However, as the extent of her mother’s dementia became clearer, Chiha had concerns. “She was very confused in my house and there was no one to help me. I couldn’t leave her alone and I began to panic. I realized that she would need more care than I could give her. “

For Chiha, the answer was to hire a home nursing assistant at a local agency to cover a few hours three days a week.

As more seniors or their families face similar dilemmas, demand is beginning to outweigh supply – and home health officials struggle to keep up.

Dave Tasto, president of Assisting Hands Home Care in Bedford, sees numerous situations like Chiha where a family pulled a senior out of a group during the pandemic. Add to the demand that hospitals place more emphasis on getting patients home quickly. Previously, the same patients may have stayed longer or gone into rehab.

“As hospitals discharge patients earlier, those patients need more support at home and sometimes support is more complex,” said Tasto.

Housekeeper Tricia Gagnon helps her client Al Wolfe play a word game in his Peabody house.
Jessica Rinaldi / Globe Staff

According to Patricia Kelleher, executive director of the Massachusetts Home Care Alliance, the hourly rate that Greater Boston customers pay for non-medical home health care is typically between $ 29 and $ 33. The costs are usually paid out of pocket unless consumers have long-term care insurance. Medicare and Medicaid only cover home health services when it is considered medically necessary.

AARP and other advocacy organizations are currently trying to find more federal funding for these services, as is President Biden Plan for Older Americans, released last fall, expressed an intention to expand Medicaid to include home care.

However, for those who can manage the expense, these services can make it possible to keep a loved one at home.

The need arose for Sherry Seaver of Concord when her husband, Bill, suffered a serious heart event shortly before his 77th birthday in August. Although it has taken time and effort, over the past few months she has managed to assemble a team of regular health workers to cover the hours when she needs help most. Still, the extra precautions needed during a pandemic have made the situation far more difficult than it imagined a year ago.

“I know all of our regular caregivers and I feel good when I ask them about their security measures, such as how many people they would vacation with,” Seaver said. “But if any of them get sick or have to be quarantined and someone new walks in, I have to start all my worries again.”

Housekeeper Tricia Gagnon stabilizes her client Al Wolfe while he works out in his Peabody house.
Housekeeper Tricia Gagnon stabilizes her client Al Wolfe while he works out in his Peabody house.
Jessica Rinaldi / Globe Staff

“As an industry in Massachusetts, prior to the pandemic, we were about 20 percent underemployed to meet demand,” said Jim Reynolds, CEO of Connected Home Care with offices in Burlington, Malden, Concord, Framingham, Peabody. Gloucester and Waltham. “And then this tsunami hit. Demand has increased and we have carers who cannot work because they do not want to get sick or because they have already been exposed, or because they have their own family needs. If you’re making $ 15 an hour and there are two or three kids in virtual school, you won’t keep working. “

As they saw the general unemployment rate rise in Massachusetts, Reynolds and his team wondered if there was a creative way to fill that void – perhaps by attracting some of the laid-off workers.

In response, Connected Home Care recently launched a major training initiative that combines online and personal elements and offers certificates in three levels of care. “We hope to attract people who are interested in learning new things and acquiring new skills,” said Nancy Johnson, director of HR / strategy for connected home care.

Kelly Magee Wright, executive director of Minuteman Senior Services, which contracts home care agencies with agencies in communities north and west of Boston, sees this as a bigger problem for the profession.

“We really need to look at the structures in place and make the necessary investments, starting with supporting wages for the direct caregivers,” Wright said. “Raising the minimum wage will help, but it’s a national challenge. We need to seize the opportunities to help direct caregivers see this as a career path. “

According to the US Bureau of Labor Statistics, the national median annual salary for a household helper in 2019 was $ 25,280, or about $ 12.15 an hour.

Even as home helpers got involved in Phase 1 of state vaccination, the pandemic has changed the way they do their jobs.

“I think we’ve lost some of the closeness we used to have with our customers,” said Alexandria Nakato Owuma, a certified nursing assistant who works with seniors in Somerville, Burlington and Newton. “You have no chance of creating the camaraderie that would otherwise have enabled you to exercise extraordinary care.”

“A lot of my work is not just personal care, but social interaction as well,” said Tricia Gagnon, a domestic help on the north coast. “It can be quite challenging when you’re wearing a mask. Not to mention some of my clients are hard of hearing and rely on lip reading. “

One of the clients Gagnon supports is Alfred Wolfe of Peabody. He has had home health care since he was diagnosed with dementia a decade ago, but when the adult daycare he attended twice a week was closed last spring due to the pandemic, their presence became even more important – not just for practical tasks like bathing, but also to keep his mind occupied with games, exercises, and walks outdoors.

According to Wolfe’s wife Phyllis, a long and trusting relationship with a consistent team of caregivers kept her from worrying more about the pandemic than she needed to be. “I know the agency tests them regularly and they are all very careful,” she said. “They are like family to us.”

“This is a sensitive business,” said Molly Rowe, co-owner with her husband of FirstLight Home Care on the north coast. “Our customers want you to hold their hand, rub your back and see your smile. It’s very difficult to operate when we’re trying to keep six feet apart. “

It’s bad enough for customers who understand the limitations, Rowe said; It’s much worse with those who may not. “When you take a patient with dementia and you show up wearing a mask, it becomes really scary. When you have a client who relies on lip reading and screams behind a mask three feet away, it’s frustrating for both us and them. “

Though she initially had high hopes for necessity innovations like clear masks, Rowe said the reality hadn’t yet come up.

Ultimately, as Reynolds of Connected Home Care points out, any progress that can be made now is an investment in the future. “Infectious disease experts have long known that one event like this is about to happen and another will happen,” he said. “It couldn’t be for another 20 years and it could be in three years. But we need to use what we know now to prepare for the next time. “

Nancy Shohet West can be contacted at [email protected].

Housekeeper Tricia Gagnon reads with her client Al Wolfe in his Peabody home.
Housekeeper Tricia Gagnon reads with her client Al Wolfe in his Peabody home.

Jessica Rinaldi / Globe Staff