It's no surprise that most older adults, when given the choice, say they would prefer to stay in their own homes for as long as possible.
But what if those older adults develop physical and cognitive challenges? Who helps them fulfill their preference to age in place?
If you said "family caregivers," your answer would be absolutely correct -- but not quite complete. That's because family caregivers often depend on another group of caregivers to help them support aging relatives.
We call those caregivers "personal and home care assistants" or PHCAs.
We owe a lot to these eldercare workers. But you'd never know it from observing the way we treat them.
Who are Personal and Home Care Assistants?
Personal and home care assistants are the people we hire to take care of aging relatives when they need help to remain independent in the place they call home.
Each day, PHCAs help our older relatives get dressed. They assist them in the bathroom. They remind them to take their medications. They cook their meals. They do light housekeeping.
PHCAs also serve as trusted companions. They may help our relatives get out of the house for medical appointments or recreational activities.
They certainly help older adults with cognitive impairments safely navigate a world that has become unfamiliar and scary.
That's pretty important work.
How are PCHAs Treated? Not Well
You'd think that people who perform such an important role would reap a host of financial, social and professional benefits.
Sadly, that's not the case.
Most PHCAs are low-income women who struggle to make ends meet. Hard as it may seem to believe, most of them do not earn a living wage for all their hard work. Few, if any, receive health insurance benefits through their jobs.
And many work in states that don't even require that they receive a certain level of training to care for a rapidly growing segment of our population.
LeadingAge: Advocating for the Eldercare Workforce
Through the LeadingAge Center for Applied Research, I've been working for more than a decade to raise the profile of these workers. Basically, LeadingAge would like to:
- Raise workers' level of training. We want states to train and certify PHCAs and offer them opportunities for career advancement. We're currently working with 6 states that are doing just that.
- Increase workers' pay. Teenagers with a weekend babysitting gig often earn more per hour than PCHAs. Does that make any sense?
- Raise the nation's respect for PHCAs. We need to spread the word about this important profession so we can bring new, high-quality workers into the field. We'd like to give high school and community college students good reasons to choose this career.
3 Things You Can Do
LeadingAge can't reach these goals on our own. We need your help in 3 areas:
1. Ask questions when hiring PHCAs.
Whether you are hiring a PHCA privately or through an agency, you need to ask questions about the worker's level of training.
Don't assume that your worker has received the training he or she needs to care for your relative. And don't assume that this work doesn't require special training.
Caring for older adults -- especially those with multiple chronic diseases or cognitive impairments -- is a complex undertaking that requires specific competencies. Make sure your workers have those competencies. LeadingAge will release a list of competencies for this workforce next year.
2. Make an investment in the workers you hire.
As consumers, we're hardwired to look for the cheapest deal when we're shopping in the open marketplace. But in this instance, hiring the cheapest labor is not the best deal for you or your older relative.
It makes better sense to pay your PHCA a living wage.
Paying for quality gives you the leverage to select the most competent and well-trained worker. It shows your PHCA that you value the service that he or she provides. And it sends a very clear message that you're willing to pay a little bit more to help preserve your relative's health and wellbeing.
3. Become an advocate for eldercare workers.
Join a consumer group that advocates for better home care. Talk to your state's legislators. Contact your state's Medicaid director.
It's time to have a conversation about reimbursement rates for home care. We need to raise those rates so agencies can train workers adequately and pay them fairly. We can't expect PHCAs to pay for their own training. They barely make enough money to support themselves and their families.
Family Members: The Key to Change
Unless our families speak up for better home care, it will be very difficult to change the way we train and reward our personal and home care assistants.
Change begins with us. If we value these workers, our society is more likely to support them too.
And let's face facts. Our parents aren't the only ones who need a high-quality eldercare workforce. We'll soon need that workforce to help us remain healthy and independent.
Let's take steps today to ensure that we will have access to a high-quality, well-trained and well-paid eldercare workforce when we need it.
When an ill person brings up subjects that make you feel uncomfortable, it's natural to want to squelch the discussion or rapidly change the subject. However, it's very important to listen unselfishly and avoid responding with, for example: "Let's not get into that right now. Can't we discuss something more pleasant?" or "Do you really think it's helpful to dwell on this topic?"
Whether the patient asks a spiritual or theological question that catches you off guard or she wants to know about the side effects of a medication, it helps to learn how to be noncommittal without seeming evasive. You don't want her to think that you don't care or that you're hiding something, and you definitely don't want to offer misinformation that might do more harm than good.
Even for people who weren't very spiritual or religious throughout most of their lives, it's natural to experience spiritual anxiety during a serious illness. And it's also natural for this anxiety to lead to questions that caregivers might find difficult or even overwhelming. If your loved one asks, for instance, 'What's next? Will prayer help? Why did God let this happen to me?' it's best to call in a qualified cleric.
Just as most of us are not comfortable with chronic illness, we are also not comfortable with crying. When tears appear, we tend to whip out a tissue and murmur something along the lines of, "It's okay. Don't cry." From now on, continue to pass the tissue when your ill loved one starts to tear up, but don't pressure him to stop sobbing. Tears are a natural emotional release for emotions ranging from anger to sadness to fear, and can be very therapeutic.
When your loved one is uncomfortable, upset, or worried, you might be tempted to utter platitudes like, "Everything will be okay," "I know how you feel," "God has given you a long life," or "It's God's will." While we hope that these phrases will be a quick fix to problems we'd rather not deal with, the truth is that they're trite and meaningless. What's more, sugarcoating reality doesn't fool most people, and it certainly doesn't spark positive change.
Anger is a natural human emotion, and it's important to recognize that chronically ill people have a lot to potentially feel upset about. Understandably, many patients are angry that they are so sick. Plus, their pain and energy levels might make them less patient or less able to handle stressful situations. Therefore, it's not unusual for caregivers to be on the receiving end when their loved one's fuse blows for any reason.
Understanding how and why an illness is getting worse and more painful is intellectual. But experiencing it is a very visceral and emotional thing. The patient needs for you to connect with him on a heart-to-heart, gut-to-gut level, not just a mental one.
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