How do we provide care to keep the Old Folks in their own homes?
As modern medicine and good sanitation has expanded life expectancy and stabilized many chronic debilitating illnesses, the question “what to do with the old folks” presents problems for most families and the society in general. By most estimates, 50 percent of seniors age 80 and above have Alzheimer’s or some other form of dementia.
Most infirm seniors would like to stay in their homes but, at some time, need outside help to do so. And most care giving relatives of the ‘sandwich generation’ would like to provide a continuum of care to permit their loved ones to live independently in their homes, but many cannot. Assisted living and nursing home care is very costly as an average day in assisted living costs about $175 and total nursing home care $280. For most seniors and their families, these costs that are not covered by Medicare quickly add up. Care at home, if possible, becomes the affordable option.
Fortunately, the vast majority of seniors will never require nursing home care. However, due to a range of cognitive and physical impairments, most will need some level of assistance to spend their declining years in their homes. The more severely disabled often need 24 hour assistance with such basic activities as dressing, bathing, feeding and going to the bathroom. Others need help with transfers to decrease the risk of falls and daily supervision to prevent memory lapses from causing problems from such things as remembering to turn off the stove, using proper hygiene or taking their medicines. Others need assistance to shop, prepare meals, clean house, keep doctor’s appointments and go to events. Some families employ home care attendants to be companions and to keep informed should any problems arise.
To be a home care worker, attendant or paid companion who provides simple home care requires no special training or certification. Thus, no valid statistics exist as to the numbers or kinds of paid home care workers. For the most part, home care is a low-wage subterranean segment of our economy, the income from which goes largely unreported to the IRS.
As a physician and SCORE counselor, I have provided free mentoring to at least a dozen new clients that wish to enter the home care business. All were women, mostly African American, who had raised families and had experience caring for either a parent, sick child or a member of a well to do family. Most had completed high school and many had some work experience in social services. None had any formal training in running a business and most had no savings. A number had worked for home care agencies that paid minimum wage for a variable work load with irregular hours. This was the motivation for some to start their home care business.
Lacking specialized training, one might conclude that the members of this group were unqualified and lacked the requisites to start a new business. However, this was not the case. All were highly motivated and eager to learn. Moreover, as a group they were very mature and even tempered and exhibited a great deal of empathy and caring for others.
Unfortunately, the going wage for a home care worker employed by an agency is about 10-12 dollars per hour, a level of compensation that requires long hours of work to provide even a subsistence living. But even at this low wage, the overriding problem for these mentees was how to recruit new clients to work with in the home. Word of mouth, announcements in church bulletins, testimonials, business cards and social media provided some marketing leads but none of the group had the networking necessary to attract enough clients to fill their work schedule.
In a recent Enquirer article, it was suggested that the home care industry requires more regulations. I agree that background checks and upfront interviews are in order. And if home care workers provide healthcare services, they should be adequately trained and licensed. As home care workers, however, that provide basic services that include safety and assistance as well as companionship to their clients, I see no need for standardized training and licensing beyond background checks and interviews.
My experience suggests that there are large numbers of underemployed conscientious home care workers and millions of functional, yet partially disabled seniors that need their services.
How can we match home care workers and needy seniors and their families?
Much like an online dating site or a volunteer matching site, a Website dedicated to matching home care workers with clients might offer a workable solution that streamlined the process of recruitment for both parties. Home care workers would register on the Website with a personal profile, work history, references, driver’s license and range of services. Registrations would include the willingness to undergo a background check. Clients, likewise, would register with personal information, family contacts and services needed. Based upon general categories of assistance, both parties would be asked to fill out a brief questionnaire to ascertain what level and hours of assistance were needed. With direct contracting, home care workers could command higher fees, perhaps $15 to $20 dollars, a rate that is lower than most home care agencies charge clients. The website would function like a clearing house and could be positioned as a nonprofit social enterprise. It would be a job creator and money saver that filled a definite gap in our current social system that will increasingly be put under stress by an aging population.
-Dick Wendel M.D. M.B.A.