“We are not looking for warm bodies,” says Robyn Stone talking about the crisis in finding enough skilled and reliable caregivers for older people. To her, retention of current workers is more important than recruiting new ones. “I would put almost all my eggs in the retention basket,” she announces.
Among the professionals who have expert knowledge of care-giving for pay, Robyn Stone stands out. Formerly Assistant Secretary for Aging in the federal department of Health and Human Services, she now does research for a national agency focused on caregiving issues. Dr. Stone spoke in Boston recently at a conference of the Massachusetts Gerontology Association entitled “Worker Shortage: Who will Provide Care Today and Tomorrow?”
Keeping current caregivers is a formidable challenge, given what they are paid. You can compare them to the much discussed security workers at airports who are notorious for their rapid turnover. Both groups are paid about the same: as recently as 1998, the hourly wage for nurse assistants in nursing homes was only seven and a half dollars.
In Massachusetts, about one hundred thousand people are currently dependent on long-term care services. That number is expected to grow much larger ten years from now. Nursing homes are having trouble getting sufficient staff and home care agencies find it difficult to recruit workers. And yet, according to Frank Caro, director of the UMass Boston gerontology center, policy makers do not seem much concerned about the situation.
These officials could profit from what Rosalynn Carter has written about the subject. “There are only four kinds of people in the world: those who have been caregivers; those who currently are caregivers; those who will be caregivers; those who will need caregivers.” The fourth and last category is about to get much larger.
The statistics about professional caregivers will dismay anyone concerned that older people receive the attention they need. Thirty-eight percent of home care workers and one-quarter of nursing assistants have less than a high school education. And yet, they are expected to handle stressful situations that make great demands on both their professional and their human resources.
“We can’t underestimate the level of intensity of this work,” says Stone. Somewhat indelicately, she dismisses the widespread idea of this caregiving as merely “butt wiping.”
Instead, this job involves intimate and personal involvement that can be emotionally challenging. Stone compared placing an inexperienced person into a long-term care world to “dropping a Martian into another planet.”
Contrary to the general impression, most professional caregivers are white, typically middle-aged women who are living at or just below the poverty level. Often, they are single mothers who have turned to this activity for lack of better paying opportunities. And, yet, much more often than not, they provide services that are much appreciated by the families of those cared for. A recent study shows how families that communicate honestly with the caregivers and keep at it develop good relationships with them.
Family members of those who receive professional care, ideally should prove the strongest advocates for improving the lot of those providing the services. They know from personal experience what a difference is made by devoted home care workers and others in the field.
Improved training for caregivers is one of the vital needs that demands attention. Robyn Stone believes that the most significant way of doing this is to help these people “to own their work.” That means taking pride in doing a good job and developing the confidence to meet challenges.
In response to Dr. Stone, three panelists added to the case for action. “Our retention rate has always stunk,” Susan Eaton said bluntly. A Harvard Kennedy School researcher, she suggested ways to treat nursing home staff members differently, as by allowing them regularly to take care of the same people and including all of them in meetings for discussion of their work and its problems.
Another respondent, Barbara Frank, agreed that the key issue is “how we care for the caregiver.” She labeled it a “cruel irony” that so many of these staffers in nursing homes do not themselves have health insurance.
Returning to the original question, we do not know who will provide care today and tomorrow and the experts cannot tell us. However, we do know that most care will be provided by family members, as it has been for generations. A promising development here may come soon when and if the Commonwealth implements a long-standing proposal to pay members of low-income families who take care of their own relatives.
We also can expect the Commonwealth to shift expenditures for care away from nursing homes and other institutional settings to care given at home. But the need for more professional caregivers will certainly grow, as the baby boomer generation becomes old in unprecedented numbers. And the caregivers themselves will still need care, a need that our society does not show signs of meeting anytime soon.
Richard Griffin