Carers and Elders: What’s Up with the System?

“Quality care through quality jobs.” It sounds perfectly reasonable. And yet the tagline of the Paraprofessional Healthcare Institute is still a rallying cry in a war now reaching a crucial phase. Along with other organizations, the Bronx-based think tank has been working to raise awareness of how seniors are being affected by labor issues in the elder-care industry.

Now it’s Congress’s turn.

Elder Care: A Booming Industry

Organizations like PHI that are pushing for elder-care labor reform find themselves up against serious resistance from the industry, according to Martin Bayne, an advocate for more enlightened care in nursing homes and in the world of home health aides.

Having spent the last 11 years in an assisted living facility surrounded by “more death, despair, disability and depression than most see in a lifetime,” Bayne has some insight on the topic of senior care. A practicing Buddhist, MIT graduate and former insurance industry CEO, intellectually vigorous despite his 18-year struggle with Parkinson’s Disease, Bayne has long spoken out about the problems plaguing elder care through his blog the Voice of Aging Boomers. He, too, links the quality of care received by elders with the conditions plaguing the elder care workforce.

“Most of them are unmarried. Most of them are struggling terribly. They were making $8.50 an hour 24 years ago and they’ve gone nowhere.” -Martin Bayne

Elder care is a growing need as life expectancy in the U.S. continues to lengthen (though not as quickly as in the rest of the industrialized world). As we survive further into old age, many of us do so with our infirmities. Almost eight in ten seniors have two or more chronic conditions, and the federal government estimates that we’ll need an additional five million elder care workers by 2020.

Elder Care Aides: Babysitters by Law

Within this elder care workforce, personal care assistants are “the single most important part of the dynamic process of healing,” Bayne told Senior Planet. Residents in assisted living facilities “depend on PCAs for what’s most important in their lives: food, bathing, dressing, hygiene.” Yet, Bayne says, under federal law, personal care and home health aides are treated like babysitters. They are exempt from minimum wage and overtime regulations.

A 1974 ruling by the Department of Labor classified aides as “companions,” no different from the teenager hired to watch TV while parents are out and the baby’s asleep.  President Obama has promised to undo it, but a review of the law begun in July 2011 has been bogged down in bureaucratic processes. A May 14 deadline for the next step may lead to Presidential intervention.

Industry groups opposing regulation say a ruling that requires them to pay minimum wage and overtime could lead to worse conditions for seniors in care, since, they claim, providers would be forced to restrict hours to 40. Quoted in CNN Money, the president of the National Association for Home Care & Hospice, Val Halamandaris, said, “It’s going to increase costs, and it’s going to make things more difficult at all levels… A lot of these individuals could end up losing these jobs.”

The situation is not universally bleak. Sixteen states and the District of Columbia have wage and hour protections for health aides. And federal “companion” status doesn’t apply to aides employed directly by nursing homes – but fully 90 percent of aides are hired directly by consumers through staffing agencies.

The Life of an Elder Care Aide 

Even with the protections offered in some states, government figures place the 2010 median annual income of home health aides at $20,560 and that of personal care aides at $19,640. According to a 2011 government report, almost one in four aids has received cash welfare benefits; fully 40 percent have been on food stamps.

“Most of them are unmarried,” Martin Bayne told us. “Most of them are struggling terribly. They were making $8.50 an hour 24 years ago and they’ve gone nowhere.” Because wages are stagnant, he said, the field “ends up attracting only those who really want to do it or those no other employer will take.”

The aide’s work is rife with physical stress. According to New York City’s Committee for Occupational Safety and Health, aides – along with nurses, hospital orderlies and other “frontline health care workers” – have “the highest rate of musculoskeletal disorders of any occupation, higher than construction workers, or laborers or industrial mechanics.”

A 2011 report from the federal Department of Health and Human Services lists abuse by patients, including biting, among the top five work-related injuries in the field. The report also notes that home health aides face the problem of arranging daily transportation from job to job – a cost that is not always reimbursed.

Revolving Door Syndrome: Bad News for Seniors

These difficulties, along with meagre wages, lead to high staff turnover. According to HHS, in 2007 annual turnover in nursing facilities was 66 percent, and in some states exceeded 100 percent, with almost half of all aides employed at more than one job in a 2-year period.  “High turnover,” HHS reported, “means that direct care workers do not get to know the needs and preferences of individual residents or consumers, possibly reducing quality of care.” (Click here to read the HSS report.)

“Revolving door syndrome,” Martin Bayne calls it. “Very bad for those of us with dementia or Alzheimer’s.” He says the situation is fraught from the start. “Assisted living residents arrive traumatized. They’ve just lost a spouse or are just out of the hospital. Suddenly this 80-year-old is thrust into the care of a 22-year old. And the aide is overworked. Facilities lack complementary staff and are understaffed, especially at night.”

A Better Way?

Efforts are afoot to improve the lot of health care aides and, consequently, their clients. Bayne says work models that exemplify “the fusion of humanity with caregiving” and have led to significant reductions in resident morbidity and mortality are taught by Virginia’s Green House Project and by Rochester-based Eden Alternative. Both are nonprofit longterm care organizations.

Still, Bayne is skeptical that the longterm care industry will reform itself. “They’re too powerful,” he says, referring to industry groups, “with too much lobbying money.” He suggests the best hope lies in “employee self-education groups.”

Unionization could be an avenue to that – and it does occur, most notably in the Northeast and the Pacific Northwest. A recent Commonwealth Fund study of New York City nursing homes concluded that “collective bargaining helps workers attain satisfaction… rather than leaving” and that “better labor-management partnerships positively influence the facility.” (Click here to read the study.)

Next Up…

As the May 14 deadline approaches, the issue is getting some serious attention. On NPR last week, Diane Rehm spent an hour exploring the home health care industry; this week, the organization Caring Across Generations launched a campaign urging Congress to strengthen longterm care through better job training, quality and pay, plus a roadmap to citizenship for workers, along with support for consumers and families.

Will there be change in our time? We’ll keep you updated.

Read More

• Click here to read Martin Bayne’s blog

• Visit the Paraprofessional Healthcare Institute site

• Visit the Caring Across Generations site

• Nursing homes are hotbeds of abusive drugging