SIOUX CITY, Iowa (AP) — When they married 31 years ago, Dave Johnson joked that someday his younger wife, Alicia, would be pushing him around in a wheelchair.
The 66-year-old Sioux City man never thought he would instead be taking care of Alicia Johnson, 53, who suffers from congestive heart failure, chronic obstructive pulmonary disease, asthma and diabetes. Sometimes her asthma attacks are so severe that she passes out. She was hospitalized nine times last year.
Dave Johnson shuttles his wife to doctor appointments, helps administer her breathing treatments every four hours, cooks meals and cleans the one-and-a-half story Leeds home they put on the market to cover the cost of medical bills.
A year ago, the couple began receiving help from nurses and home health aides provided through Hospice of Siouxland's Palliative Care program.
"They're like our right arm. We've called them for everything," Alicia Johnson told the Sioux City Journal (http://bit.ly/1hLATG9).
Their story is not unique.
Director Linda Todd said Hospice of Siouxland tries to fill the gaps in health care delivery that exist in the community. As baby boomers age and numerous home health aides and nurses in their 50s and 60s retire, Todd said, the demand for paid caregivers will only increase.
By 2020 Iowa will need 95,000 paid caregivers. The average annual turnover rate for the profession in the state is more than 60 percent, according to the Iowa CareGivers Association. The organization founded by Di Findley, a 13-year nurse aide, estimates that to keep up with the turnover, Iowa employers spent $193 million to recruit and train new staff in 2012.
"It's been a pretty invisible workforce," Findley said. "It doesn't matter if you've been working in this field for a year or even 40 years, they're still viewed as entry-level workers, and that's just not right."
Encouraging people to join the caregiver workforce can be a hard sell. Ninety percent of caregivers in Iowa are women who earn between $9 and $11 an hour. Twenty-five percent of them don't have health insurance, according to Findley.
The job involves frequent bending and lifting and has one of the highest rates of occupational injury, particularly to the low back. In-home paid caregivers in rural areas drive long distances to reach clients' homes, and those working in long-term care facilities often tend to a high number of patients.
Doris Shoultz, who has worked for Hospice of Siouxland since 1991, said the occupation also takes an emotional toll.
"Some of the hardest things are having people die of your age and younger," she said. "It's just very heartbreaking to see the emotional struggles of their families and their friends."
As the health care system focuses on prevention and wellness rather than sickness and disease, more people are planning to spend their golden years in their own homes.
Last summer, surgeons at Mercy Medical Center amputated Gary Kelley's left leg. The 66-year-old spent three months at Holy Spirit Retirement Home before returning to his handicapped accessible condo on the city's east side. Mercy Home Care provided wound care and antibiotic infusions until his wife, Helen, 72, could take over. Without assistance, Kelley said he doesn't think he would be able to remain in his home. He developed an infection after surgery.
"Because of the extensive wound I had, if I came home they didn't think my wife could take care of it," he said. "At that time I don't think that she would because it was quite large."
Medicare no longer pays for the days patients spend in a hospital that aren't medically necessary. If patients' needs go unmet after they're discharged, they'll end up back at the emergency room.
"We see people coming out of the hospital who are very sick. Huge needs. Lots of needs," Todd said.
Jane Arnold, vice president of operations for UnityPoint at Home, a company that provides a wide range of home care services in Siouxland, said the biggest challenge facing the health care industry is shifting resources from hospitals and long-term care facilitates into the home.
"Historically (home care) has been a smaller portion of it," she said. "Now it's becoming a larger focus within the health care system and with the changes with the Affordable Care Act."
UnityPoint at Home, Arnold said, is partnering with St. Luke's College to give nursing students an opportunity to spend time training in the home environment. Mike Stiles, the college's chancellor, said he doesn't think hospitals will struggle to find certified nursing assistants and nurses in the near future as much as home care companies will.
"I think there will be a lot more care provided in places and settings other than the hospitals, and that's where we're going to have shortages, particularly because the skill sets that are necessary haven't been fully determined yet," he said. "I think the landscape is going to be changing drastically in the next decade — more emphasis on the physician level, more emphasis on primary care, and less emphasis on specialty care."
Chris Severson, assistant administrator at Holy Spirit Retirement Home, said she isn't concerned about a potential paid caregiver shortage. The long-term care facility on the city's west side is a teaching facility that trains Briar Cliff University and Western Iowa Tech Community College students.
"They get experience for geriatrics, and that fulfills their commitment to their education," she said. "Fortunately for us, we have nurses that come back and apply here because they like the environment."
Findley thinks allowing paid caregivers to specialize and receive training in areas such as dementia, Alzheimer's disease and autism will draw more people to the field.
"People who enter it for the right reasons find it very rewarding," she said. "It's the toughest job you'll ever love."
Information from: Sioux City Journal, http://www.siouxcityjournal.com