No Children
Black Women's Plight
The
Underclass
Child
Support But Not Your Children
False Witness
Reverse
Discrimination against Asian Americans
No children
Feminists: not having
children is fine.
No children = no young workers.
No young workers = no taxpayers paying Social Security or Medicare taxes.
The National Organization of Women opposes Social Security reform.
Feminists: we want the children of Republicans, Catholics and Mormons to support us in our old
age.
5/3/06 CNNMoney.com: The trustees of Social Security and Medicare now estimate
that the Social Security trust fund will be exhausted in 2040 while the Medicare
trust fund will be depleted in 2018, slightly sooner than previously forecast.
2/22/06 Wall Street Journal: "Long-term care is a women's issue," says
Marc Cohen, president of LifePlans in Waltham, Mass., which conducts research
into long-term care. The people who spend years in a nursing home "tend to
be single, female, over age 80 and suffering from dementia. Their husbands have
died and they don't have family support, so they're unable to live
independently."
9/22/06
New York Times (David Brooks): Women initiate 65% of divorces after age 50.
7/4/07 The Dallas Morning
News: Who'll care for aging boomers? Too
many patients, too few workers could cause home health care crisis,
by Bob Moos
Mathilde Spett of
Dallas
says she owes her happiness and maybe even her life to the woman who
comes to her apartment in the morning and stays until dinnertime.
Ms. Spett, who's 91, injured herself in a fall early this
year and was also found to have diabetes. But she recently graduated from a
walker to a cane and learned how to follow her diet. She credits her home care
aide, Marilyn Ferguson, for her progress.
"I was pretty low, but Marilyn's brought me back. We
just enjoy each other's company," she said.
Tomorrow's seniors may not be as fortunate in finding someone
like Ms. Ferguson.
As boomers begin encountering the frailties of old age, the
nation will face a widening "care gap" that experts fear will
compromise the quality of home care and force people into nursing homes too
soon.
"Americans have presumed they'd always have an endless
supply of personal care aides to look after their mothers and fathers, and
eventually themselves, but they're mistaken," Steven Dawson, president of
the Paraprofessional Healthcare Institute.
Experts predict that the nation will need 1 million more home
care workers by 2017 and as many as 3 million more by 2030, when all 78 million
surviving baby boomers are older than 65. There are now about 1 million aides.
The nonmedical aides, who are often middle-aged women, come
into the homes of disabled older adults and help with bathing, dressing, meal
preparation and everyday chores. Unlike home health aides, they don't do
physical therapy or handle medications.
Many work through home care agencies, while others work
directly for families.
Most seniors pay out of pocket or tap their long-term care
insurance policies for the in-home care, but some on lower incomes qualify for
help from Medicaid.
Supply and demand
The growing demand for the care will come from a doubling of
the 65-plus population in the next 25 years and seniors' preference to remain
out of nursing homes.
Also, more families are relying on paid caregivers because
more women work than in previous generations and can't attend to elderly parents
during the day.
Meanwhile, the traditional labor pool for home care workers
will barely increase.
Immigrants will answer some of the demand, but the women who
typically went to work as caregivers now have better-paying, less demanding
options in other fields.
"The job requires a lot of patience, a tough skin and a
big heart," said Bill Dombi, a vice president with the National Association
for Home Care and Hospice.
The median annual wage for home care aides was $17,710 in
2005, according to the federal Bureau of Labor Statistics. That's about what
store cashiers and maids make.
About half of home care workers lack health insurance, the
AARP Public Policy Institute says. If a caregiver has coverage, it's usually
because of a spouse or another job.
Florene Murphy, who's been a caregiver for much of her
40-year working life, gets $9 an hour for most of her home care. She averaged
just $4 an hour when she was a live-in aide on duty around the clock for five
days each week.
"That job wore me out," she said. "I was
afraid of becoming a patient myself."
Ms. Murphy estimates she earns $10,000 to $20,000 a year,
depending on the number of hours she works. She says she makes ends meet by
living in a sparsely furnished, government-subsidized apartment in
Dallas
that costs her $80 a month.
Underscoring the stark economics of home care aides, the U.S.
Supreme Court ruled in June that federal minimum wage and overtime laws, as
currently written, don't apply to them.
A home care worker in
New York
had filed the lawsuit because she sometimes worked 70 hours a week without
receiving time-and-a-half pay for overtime.
"If we don't find a way for people to earn a living wage
from home care, we won't get the workers we need, certainly not good ones,"
said Dr. Larry Wright, co-director of the Caregiving Project for Older
Americans, a national panel of experts studying the issue.
A sense of mission
Because of the low pay and few benefits, home care aides must
often explain to others why they do what they do. Almost all say they're
motivated by a sense of mission.
"They see it as a calling. Many have cared for their own
parents and discovered how emotionally rewarding it is and then try to help
other families," said Lori Nesler, who owns two ComfortKeepers home care
franchises in the
Dallas
area.
Ms. Ferguson, who cares for Ms. Spett, said she had been a
teller at a credit union but found she had an interest in caregiving when she
offered to help a neighbor look after his wife, who was suffering from
Alzheimer's disease.
"I got so much satisfaction from doing that," she
said. "I just had to find a way to continue."
Ms. Ferguson, who works for Home Instead Senior Care, drives
Ms. Spett to the doctor, does her laundry, prepares lunch, runs errands and
lifts the woman's spirits.
Many home care aides say they like the flexible hours.
They can work as little or as much as they like and fit their
assignments around the rest of their lives.
Senzeni Achodo, who emigrated from
Zimbabwe
six years ago, is studying to become a nurse and paying for her schooling by
caring for an older woman through the Home Helpers agency in
Dallas
and attending to another woman on her own.
"It's tough some days, but I know I need an education to
get ahead in
America
," she said.
Employing students like Ms. Achodo will be one way for home
care agencies to meet the growing demand for aides, experts say. Another will be
tapping older adults who want to stay active during retirement and supplement
their Social Security income.
"We see a great opportunity for seniors caring for
seniors," said Paul Hogan, president of Home Instead Senior Care.
"Boomers say they're going to work, either for money or personal
interaction. What offers more interaction than home care?"
High turnover
Mr. Dawson of the Paraprofessional Healthcare Institute said
recruiting enough home care workers is only half of the challenge; holding on to
them is the other. Depending on the agency, turnover runs from 40 percent to 100
percent a year.
In addition to having to cope with low pay and lack of
benefits, some workers find they're ill prepared for the demands placed on them
and leave their jobs within the first few months.
The Service Employees International Union, whose members
include 400,000 home care workers, has advocated for wage increases, health
insurance and better working conditions to close the emerging care gap.
Some home care agencies have tried to improve compensation by
offering bonuses, college scholarships, catastrophic health care coverage,
overtime and paid time off.
At a Home Helpers franchise in
Dallas
, president Anna Carlson says she pays monthly bonuses to employees who get
strong reviews from clients.
At ComfortKeepers, Ms. Nesler has flowers delivered to her
"caregiver of the month" while on the job and gives the honored
employee a gift card.
Still, the agencies say they can raise wages and benefits
only so far without pricing themselves out of the market and driving clients
into the arms of independent caregivers who may charge $5 less an hour.
"It's a good feeling to put people to work, but it's sad
I can't pay them what they truly deserve. If I did, many seniors on limited
incomes couldn't afford the care," said Nancy Oppenheimer-Marks, a Home
Instead franchise owner in
Dallas
.
Mr. Hogan said the "gray market" of private
caregivers presents a mounting problem for agencies licensed and inspected by
states. The freelancers get jobs by word of mouth and are rarely screened,
trained or supervised. Yet they're almost always cheaper.
Agencies typically charge $15 to $17 an hour, paying their
caregivers $8 or $9 an hour and using the rest for taxes, fees and overhead.
Independent aides often charge $10 or $12.
"We try to explain how people put themselves at risk for
abuse and neglect in the gray market," Mr. Hogan said. "Still, some
end up exploited."
Training programs
As the demand for home care workers grows, so will the need
for better training, said Dr. Wright from the Caregiving Project for Older
Americans.
"Only one in four paid caregivers receives any formal
instruction, and even that training is often minimal, he said. "People are
given handbooks and told to read them."
Dr. Wright, who oversees the
Schmieding
Center
for Senior Health and Education in
Springdale
,
Ark.
, has developed one of the nation's few training programs for in-home
caregivers. It covers such skills as bathing, feeding and moving the elderly.
The nonprofit center had hoped to market the 115 hours of
instruction to home care agencies but found most of them weren't interested in
investing that much time, he said.
Few states require such formal training.
In
Texas
, professional in-home caregivers must demonstrate "competency," which
agencies can determine through observation or written exams.
Inspectors from the state Department of Aging and Disability
Services then make unannounced visits to licensed home care agencies and
randomly question clients about the quality of care.
"Home care may be a low-wage job, but it's not a
low-skill job," Mr. Dawson said. "In-home caregivers work alone and
must be ready for whatever comes their way."
The caregiver advocate says he worries that many states are
racing toward home-based care without making sure there's a trained workforce to
support that policy shift.
"If we paid these people a livable wage, offered them
health insurance, trained them better and listened to them, we'd solve this
'workforce crisis' in months,"
Mr. Dawson said. "But we can't do that as long as our
policymakers treat them as invisible."
