CAREGIVER RESOUCES Archives ⋆ Cathy Cress

Why are Care Providers for Clients So Hard to Find ?

September 8, 2021

Home care aides all over the US are AWOL. Care Management, home care agencies, nursing homes are severely understaffed and cannot find enough caregivers to staff cases for shifts. Why?

Disorganization of Home Care Industry

Staffing shortages have frustrated the home care and care management industry for

decades, according to Paula Hahn author of the New old Aging blog for the New York Times. . There is no national recruiting or training program for this huge industry.The home care industry has always been a hodgepodge of for-profit companies and chains, nonprofit programs and publicly funded care through Medicaid, all operating under a confusing welter of state and federal regulations, plus an uncharted “gray market” of clients who avoid agencies and hire privately. But Covid-19 has intensified the problem.

“I’ve never heard such frustration over finding workers, and I’ve been doing this for 20 years,” said Vicki Hoak, executive director of the Home Care Association of America, whose 4,000-member agencies collectively employ about 500,000 people.

Bureau of Labor Predicted this in 2020 -Pre-COVID

This was foreseen and was by the Bureau of Labor statistics. They predicted in 2020 that the long-term care sector would need to fill an additional 6.2 million direct care job openings between 2019 and 2029 as workers leave the field for a new occupation or leave the labor force altogether due to retirement, disability, or some other reasons. Combining these departures and new jobs, they projected a 7.4 million total direct care job openings in the decade ahead

Mammoth Growth in # of Seniors Who Want to Age

in Place

The bigger problem is the growing need for home care. Each day 10,000 seniors turn 65

in the US and the number of older adults will more than double over the next several decades to top 88 million people and represent over 20 percent of the population by 2050. . The majority want to age in their home and need home care, where today there are not enough home care workers to fill those jobs.

More $ Spent on Home Care than Nursing Homes

2015, was the first time nationally that more money was spent on home care than nursing home care. We’ve seen a culture and financing shift toward home and community-based care.”
Covid -19 now the Delta variant has wreaked more chaos into the home care market. Home care workers are mainly women and had to stay home with their children when school closed down. They were also hot hard by COVID themselves, working with seniors before a vaccine was developed.

Solutions to the National loss of caregivers

There are many other factors the loss of care providers and great solutions offered by Leading Age a national non profit for aging and home care.

Is Biden’s Caregiver Bill Really Infrastructure?

May 11, 2021

House Republicans Denounce Biden Caregiver Infrastructure Plan -Say It Is Not Infrastructure.

House Democrats defended President Joe Biden’s inclusion in his “American Jobs Plan” of $400 billion in support for caregiving, after Republicans criticized the package as stretching the definition of infrastructure and called on the White House to scale it back.

WHY CALL It INFRASTRUCTURE

The word “infrastructure” means something solid, essential, distributed and in the public interest. But as we have all learned in the pandemic year, care infrastructure is just that: UNPAID OR LOW PAID Caregivers are “rocks” and the solid foundation upon which the economy works. Without it, our families, our paychecks, our labor force participation, our workplaces all decline and we all suffer and collectively fall behind.

Like sagging bridges , unpaid women caregivers hold up the care infractstruce. In 2017, AARP found that about 41 million family caregivers in America perform roughly $470 billion worth of unpaid labor a year. Since then, the number of caregivers has increased to 53 million, meaning that more than one out of five Americans are unpaid caregivers, according to AARP’s latest report.

The Care Infrastructure Collapsing

From February 2020 to January 2021 more than 2.3 million left their jobs, and that puts women’s labor force participation rate at 57%, the lowest it’s been since 1988. This was due to a lack of childcare and closing of schools due to COVID when 39% of women family caregivers leave their job to have more time to care for a loved one.

Caregiving for an elder reduces paid work hours for middle aged women by about 41 percent. In total, the cost impact of caregiving on the individual female caregiver in terms of lost wages and Social Security benefits equals $324,044. 34% leave because their work does not provide flexible hours.

HOW MUCH WOULD IT COST GOVERNMENT IF FREE CAREGIVERS QUIT

Let’s put that free caregiving into context.At $470 billion in 2013, the value of unpaid caregiving exceeded the value of paid home care and total Medicaid spending in the same year, and nearly matched the value of the sales of the world’s largest company, Wall-Mart ($477 billion). [AARP Public Policy Institute. (2015). Valuing the Invaluable: 2015 Update.]

So in 2013 the US Government would have to come up with $477 billion to replace free caregiving.

Let’s put that free caregiving into 2017 context. AARP notes unpaid caregivers’ economic impact was more than all out-of-pocket spending on U.S. health care in 2017($470 billion)and the total combined value added to the U.S. economy by the agriculture/forestry and mining sectors ($438 billion) that year.

So caregiving was not free, the US would have to come up with $477 billion in 2017 to replace it.

WHAT IF UNPAID CAREGIVERS Totally COLLAPSED

If all these unpaid family caregivers stopped caring the national caregiving system would collapse, like dangerous American bridges .Then the US government would have to come up with $470 Billion to replace free caregivers or put all elderly in nursing homes , which are havens for disease spread , which we know from the pandemic making them a holocaust of death. Congregate nursing homes and have become a broken national system since COVID.

So Biden has brilliantly found a way to avoid the $470,00 billion bill and instead create jobs that will keep elders at home cared for through home health care paid through Medicare.

What Will Biden’s Investment Create- in Jobs and the Economy

Sixty-five percent of the jobs — approximately 1.5 million jobs —resulting from Biden’s investment would be in child care, residential care, and home health care. An additional 225,000 jobs can be created or supported in sectors that support care work, and over 500,000 jobs would be supported in other sectors as direct care workers spend their wages on goods and services.

Biden’s Plan of investing $77.5 billion per year would support over two million new jobs, at an average cost of $34,496 per supported job. Over 10 years, this translates to 22.5 million new jobs. Annually, a $77.5 billion investment in new jobs translates into $220 billion in new economic activity.

So find your local representative and tell them to support Biden’s bill if you care about aging or caregivers or women or shoring up the frayed- fraught care infrastructure.I have done a series of blogs on the bill . Check them out now

What Does Biden’s Infrastructure Plan Do For Family Caregivers?

April 26, 2021

What Does Biden’s Caregiver Infrastructure Plan Do For Families?

President Biden’s Caregiver Infrastructure plan will help families -the very infrastructure that supports elders as they age. What do I mean? Currently, 53 million family members provide most of the care that vulnerable seniors and people with disabilities require — without being paid as Medicare does not pay for long-term caregiving.

Family Members Provide Care for No Pay

There is often a significant financial and emotional cost to these family caregivers. According to AARP, family caregivers on average devote about 24 hours a week to helping loved ones and spend around $7,000 out-of-pocket on that care.

The value of this unpaid labor force is estimated to be at least $306 billion annually, nearly double the combined costs of home health care ($43 billion) and nursing home care ($115 billion)

Medicare Does Not Pay for Custodial Caregiving

Families are shocked when they discover that Medicare does not pay for custodial caregiving or long-term care. This is the type of care that most elders will eventually need as they age. They will pay for short-term care post-hospitalization. So most elders must depend on their families for this care or if they are in the upper 10-15% pay for private duty home care which can run up to $4000-$6000 a month if they need 24-hour care, creating severe inequality in out care infrastructure.

Some Family Caregivers Can Be Paid Through Medicaid and the VA

Although family caregivers and actually in-home care is not paid by Medicare, some family caregivers are paid through the VA and family caregivers supporting a relative on Medicaid

In the US 1-5 Americans receive Medicaid. which is only available for low-income individuals.VA Homecare is only available to veterans with specific criteria

Biden’s Caregiver Program May Help Medicaid Family Caregivers

The median salary for these home-care workers, who care for low-income Medicaid recipients, is approximately $17,200 per year, said Leslie Frane, executive vice president at SEIU. This is in large part because the United States pays only limited amounts to states to compensate them for Medicaid care in the home. More than half of home-care workers are on some form of public assistance themselves such as food stamps, Frane said. They are overwhelmingly female and far more likely to be people of color than the general population.

Being a Caregiver on Medicaid Comes at a High Personal Cost

Being a caregiver for a family member presents incredible hurdles for all family caregivers but under Medicaid comes at a high cost. .Caregivers often have to significantly reduce their number of hours working outside the home or leave their jobs entirely in order to provide quality care for their loved one. This means that caregivers are spending hours assisting loved ones with daily tasks, cooking meals, taking them to appointments, ensuring their safety and well-being, and providing companionship, but are not being compensated for their time.

Biden’s Health Care Plan May be Unveiled This Week

As I mentioned in my last blog, there are still few details about how Biden’s Caregiver Infrastructure Bill of $400 million will be allocated. However, there is reason to believe that a large part will go to these family caregivers who support their elderly relatives on Medicaid.

We may get a hint of what and when that will be this week when Biden will discuss changes in Heath care he will include in the will try to include in his American Family Plan.

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Can a Caregiver Assessment Avoid UnnecessaryPlacement ?

April 9, 2021

When a Caregiver is so Overwhelmed that A SNF is a Choice but a Very Bad Choice

If the family is so overwhelmed by the care that they are considering placement, this threat should trigger the GCM to do a caregiver assessment immediately, found in the Handbook of Geriatric Care Management If the GCM is called to relocate an older person and the underlying cause seems to be caregiver burnout, this can be another trigger to use this valuable GCM tool. By using a caregiver assessment the geriatric care manager may find that building respite for the caregiver, through other relative or paid caregivers, a caregiver support group, or coaching the caregiver to make changes that make her/ his tasks more bearable and doable and avoid inappropriate placement of the older person

Avoid Elder Physical Abuse Though a Caregiver Assessment

If caregiver abuse is suspected, a caregiver assessment is a critical immediate tool. This is a situation where the GCM must contact Adult Protective Services, following their own state’s laws. Elder abuse can be triggered by caregiver stress in some situations. Depression that reaches a clinical level in a caregiver can be predictive of elder abuse of an elderly client can prompt a GCM to do a caregiver assessment. You should also do a geriatric depression scale at the same time. Use the GDS and the caregiver assessment to help both the caregiver and the care receiver and avoid the risk of physical abuse and prevent involvement of APS making the caregiver and care receiver’s lives even more painful and chaotic and risking placement in a nursing home.

Mrs. Handy has Two Dads in Her Head

Let’s take the example of Mrs. Handy, a caregiver daughter caregiver She calls a GCM as she is about to place her Dad. Besieged by so many other stressors, her own health is deteriorating because she cannot get any sleep, due to her Dad going to bed so late and her inability to rise above her old self when her Dad was 40 and she was 19 and what he said she did. Now he is 70, very impaired with vascular dementia, incontinent and she needs to be who she is in the here and now a woman of 40, caring for an impaired Dad in her 70’s. The care manager coached her to set a new boundary for him to go to bed early. She needs help in getting rid of the old parent in her head and putting the 70-year-old demented incontinent parent before her. In addition, she sees her doctor for depression, joins an online caregiver support group, and asks siblings in other towns to take her Dad once a month for a week. Her Dad is not moved to skilled nursing. This is what a geriatric care manager can do for her to help avoid unnecessary placement.

Find out more on my playlist “Caregiver Assessment” on My Youtube channel Geriatric Care

Caregiver Assessment- What Does It Takes Professionally ?

March 30, 2021

Doing TWO Assessments

To meet the needs of the whole aging family, the care receiver, and the caregivers, GCMs need to begin assessing the caregiver as well as the care receiver. There is a synergy between the caregiver and client – they are interdependent. If the caregiver is stressed or weak the client does not receive good care. They both suffer without supports that a care manager can give them.

A caregiver assessment helps the GCM see this faltering interdependence by using a caregiver assessment. The National Center on Caregiving at the Family Caregiver Alliance calls this a process gathering information describing the caregiving situation and identifying the family caregivers’ particular problems, needs, resources, and strengths. This means that the care manager can see issues from a caregiver’s perspective and can focus on what supports they need to give them the best care. The GCM compares this to the client’s assessment of needs. The result of doing two assessments is discovering both the client/ care receiver needs and restore health and well-being, prevent poor care, client injury or illness, caregiver burnout, trauma or quiting, and unnecessary placement in a nursing home.

Create a Circle of Care

One resource that a GCM can bring to a caregiving family is what Gail Sheehy calls a circle of care. To create this supportive connection, the GCM needs to take her or his coaching skills and put together a support system around the formerly isolated, solitary family caregiver. The GCM can coach the family caregiver to ask for help so the GCM can assist in reorganizing the family so adult siblings can share in the care of the older client with the identified family caregiver. The GCM is what Sheehy calls a compassionate coach who can help the beleaguered caregiver attract and assemble a platform to keep on giving the care she or he wants to give the aging person.

Caregiver Resources

A circle of care includes emotional resources for the direct family caregiver. These emotional resources could and should include adult siblings. Reconnecting midlife brothers and sisters, through the circle of care, is an important GCM task, as siblings are the longest and deepest relationships in any person’s life. The GCM may have to depend on his or her clinical skills in helping siblings with forgiveness or reconnecting siblings who live long distances apart to add them to a circle of care. Midlife siblings have often spent the last 30 years tending to their own families, so the point of reconnection of midlife brothers and sisters often happens when they are in middle age in the midst of a crisis in parent care. This is where the GCM needs to employ clinical skills in midlife sibling work or to find the resources for the family to help with this healing sibling reconnection.

Can a Caregiver Assessment Avoid UnnecessaryPlacement ?

When a Caregiver is so Overwhelmed that A SNF is a Choice but a Very Bad Choice

Avoid Elder Physical Abuse Though a Caregiver Assessment

Mrs. Handy has Two Dads in Her Head

Find out more on my playlist “Caregiver Assessment” on My Youtube channel Geriatric Care

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