“It’s the most high-need consumers struggling the most in finding workers,” says Rebecca Gutman, vice president of home care for Local 1199 of the Service Employees International Union. The so-called rejection rate was 76 percent in January, according to WellSky, a technology company that serves 130,000 home health care agencies and social service providers. “Home care agencies get a flat payment for 30 days per patient,” she says, and each agency gets to decide which services they will provide — nursing care, physical therapy, speech therapy, or something else.