can even begin to reconcile it…I could just say that my mom has lived a really good life and she’s in the happiest place she can be in. I’ve done everything I can to try to keep her safe and if something happens to her,” Drake said, trailing off. “I don’t know what else to do.”

Juggling career, family

When Drake began caring for her mother she was faced with two options: quit her job and jeopardize her retirement, or find a caregiver.

Drake is the executive director of Billings TrailNet, a non-profit that works to bring walking and biking trails to the city. Her goal is to provide a place for families to spend time together and create opportunities to connect with others.

It’s clear that Drake loves her job, and she’s only about nine years into her career.

When Drake was in her 20s and 30s she was primarily a mother, caring for her two daughters. Once she raised her children, Drake enrolled at MSUB to earn a master’s degree in public relations. She graduated in 2012 and began working for United Way in substance abuse and prevention.

“After I raised my kids, I had this blip in time where I could do my own thing, and that was maybe six or seven years,” Drake said, whose mother moved to Billings about two years ago. “And then I got my mom (to care for).”

Nationally, about 43 million Americans are providing care for a family member, and more often than not, the caregiving role falls to women, according to the Family Caregiver Alliance.

"Women are the ones having to make the choice of leaving the workforce,” said Susan Kohler, CEO of Missoula Aging Services.

And when a loved one takes on the caregiving role, there is no financial compensation, meaning about $470 billion worth of unpaid caregiving is taking place in the U.S., Kohler said.

But hiring a caregiver can be financially limiting with agency rates starting around $25 an hour and climbing to $40 or more.

“If you have the resources, great. But many don’t,” Kohler said. “It’s horrifying to feel that you can’t provide support. They don’t have money to pay and they have to work.”

The Medicaid reimbursement rate, which is limited to very low-income individuals, “doesn’t speak to the work that has to get done,” Kohler said, adding that the state needs affordable caregivers and a way to offer a professional wage to workers.

The tendrils of the health care workforce shortage continue to stretch down through health services and have left Kohler to manage a waitlist of about 50 to 60 people in need of in-home or respite care in Missoula County.

St. John’s United has stopped marketing its At Home program, which offers in-home support for elderly in the community as well as the residents of its retirement community, because there aren’t enough caregivers, according to manager Sarah Schroefel.

St. John’s even offers certified nursing assistant training upon hire, but still no one is applying. Some positions have been advertised for 120 days.

“We’re not able to meet the demand. We would be serving more people if we could,” Schroefel said.

Some Yellowstone County residents are utilizing in-home care services because there is no available bed space in assisted living or skilled nursing facilities, said Sue Bailey, program director at Adult Resource Alliance of Yellowstone County.

And in rural communities, formal caregiving is even more difficult to come by.

Eastern Montana

Traditionally, churches that provide wrap-around services, a strong cultural sense of community and generational connectedness have been the modes of caregiving in rural places, according to Kohler.

But families have to do their own caregiving in Eastern Montana, said Heather Handran, program director of Area I Agency on Aging. There simply aren’t people in the 17 counties that fall under Area I to provide caregiving services.

“I’m aware there’s a need, but we just can’t provide it. There’s nobody here to do it,” Handran said.

A lack of services often forces elderly to go without assistance longer than they should, leading them to dangerous situations that could land them in a skilled nursing facility, said Bailey.

“(Caregiving) is a really hard job. You’re their lifeline to the community and the community doesn’t recognize the value” Bailey said. “We don’t have the same reverence for the elderly as we do for young people.”

Bailey and her counterparts call for more recognition for those in the field and a wage that reflects professionalism. 

The huge demand for aging services in rural Montana is only expected to grow, said Batista with Montana AARP.

“We have a long history in Montana of doing things the way we’ve always done it,” Batista said. “These are issues that require a shift in philosophy. Institutional care isn’t the best option for some people…The state needs to develop a vision for the future.”