Published Monday May 11, 2009
THE WASHINGTON POST
WASHINGTON - The country will need hundreds of thousands more home-care aides if it's going to keep today's elderly, followed by their far more numerous baby boomer children, out of institutions. Already, the occupational category called "personal and home-care aides" is the nation's second-fastest-growing, the Bureau of Labor Statistics reports. It projects a more than 50 percent increase in such jobs by 2016, second only to the demand for "network systems and data communications analysts."
It's not hard to see what's fueling the need. Americans survive far longer than they used to: A man who reaches age 65 can now expect to reach 82, and a woman 85, the National Center for Health Statistics reports. But most spend those extended lives contending with chronic illnesses and disabilities, including climbing rates of Alzheimer's, that can make it risky and difficult to maintain an independent household.
When that happens, when elders need long-term care - and health policy analysts say more than two-thirds of them will - they can be highly vocal about where they want to get it. A typically horrified reaction, from Marilyn Daniel's Washington client Willie Alston: "Oh, no, I don't want no nursing home - that's the last place I want to be." Fairly or not, nursing homes are seen as grim thresholds to the grave, and years of hearings and headlines about deplorable conditions in some facilities have made senior citizens and their families willing to go to extraordinary lengths to avoid them.
"You have to look at the quality of life," says Marla Lahat, executive director of Home Care Partners, Daniel's employer. She mentions a 95-year-old client, fiercely lucid but very frail, requiring a squadron of daily and overnight helpers, both agency workers and privately hired aides. "If she knew she could stay one more month in her home or live three more years in a nursing home, I think I know what she'd say."
Home care is generally less expensive, too, though hardly cheap. So perhaps it isn't surprising that the nursing home population has been shrinking in recent years and the once-dramatic growth in assisted living has leveled off. Most older Americans who need help aren't in any facility; they're at home.
But finding reliable, compassionate caregivers to help keep senior citizens in their homes isn't easy, even in these miserable economic times. That's in large part because these demanding jobs are so poorly compensated. Benefits, particularly health insurance, are rare, and wages can be so low that many aides are eligible for food stamps.
Home-care aides make an annual appearance on Forbes magazine's list of the 25 worst-paying jobs in America. (The aides' mean annual wages put them ahead of shampooers and waiters, but behind parking lot attendants.) Once hired, they leave in droves; turnover rates run 40 to 60 percent a year, says labor economist Dorie Seavey of PHI, a nonprofit that aims to improve direct-care work.
"Who's going to want this job, even if you enjoy caring for people, when you know you'll barely make minimum wage, you're not going to have health insurance, you're doing a job that's backbreaking?" asks Leonila Vega of the nonprofit Direct Care Alliance, recently formed to push for better pay and conditions for caregivers. "You can be a home-care worker for 20 or 30 years and never receive a meaningful wage increase, never get a promotion. You could become an expert in working with people with physical disabilities or Alzheimer's; yet you never receive any recognition for your increased learning and experience."
Aides who do hands-on work with the elderly also suffer some of the highest workplace injury rates of any occupational group. When clients can't walk or shift from a wheelchair to a toilet seat, their aides do a lot of lifting and maneuvering that can cause orthopedic damage. And patients sometimes hurt aides; those suffering from dementia, in particular, can lash out, hit or spit. Daniel has been bitten several times when a woman with Alzheimer's clamped down during toothbrushing.
When it comes to wages and benefits, Daniel does better than many of her colleagues. Because it's a nonprofit funded primarily by the D.C. Office on Aging and because Washington has a living wage law, Home Care Partners pays more than most agencies - an average $12.40 an hour.
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