A Fair Wage for Caregivers

The New York Times recently ran an editorial advocating that home care workers be paid in accordance to federal labor laws that cover other employees, including paying at least minimum wage and overtime.

Currently in several states home care workers can be covered under a “companion” exemption and paid less than minimum wage, with no overtime requirements.

One the one hand, I completely support this change. I believe that ALL caregivers should be paid a fair wage. Far too many caregivers, in a variety of care settings, are paid so poorly that they are eligible for food stamps, Medicaid and other benefits that we all end of paying for. In addition, poor pay is a leading cause of turnover and the inability to attract the best and brightest individuals into this field. That hurts all of us.

Let me play devil’s advocate for just a moment, however. Let’s say that my mom needs someone at her home 24 hours a day. She needs assistance to the toilet, and someone available if she should fall during the night hours as well as during the day.

During the daytime while she’s awake, my mom needs a considerable amount of assistance – bathing, dressing, meal preparation and laundry, for example (in this hypothetical situation). At night, she sleeps soundly with rare exceptions, at least 8 hours each night.

With a minimum wage requirement, I’d be forced to pay at least $7.25 per hour for the nighttime person, even if they slept through almost all nights. With the companion provision, I’d might be able to pay a flat rate for nighttime that would allow me to keep my mother at home longer. I’d also be able to have a caregiver, conceivably, work evenings helping my mom get ready for bed, then sleep through the night. The caregiver might be “working” 10 – 12 hours, but actually sleeping 6-7 hours of that time. The change in the law would require overtime pay at a minimum of $10.88 per hour for those extra 2-4 hours each evening.

In the end, the round-the-clock care would cost me at least $175 per day, not including the time I need to cover meals and breaks. That’s over $5,000 per month. According to Genworth Financial, the average monthly rate of assisted living is $3,008 (2008); clearly, that would be the more financially feasible solution.

It’s a challenging dilemma for all of us to consider. I think it’s possible that business interests may well create their own solution. Agencies employing home care workers that treat those workers fairly and pay them well will retain their workers. Their reputation will grow and they’ll experience success.

Conversely, those agencies that choose to cut corners on pay and benefits will see the results in high turnover, resulting in poor services and an even poorer reputation.

Today, home care agencies are expanding at an exponential rate. Communities – and families – typically have more than one choice. If we do our own due diligence as consumers and check out the reputation and turnover rate of an agency before we sign up for services, we may be able to directly affect this process and support those that treat their workers well and fairly.

For those who have no choice – typically those receiving publicly funded services - we may well need to change the law to support those who provide the most basic care for our loved ones in their homes.

Of caregiving and budgets

It’s a very sorry state of affairs when California needs to cut essential services to seniors and their families to help balance the budget.

Earlier this month the Los Angeles Times ran a news story about governor Schwarzenegger’s proposal to shut down state supported day health programs, many designed especially for elderly or individuals with Alzheimer’s disease.

Anyone who has cared for an individual with Alzheimer’s knows what a daunting task this is. Not only is there a constant need to anticipate the desires of the person in your care, but there is a constant need for safety supervision.

Usually, quality of life is only a phrase in someone else’s vocabulary – not even a consideration when you’re just trying to get through the day. There are behavioral challenges and wandering issues; nighttime awakenings and daytime confusion. All in all, families who provide this care deserve every bit of support that we, as a society, can give them.

One of the program directors involved estimates that families facing the loss of day programs will have little choice but to seek nursing home care for their loved one, usually at the state’s expense.

What seems like a savings of $385.8 million could, estimates Debra Cherry, end up costing the state many times more if nursing home care is needed for these individuals.

That’s the economic reality. The personal reality is much more heartbreaking and, well, personal.

Join the healthcare debate

According to the recent New York Times/CBS poll, the majority of Americans wants a government run healthcare system and would be willing to pay extra taxes for it. Of the people participating in the poll, 85% reportedly believe the healthcare system needs to be “fundamentally changed or completely rebuilt.”

Google the words “healthcare poll” and you’ll find articles from the Wall Street Journal to bloggers on the street debating this subject – usually in no gentle terms.

I’ve been reading the letters to the editor in my own local paper, though, and repeatedly I see the support that the New York Times' poll expressed. People are tired – exhausted, actually – with the constant fear of bankruptcy and ruin because of the high cost of health care.

Oh sure, most of us have insurance. But most of us also know friends or family members, if we haven’t experienced it ourselves, who had insurance but who still experienced the nightmare of our healthcare system’s dysfunction.

Like my friend, Melanie, who has been clean of her dual-sited cancer now for more than two years. The medication she takes to keep her that way costs nearly $1,000 per month. That’s the co-pay after her insurance kicks in its share.

Or my oldest daughter who, at age 23 is still on our family health insurance plan. In the current job market, she is unable to find a job that includes health insurance, or pays enough to allow her to purchase her own private coverage. She’s a college grad and a willing worker, but she’s stuck.

One person writing in to our local paper notes, “I’ve been driving on ‘socialized’ streets all my life, and sending my kids to ‘socialized’ schools. It works reasonably well in those areas – what’s so awful about the idea of ‘socialized’ medicine?” Used in this way, the term “socialized” simply means “publicly funded.” Seriously, what IS so wrong about that?

My favorite line from the entire last season of the TV show, Desperate Housewives, occurred when Teri Hatcher’s character, Susan Mayer, was arguing with her old boyfriend who now wanted to marry her to avoid being deported back to Canada. Frustrated with his demands, she resists, saying, “It’s Canada – it’s not Iran. It’s like American, but with free health insurance.”

People from this country often point to Canada as an example of healthcare gone wrong. Maybe it’s different now, but as a graduate student many years ago, living in Canada and paying for student coverage in the national health insurance program, I loved it. Despite a series of minor health problems, one of which required outpatient surgery, worries about cost or access never once took my mind off my studies or my future. I was covered, for whatever I needed. I was free to choose my own provider, and I recall no long waits for appointments, either. What I remember was a series of health care professionals who treated me with respect, educating me about my condition and my needs and inviting me to participate in the decisions about my care.

As the population of the United States ages, we’ll all experience more health care needs. We’ll all pay for it, too, one way or another.

From my daughter, who would likely require publicly supported health care with one major illness or accident, were she not on our policy, to my grandmother, who is on the waiting list for a Medicaid-funded nursing home bed in her small town; we all pay the price of healthcare.

Let’s find a system that, like our schools and roads, offers access to everyone, no matter what their income level. Let’s include long term care in the conversation, as well. Our roads may not be perfect and our schools may have challenges of their own, but in these areas at least we can boast some level of world leadership. In healthcare? Not so much.