According to the Wall Street Journal (January 23, 2023), the rate of turnover among caregivers hired to work in the home has skyrocketed past 65%, reflecting a major supply gap in the home care industry. The gap first appeared during the pandemic, but it widened as more people wanted to stay at home, given the high rates of infection in group homes and daycare services.
Between 2008 and 2018, the number of home care workers more than doubled to 2.26 million from less than one million. However, the Labor Department projects a 25% growth in the number needed over the next decade, including those who work in group homes and daycare. There is good reason to believe we will see even more significant shortages in this labor market.
Home care agencies have boosted incentives, wages, and bonuses, yet median pay lags behind national averages, adding up to less than $30,000 per year. Moreover, the jobs are challenging to fill because clients can be demanding, and the work can be taxing physically and emotionally.
For those who need home care, high turnover means there is great uncertainty about whether a family can find help or whether anyone they find will stay. In addition, caregivers often have emergencies of their own, and clients get last-minute calls telling them the caregiver cannot show up, which means someone in the family must miss work or find a substitute caregiver at the last minute.
Last-minute glitches also mean that the person who shows up at the door in the morning may be someone that the family doesn’t know, creating a stressful situation all by itself. And that is if you use an agency. Hiring a caregiver directly, however, raises many issues. For example, what do you do if the caregiver you hire gets sick? If you hire an agency, they will likely have a substitute available. Most agencies cannot guarantee that they will send a substitute, but they will try to do so.
Many caregiver agencies also provide training for new employees. This may include special training for those working with people with Parkinson’s or Alzheimer’s. Even so, whenever a family gets a new caregiver, they must train that person to deal with a specific patient. That means everything from what time the patient gets up to when he or she eats, what clothes they wear, what TV they watch, what medications they take and when, as well as what to do in an emergency.
The Wall Street Journal advises readers to have at least two caregivers, each with a different shift (say M, W, F vs. T, Th, Sat), so one can come when the other cannot. They also advise keeping a checklist of daily routines, medications, and so on so people can come on short notice. Families often go through several caregivers in the course of a year. Often, caregivers cannot cope with the stress of demanding patients or critical family members.
Of course, it is even more difficult to find caregivers for those with Alzheimer’s, ALS, or Parkinson’s since they require special training, and caregivers burn out sooner when working with clients who need special care or have severe disabilities. Caregiving is not an easy job!
Family members who take on the burden of caring for another member often ignore their own needs, become isolated, or fail to tell other people they are working as caregivers and need extra support. Marc Agronin, a geriatric psychiatrist, says that family caregivers often do things that they believe are in the patient’s best interest but end up only undermining their own health. Agronin tells people that they have to remember what is good for the caretaker and what is good for the patient.
This means that caretakers must be sure to maintain their own health or risk physical or mental illness. This is even more important for those who care for dementia patients. Interestingly, when dementia patients are unable to express their emotions or react to their caregivers, their caregivers’ health suffers. People not only appreciate positive feedback, but they also need it.
Caregivers have to prioritize their routine checkups, especially if they suffer from high blood pressure, elevated glucose levels, or depression. It is also important that caregivers maintain their own personal relationships. They need regular face-to-face time with friends to live with a sense of normalcy and community. Agronin writes that caregivers can turn into “lonely warriors.” This stance can cause excessive stress and social and financial problems because warriors do not need help.
He advises families to build a team that includes trusted professionals and specialists (doctors, nurses, etc.), family and friends that one can call on for companionship, emotional support, and breaks, and a team coordinator (not the caregiver) who makes sure that appointments are made and kept and people show up when they are supposed to.
Between aging and illness, remembering that the person is not the disease is often complex. Some family caregivers become quite upset or depressed by caring for someone on a downward trajectory. It is important for caregivers to be able to imagine what the patient experiences so they can think creatively about ways to improve care and provide stimulation for the patient. A good caretaker has the potential to alter the course of the disease and increase the well-being of the patient by engaging the patient in positive and meaningful ways. They need to be reminded of what a difference they can make.
As the Baby Boomers approach old age (the oldest are now in their late 70s), the situation will probably deteriorate. Although they may be in better general health and live slightly longer than earlier cohorts, consider the fact that by the end of the decade, 20% of the population will be over 65 years old, and they will probably not have given any thought to their own care. Even adults over seventy-five do not really think about how they want to approach the end of their own lives, despite the fact that nearly two-thirds of people over sixty-five have chronic illnesses. After age eighty-five, one-half suffer from Alzheimer’s. It is good to make out those advanced directives while you’re still playing with a full deck.
It also makes a lot of sense to think about and discuss how to manage care if you should need or want it. Is a family member willing and able? Neither my husband nor I are good caretakers, so we discussed it and decided to hire outside help when the time came. If you make this decision, would you use an agency, or do you have some other source of referrals? What are the benefits of your long-term care policy if you have one? If you do not help to come in, where would you live if you need help? In our community, there are several living/care facilities for people with dementia and Alzheimer’s or Parkinson’s. Do you know much about the ones in your town?
In Santa Barbara, there is also a Senior Expo every year. For many years, I have attended it either working at the hospice desk or with a friend who does virtual reality for people who are shut in. You can discover a wide variety of different services and facilities by attending a Senior Expo. Most community resources are represented, like hospices or agencies that employ caregivers and many private enterprises like my friend’s virtual reality business. There will also be reps from all the retirement communities, memory care, and end-of-life care, including funeral homes, cremation services, and other end-of-life services.
Prepare now so you will not be overwhelmed if and when you need to make these decisions. As my mother used to say, “A stitch in time saves nine,” and it lowers the stress level considerably!