Aging parents, aging grandparents, aging friends and neighbors. Like other middle-aged adults, I am surrounded by family and friends who either need care, provide care, or will be providing care in the not-so-distant future. That is why this year’s White House Conference on Aging on Monday — held once a decade to assess the status of older Americans and our system of aging services — resonates with me.
Case in point: my father-in-law. Self-employed, working as a carpenter into his 70s, Bill managed to get by in rural New England, but he never could afford health insurance. He pretty much managed on his own, sharing a house with a younger brother, who had a stroke and Bill cared for, until the day he broke his hip. Without an income, he had no choice but to apply for Medicaid benefits. Medicaid covered some occupational and physical therapy, and limited personal care services, but his recovery was complicated by the vestiges of childhood polio. With his mobility seriously impaired, he grew depressed and didn’t take very good care of himself.
Here on Long Island, my partner and I worried about Bill, his eating habits, lack of exercise and depression, but it was clear he had no interest in our advice on healthy living and “recovery.” Without consistent in-home care to help prepare nutritious meals and assist him with exercises to increase mobility, Bill lost part of his lower leg. He and his brother could no longer care for each other, and they were forced to move to the county nursing home.
Bill and his brother are typical of many older Americans — living on their own, children out-of-state, unable to get adequate day-to-day support. What they and our families need is an eldercare system that makes it easier to access a robust, flexible and affordable system of long-term services and support. Improving that system is one theme of the White House conference.
But long-term services and support stand on a shaky foundation. What people who are aging need are trained and experienced home-care aides who can meet them where they are and provide support that acknowledges individual personality, health status and lifestyle. But as a nation, we have dramatically failed to invest in this workforce, which provides the vast majority of paid “hands-on” care for elders with functional limitations.
New York’s home care workers earn a median wage of about $10.50, hardly a living wage. In addition, workers receive minimal training, leaving them without the skills they need to deal with their clients’ complex emotional and physical problems. Consequently, 1 in 2 home-care aides leaves the field each year. That cripples our system of long-term services and support, and leads many families to hire aides who are figuring out on-the-job how to cope with depression or overcome the fear of a client with Alzheimer’s disease.
To reduce direct-care worker turnover and grow the workforce to meet exploding demand, we need to develop a new workforce model, one that invests in a stable and skilled workforce that can meet the needs of a diverse elder population. With steady, attentive home-care support, Bill might have overcome the limitations brought on by a broken hip and continued to live at home, where he and his brother could have supported one another.
The White House conference, as it explores the many issues confronting older Americans, should prioritize building a stable and skilled direct-care workforce. We need to make a national investment in jobs that pay fair wages, provide adequate training, and give workers advancement opportunities so they can make direct-care a career, not a stopover on the way to something better. Whether we are caring for family members or need care ourselves, we all deserve access to affordable, skilled aides, who are committed to delivering high-quality services.
Jodi M. Sturgeon of Huntington is president of Paraprofessional Healthcare Institute.