By Alexia Underwood
California Health Report
As the US population ages in record numbers, home care workers are becoming part of an increasingly in-demand market. They make an independent life possible for thousands of seniors and people with disabilities, but in the Central Valley and elsewhere across California and the US, they’re barely scraping by themselves.
Many seniors are choosing to stay in their homes for as long as possible, and employing a home care worker – or two – is one way to make this arrangement work. According to a study done by AARP in 2010, more than 90 percent of Americans over 65 would prefer to stay in their homes as they age. This is often referred to as ‘aging in place.’ Melissa Norton of Assured Care, a family-run caregiver agency in Modesto that employs around 30 people, has noticed the growing need in her community for in-home care services. People often choose this route because of the personal attention they receive, and because they are more comfortable in their homes, she said. “They have more of a say of what goes on in their daily lives.”
According to the Bureau of Labor Statistics, the demand for home care workers is swiftly increasing. Home health aides and personal care aides (who do much of the same work but are required to have less training) are among the fastest growing occupations in the nation. The Paraprofessional Healthcare Institute (PHI’s) website states that by 2020, there will be 1.6 million more positions to fill.
Jill McFarlane, 59, employs two home care workers to take care of her 96-year-old father in Turlock. A dairy farmer for more than sixty years, her father recently fell and broke his hip after getting off of a tractor. She lives close by and sees her dad frequently for meals and visits. Though he can’t work anymore, he can still do some of the things he enjoys, and he’s much happier than if he were in a facility, she said. “He says that if he were put in a convalescent home, we would be visiting him in a graveyard now instead of at home.”
But paying for this kind of one-on-one care can be very expensive. Agencies like ResCare, which screen home care workers and offer services ranging from a few hours a week to live-in arrangements, normally charge between $17 and $25 an hour. Medicare will only cover very limited home care help in specific situations, like after a hospital stay. For many seniors and their families, though, hiring in-home help is worth the price.
However, the workers who are allowing our aging population to live out their last years comfortably and independently are among the worst paid in the nation. In California, wages for home care workers fell well below the 2009 federal poverty line, according to PHI. On the national level, home care workers are considered exempt from minimum wage and overtime wage protections, under the Fair Labor Standards Act. President Obama announced his intention to change this law in 2011, but the proposal has stalled. The approximately 2.5 million home care aides in the U.S. are disproportionately women, and many are immigrants or women of color. Almost half receive some type of public assistance, like food stamps or Medicaid.
Typical is the story of a home health aide for an elderly woman in Hughson, a small farming town east of Modesto. The aide, who asked that her name not be used to protect the privacy of her clients, spends her days cooking, cleaning, doing laundry, and helping her client do basic tasks, like walking to the bathroom, bathing, and washing her hair. At night, she reads to her client, gets her medication ready, and helps her take out her teeth. The aide, who is a Certified Nurse’s Assistant (CNA) and has years of experience working as a caregiver in private homes and convalescent homes, gets paid $9 an hour. She works for a caregiving agency, but receives no health insurance or paid holidays. While she enjoys building personal relationships with her clients, the money she earns just isn’t enough for herself and her family. “If it were just me, fine. But I’m supporting two other people. I have two sons who are both living with me,” she said.
Maria Rivera, 36, a former home health aide from Turlock, spent over three years working seven days a week so that she could qualify for health insurance. She divided her time between working at a nursing home and being an in-home caregiver, and made less than $11 an hour at both jobs.
Rivera enjoyed the work, she said. “I like being of service to people who really need it.” But there were plenty of challenges. She had to learn how to not take things to heart, like when one client refused to let her into the house one day over a petty disagreement. “A lot of people have no idea how to care for the elderly. Sometimes it’s like caring for a child, but they know they’re adults and they don’t want to take orders from someone one-third their age,” she said. And the most difficult part, by far, was losing the people she cared for. Watching a recent client’s health deteriorate over time was “devastating.”
There were also other, more day-to-day difficulties – like when the next caregiver from the agency where she worked didn’t show up. “When there’s one person, one caretaker, you can’t take breaks,” she said. “At night, sometimes you’re up every 15 minutes.”
In addition to this, the nursing home work was physically challenging for Rivera, who has congenital scoliosis, and has no cartilage between the discs in her back. In 2005, she had surgery, which required her to put metal rods in her back. One day in March of 2011, after lifting a client at the nursing home, she felt the left rod in her back snap. “I could still move, and walk, but it caused me pain and I couldn’t lift anything,” she said. Finally, in April of the following year, the company’s worker’s compensation fund paid for her to have surgery again and fix the problem.
Now, Rivera is receiving disability payments and living with her parents. Though the demand for home care workers with skills and experience like Rivera will only increase in the coming years, she’s hoping to move on to something more lucrative where there are better opportunities. Her dream career is to be a pharmacist. The median pay for home health aides in 2010 was about $20,000 a year, but pharmacists made over five times that much.