In a thriving care economy, direct care workers earn a living wage. That also may mean many family caregivers can’t afford care. The math never quite works.
In 2017, my parents moved to a condo complex built in 2008 in the downtown area of our suburb. They rented a two-bedroom condo and enjoyed maintenance-free living plus the convenience of living across the street from Trader’s Joe’s, our library and a variety of restaurants.
But there was a terrible problem with the building. The address was 10 N. Main Street but the entrance was on the other side of the building, accessed through a parking lot.
When home health, palliative care, home care and hospice staff called to schedule visits, I repeat detailed instructions on how to access the building. The instructions caused lots of confusion: “I can’t enter the building from its address?”
On one particular Sunday afternoon, I answered several calls from a home health aide trying desperately to figure out how to park and find the building entrance. (Not sure why she came on a Sunday, which really wasn’t the best day for any of us. But she came on a Sunday.)
Finally, I told her to stay on the phone with me, that I would stand in the street and direct her to the parking lot and the apartment entrance. So off I went, phone in hand, to stand in the street.
I immediately spotted her, waved my hands and then directed her, like I worked at the airport landing planes, into the parking lot. I calmly waited for her and then accompanied her to my parents’ apartment.
The Look of a Missing Care Economy
But, oh, her car.
I have no idea how her car started every morning and how it made it to each client and then returned her home at the end of the day. To call it a tin can on wheels would be too generous.
I saw her car five years ago and I still remember it. I am still horrified that someone who works hard in a profession that requires hard work drove that kind of safety hazard.
We talk about our poorly paid direct care workforce. We need to see what that looks like — the car, the house, the lack of quality of life. Once you see it, you can’t unsee it.
You also can’t help but worry about a professional who clearly struggles in her day, wonder how that struggle shows up in her work and consider the possibility that it impacts the care she provides.
We haven’t figured out the economics of paying a living wage to our direct care workforce so they don’t take their lives in their hands simply driving to work. If we did, then our direct care professionals could enjoy reliable transportation. We then could be comforted by the arrival of a professional who can show up as just that — a professional.
We Lack Commitment to a Care Economy
In many ways, we haven’t committed to figuring this out. One of our national organizations, Caring Across Generations, describes its focus as “working to build real, helpful, thoughtful care systems.” Yet, one of its major initiatives over the past few years is to “elevate the portrayal of caregiving in film and television.”
In its press release about the Creative Care Council, the organizations says:
”Throughout the next year, council members will meet with screenwriters and other content creators to develop more care-related storylines in TV and movies, share their personal care experiences with political and business leaders and help advocate for concrete solutions, and use their platforms to amplify other caregivers’ stories and spark a national conversation about care.”
How will this get a better car for the home health aide?
The answer, of course, is that another documentary will never deliver reliable transportation to the direct care professional. The direct care profession deserves a living wage. But the crux of creating that living wage for home health aides often means family caregivers can’t afford care.
A few years ago, the CEO of a large home care company said he knows his business can only serve 5% of the market because only 5% of the market can pay the price of his services. That disconnect between a living wage and providing affordable care doesn’t just happen in the private pay space. It’s also a reimbursement issue; providers offering services through Medicare and Medicaid can’t increase reimbursement rates. Medicare and Medicaid set those rates; providers have to figure out how to deliver care within a set budget.
The math never quite works — not for the direct care worker, not for the family caregiver, and not for the caree who needs consistent, stable, professional care. We haven’t solved this because it’s hard to solve a systemic problem involving multiple systems — provider, payer, financial, health care, medical, community.
I am sure we won’t solve it by putting caregiving storylines on television.
I’m struck that it’s not just the professionals trying to find my parents’ condo who lost their way. So many in our space have just lost their way, choosing to chase fame rather than create sustainable, impactful solutions.
We need to find our way into solutions that bring quality of life to everyone — the caree waiting for help, the family caregiver directing the help, and the professional standing in the parking lot after helping, hoping her car starts for the ride home.
When do you worry about the direct care professionals who provide care?
Cost of Care Economy Follow-Up
Last week, I wrote about the cost of our caregiving experience to our local communities. June, a member of our Caring Our Way community, calculated that she stopped spending $320 per month at her local businesses when her caregiving started. For communities that have 15,000 residents like June, that’s a monthly economic loss of $4,800,000. If the local community offered support to re-engage just 25% of those family caregivers, the local economy recovers $1,200,000. Calculate the cost of care to your community.
Resources
- I believe we can change the support family caregivers receive by training caregiving coaches. I’m sharing how to build that sustainable coaching business through a five-part series. Watch the first three in the series and join me for part four on April 18 at 9:30 a.m. ET (8:30 a.m. CT, 6:30 a.m. PT).
- Image by Stefan Schweihofer from Pixabay
