Along Heather Grow’s daily drive to work, she passes three signs advertising open positions.
A McDonald’s poster along South Main Street: $15.50 an hour. A white lawn sign outside Concord Auto Spa: $17 an hour.
Most of the signs popped up recently, as businesses reopened to a dearth of young workers. To Grow, the signs didn’t seem like an innocuous symptom of a staffing shortage. They were a cruel reminder of all the places she could work and earn more money.
The last sign came a block before her final destination. Dunkin’ Donuts: $13 an hour.
“Ugh,” she said, rolling her eyes and pressing her head against the seat. “I just surpassed that.”
After 15 years of experience in the home care industry, Grow had recently started making $13.85 an hour, thanks to a modest bump in Medicaid reimbursements written into the state budget.
She belonged to an agency, Ascentria Care Alliance, that sent mostly middle-aged women to the homes of disabled or homebound Granite Staters to provide non-medical care. The job was often unglamorous — bathing, feeding and cleaning for her clients were some daily duties — but Grow loved it.
She loved sitting beside her clients and listening to their stories, a passion she developed at 6 years old when she insisted on visiting her elderly neighbors after school. She loved acting as a reprieve for exhausted family members who often told her they couldn’t live without her. She loved that she helped keep people in their homes, rather than a facility, with their family and belongings.
She didn’t love the pay.
In order to afford to live in Concord, she took on a slew of other jobs. She cleaned the homes of some close friends, delivered food on DoorDash and worked overnight shifts for a residential home.
Amy Moore, the director of in-home care at Ascentria, said this is common for her home care workers.
“Most of them have either a spouse to support them or they have another job,” she said.
In recent years, many home care workers left their jobs in search of higher wages, creating a vacuum of workers to provide vital care to the state’s elderly and disabled.
Deborah Ritcey, the CEO of Granite State Independent Living, a nonprofit that connects clients to home caregivers, said every week about 18,000 hours worth of requests for care go unanswered.
She said her clients are sometimes forced to choose which services are most important to them – often getting out of bed and getting dressed – while other requests, like help moving around during the day, are pushed to the wayside.
In these cases, family members or friends sometimes quit their jobs to serve as their loved one’s caregiver — about 70% of the caregivers at Ascentria fit this description. The other possible outcome, which Moore doesn’t like to think about, is they leave their homes to live in a long-term care facility well before that level of care is necessary.
To help fill some of the vacant positions, Ascentria hired a recruiter who asked Moore which agencies posed the greatest hiring competition.
“My competition is everyone,” she told him. “My competition is Dunkin’ Donuts. Frankly, my daughter is 13, and she can go babysit and make more.”
At 10:30 a.m., Grow crept into a dark bedroom, where Larry Taylor was fast asleep in a hospital bed next to the window. She laid out his clothes for the day — one pair of pants, a blue polo and two diapers.
Grow started caring for Taylor a year ago, when the 6-foot, 2-inch former broadcast engineer was well enough to make witty comments and stubbornly resist help using the restroom. Now, his late-stage dementia and Parkinson’s renders him immobile and aphasic.
Grow liked waking him up slowly to the sound of her preparing the room for the day.
She moved to the bed of Grace Taylor, Larry’s wife of 51 years, where she arranged the sheets and laid the quilt just so. She set a pair of fresh pajamas at the top of the bed, smoothed the pile, then replaced the pillow.
Technically, this is not in Grow’s job description. Neither is cleaning Grace’s bathroom or kneeling down to wrap her foot in a bandage, which she also dutifully did. Her Medicaid-reimbursed tasks are strictly to provide essential services to Larry.
Grow couldn’t help herself.
“When I love, I love big,” she said. “I struggle with the boundaries of helping.”
The Taylors live on a quaint cul de sac lined with gray and tan single-story homes. Grow fit perfectly into the tidy little home — she reached for ingredients in the pantry without looking. She knows which of the Taylors’ children were assigned to which ringtone, and she often chimed in with details about their lives when Grace drew a blank.
“I would love to live here,” Grow said, looking out at the kempt lawn and verdant backdrop of maple trees.
Grow lived with her best friend in a 2-bedroom attic unit of the house a block from the Concord YMCA.
At 40 years old, Grow didn’t want to share her apartment with a roommate. But when she or her best friend tried — and they both tried several times — to find units of their own, the listings were way out of budget.
Soon, the cost of their current apartment would be too much. Her building was sold in June to a new landlord, who increased rent from $950 to $1,360 a month.
Grow stretched her modest budget as far as it could go.
Sometimes, while helping clients empty their refrigerators, she stowed the discarded food at the top of the trash bag, so when she brought out the garbage she could pluck it off the top and bring it home.
When bringing groceries to a client in downtown Concord, she drove past the open parking spaces in front of the apartment complex to a garage a few blocks away, which is 50 cents cheaper.
Even though her agency reimbursed parking expenses, Grow noted those dollars don’t go back into her account until her paycheck arrives.
“Money can get tight,” she said.
Finding a new job that pays more — which at this point is most other jobs— would solve many of her problems.
Larry and Grace Taylor are the reason Grow won’t leave home caregiving. At least not yet.
“Before she came, I couldn’t even go grocery shopping,” Grace said. “Without her, I’d probably be at the mental hospital.”
With a sharp snap, Grow pulled on vinyl exam gloves in preparation for Larry’s morning bathroom trip and gingerly rubbed his chest.
“Laaaaarryyy,” she said. “Are you still dreamin’?”
A low gurgling sound came from the back of his throat – mucus that had dripped from his nose down into his esophagus while he slept.
Grace and Grow coaxed the liquid out with a nasal aspirator that resembled a small turkey baster, a glass of vinegar and essential oils until a navy blue dribble from yesterday’s blueberry cookies slid out the side of his mouth. Grow caught it in a towel and rolled him onto his side.
With knitted eyebrows and wringing hands, they agreed to let him sleep a bit longer.
Today there would be no shower, no playing with colorful wooden children’s toys in the living room, no arduous trips to and from the bathroom.
Grow kept busy mopping the floor, folding laundry and preparing snack trays until 12:15 — 15 minutes before her shift officially ended — when every surface had been scrubbed.
She started packing her things.
“I don’t want you to get short,” Grace said. “It’s already such a short week.”
For the first time in years, Grace was leaving for vacation to visit her son in Seattle. Larry would stay in a nursing home until she returned, leaving Grow with a 29-hour gap in her schedule and a $400 gap in her wallet. Grace worried about that.
Grow asked her boss for leads on other caretaking gigs but hadn’t heard back yet.
“I have no idea what’s going to happen,” she said.
Leaving work 15 minutes early wouldn’t affect her pay much, but Grow puttered around the kitchen for the remaining minutes to soothe Grace’s worries.
Before leaving, she brewed a fresh cup of coffee and placed it on a coaster next to Grace’s computer.