Do programs like Family Care encourage dependency?

A reader commented on Family Care and other programs like it:

Even though I see a lot of effectiveness with the program, I see first hand the abuse. The money spent on providing care for someone who should be challenged to do more for themselves.

The extensive equipment that is purchased so that the client has everything they want regardless of whether they physically need it or rather should have it.

Paying of family members to provide care even though the client should re-trained to do it themselves as well as family members who should want to care for others out of love not money.

I am hopeful but not optimistic that as the population ages, more people will realize that we need to help seniors HELP THEMSELVES so as to age more gracefully and safely.

Are too many clients being overserved, having things done for them that they could do themselves? Are we “enabling” older adults to be dependent? I’m hoping some of you will continue this discussion, because I don’t have any professional knowledge about it.

I do have personal experience with my mother, who’s now over 85, living in independent senior apartments, and needing more help to get along. She’s frail and no longer drives. Judging by this brave woman, who's always made decisions that would keep her independent and not "burden" others, elders eventually reach a point at which no amount of retraining can compensate for lost health and abilities.

And daughters like me are pressured by jobs to support their families and responsibilities to their own children. That can get in the way of expressing love through caregiving the way we might like to do it.

Close to home

There are only four kinds of people in the world: those who have been caregivers; those who are currently caregivers; those who will be caregivers; those who will need caregivers.

Oh boyhowdy, was Rosalynn Carter right about that!

There’s another group, though: those of us who should – or would like to - be caregivers but can’t and feel guilty about it.

I’m in that group. While Mom lives independently in senior apartments, she can’t drive anymore and needs help with transportation and other things. Because she lives in Oshkosh, and because I’m a sandwicher with kids still at home, my sister and niece share the privilege and responsibility. I know my sister is overwhelmed sometimes, and tired often.

A friend of mine e-mailed me today to explain that she wasn’t coming to our women’s group meeting tonight because she was in California. Her mother had a bad fall and had been having a rocky recuperation.

I'm flying back to Milwaukee Wednesday. My sister-in-law will be here for a couple of days. The big question then becomes whether or not Mom and William will accept the amount of home-health assistance Mom really requires for as long as she requires it.

Concerns about caregiving are everywhere, if you talk to people long enough. Without a “seamless” system of caregiving, everyone has to figure out how to patch together a net of help that eventually goes beyond family and friends.

The umbrella name for all that’s needed, I’ve recently learned, is longterm care. I used to think that meant nursing homes!

In Milwaukee County, we’re fortunate to have Connecting Caring Communities to help in “developing partnerships to improve long term care and supportive services systems to meet the current and future needs of older adults” and in getting the word out on longterm care.

And then there's Elderlink, a great centralized source of information and assistance. Calling 414-289-6874 opens the doors of information to the county's older people and those who are helping them.

Maybe later we can talk about the two elephants in the room when we're on the subject of caregivers this subject. The first is public policy for a national system of caregiving: there isn’t one.

The second is gender: caregiving is largely a woman’s issue. The white paper Caregiving in America, prepared in conjunction with the Caregiving Project for Older Americans and available online, found that 90% of unpaid caregivers are women. And most of the people they care for are women. Especially when you enter the domain of the old old, those over age 85.

Mom, if you're reading this: you don't look old old, though I know sometimes you feel it.

What's a job worth?

Most prognosticators seem to agree that in the new year, the rich will get richer and the rest of us. . . won't.

Ex-CEO Bob Nardelli will be given $262 million to walk quietly out the door of Home Depot in one day. Meanwhile, most of us will earn the same amount we earned last year, more or less, even when the people we work for are delighted with our performance.

Flat wages and increasing costs of living are especially a problem for direct caregivers.

In Wisconsin, the average wage for nursing assistants, home health aides, and personal care aides is $10.37 an hour (National Clearinghouse on the Direct Care Workforce. That's $5.35 an hour less than the "self-sufficiency" hourly rate for a full-time worker with one child in Milwaukee County (The Self-Sufficiency Guide for Wisconsin).

Why does a home health aide make $9.68 an hour while a copy-machine repair technician makes $17 an hour as a trainee, $22 in the field afterward? Aren't our parents and our children as valuable as our office machines?

Of course they are. But we don't need copy machine technicians 24/7, and the ratio of technician to machine is much higher than the ratio of caregiver-to-care-needer.

Then there's the elephant in the room: caregiving is still largely a woman's job, whereas copy machine repair is. . . not. At least not traditionally. And in Wisconsin, even for the same job, women make 71 cents for a man's dollar.

I think every job should afford a person who works it full-time and does a good job the income to be self-sufficient--have enough food to eat, a roof over his or her head, health care. . .

But how do we accomplish that? Even non-profit organizations need to have enough money (margin) to do their job well. As the head of a Catholic hospital I once knew always said, "No margin, no mission."

It would be hard to dispute that reimbursement isn't high enough and costs keep rising. Institutions face problems with money-in versus money-out, too, but on a larger scale.

And it would be easy to get discouraged and overlook the accomplishments of so many astonishing people who dedicate their lives to this work. Then we remember programs like Wisconsin's admirable pilot Family Care to improve choice, access, quality, and cost-effectiveness in long-term care.

Disclaimer time: please remember that these are my personal ruminations, and while this blog is for issues near the heart of The Milwaukee Aging Consortium, they aren't the Consortium's notions. Our members are both caregivers and organizations that hire them. Everyone is committed to making the lives of older people better, but there will always be differences among us about how to do that. Let's talk about it here, in the interest of better understanding--and finding win-win-win solutions!

One thing that might help: taking some of the burden of health insurance off the employer's back. Governor Doyle wants to expand Badger Care to cover all children in the state. That's a noble goal, but what about covering all people in the state? I'm buying the evidence that a statewide plan for everyone could be much less expensive for both the employer and the employee.

What's your take on this? How can we help employers, employees, and the people we serve to thrive, not just survive?