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Column: It is time for America to invest in our undervalued caregivers

For the Valley News
Published: 5/11/2021 10:20:04 PM
Modified: 5/11/2021 10:20:02 PM

There is undeniable irony in the world of caregiving. When we are ill we see the doctor or the nurse practitioner. Whether it’s in the clinic or the emergency department or the rehabilitation facility, we are cared for by the aide. The aide can have many titles: CNA, LNA, RSP, RA. Some are formally trained and others have learned on the job.

What many have in common is poverty.

They are the front lines. They are the eyes, ears and definitely the nose of the nurses and doctors. A good aide will be the first one to report a medical anomaly, catching an illness, bed sores, depression, unexplained pain, etc., in their infancy. They will persist if a problem is not addressed. A good nurse or doctor will say thank you.

Many aides will work long hours to earn overtime to try to make ends meet. This affords them no time with their own families and “too much income” to qualify for assistance. Many are single parents. Most are women. Many are working for agencies that offer a bit more per hour. Most are uninsured. When they call out due to illness, they don’t get paid.

Let me take you through a typical day for most aides:

They arrive at work in clean scrubs and wash their hands. If they work in a skilled facility, such as a nursing home, they begin care immediately. They wake Mrs. Jones up, change her adult brief, mark down that she has urinated and defecated in the brief. If Mrs. Jones had diarrhea or complaints of pain with urination, it’s reported to the nurse. If Mrs. Jones has a bed sore on her right buttock that is oozing exudate, it’s reported to the nurse.

Mrs. Jones needs a “stand pivot” transfer into her wheelchair, which requires the aide to steady herself between Mrs. Jones and the chair in order to lift her with a gait belt and safely place her in the locked chair. Mrs. Jones is assisted into the shower chair and bathed by the aide. Her teeth are brushed by the aide. Her hair is braided by the aide. Her deodorant is put on by the aide. The aide puts Mrs. Jones’ compression stockings on after drying her legs.

Mrs. Jones is at risk for aspiration, so the aide reminds the nurse that she will need a pureed breakfast and thickened fluids. Mrs. Jones is also diabetic, so the aide reminds the kitchen not to give her pureed pastries. The aide reminds the nurse that Mrs. Jones will need her a finger stick to determine her blood sugar levels prior to breakfast.

Mrs. Jones is crying, so the aide sits with her for a moment and rubs her back, chatting with her about her late husband. In an hour, Mrs. Jones will need to be toileted again. The aide washes her hands and proceeds to assist 10 more clients.

After 8-12 hours of nonstop work, the aide goes home to her three children, who are being cared for by her elderly mother. She makes dinner, checks that homework is done and puts everyone to bed. Then she has to get up at 5 the next morning for the 45-minute commute to work.

I have been a nurse for eight years. I started as an LNA, a licensed nursing assistant, and am now a registered nurse. It is blood, sweat and tears — and a great deal of urine and feces. The caregivers I have known over the years have been in varying states of financial distress. Some have lived in tents with their children during the warmer months because they have been evicted or their rental house was sold by the owner. Many of them are just a whisper away from homelessness. Many pack their families into cramped quarters. None of them can afford to purchase a home.

Some of them are caring for more than their own children or they are caring for their grandchildren. Some have lost everything they have because of a family illness. None of them can retire comfortably. The aides who are expected to give exemplary care to our loved ones are not eligible for that care when and if they retire.

President Joe Biden’s infrastructure plan contains a provision for caregivers, and he highlighted them in a March 31 speech in Pittsburgh: “For too long, caregivers — who are disproportionately women, and women of color, and immigrants — have been unseen, underpaid, and undervalued.”

The $400 billion earmarked for elder care has been largely criticized as having nothing to do with infrastructure. Really? Our parents are living longer. Chronic illness can go on for years and has replaced acute illness as the leading problem for older adults. Elderly parents are not cared for by their working adult children. When will we recognize this as a real phenomenon? According to the Institute on Aging, the number of older adults entering care facilities tripled between 1992 and 2009. The number is only going up.

The number of aides necessary to care for a fast-growing older population is huge. As older adults enjoy the benefits of a longer life, shouldn’t we invest in excellent care? Who else should care for caregivers than the American families who rely on them every day?

Better care starts with paying our caregivers a dignified wage and providing benefits and insurance to them and their families. Let’s improve the quality of life for the aides who ensure that quality of life to our elders.

Susan McCarthy, of White River Junction, is a registered nurse who works at a residence for disabled adults in New Hampshire.




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