By Rosanna Fay
Why would California keep in-home caregivers of the disabled and elderly in the same “domestic workers” category as housekeepers?
Having worked with my elderly parents’ caregivers, I can’t help seeing this as one of two dangerous flaws in California’s AB 241, which went into effect in January.
True, the definition originating from a painfully outdated provision in the federal Fair Labor Standards Act will ensure overtime payments for long hours. But it’ll hardly solve the underlying and more important issue we face: quality of care.
This is the bill’s second dangerous flaw.
In 2008, my brothers and I hired professional caregivers for our parents. Our father was suffering from congestive heart failure, and our mother had an invasive brain tumor. Living far away, we agreed that to respect their wishes to remain at home, at-home care was required.
Despite using professional agencies, our yearlong experience was one disaster after the next. One caregiver forced our mother to stay in her room for 36 hours without food during her final days. Another totaled my father’s car while he was in the passenger seat. It turned out she didn’t have a license. Others stole clothing and food.
The most disturbing discovery was that a caregiver who appeared to be exceptionally conscientious had been taking our father’s morphine.
From other families’ stories, I don’t believe this experience is unique. The fundamental reason for this poor quality is in-home caregivers’ lack of education and training.
While some are performing light household duties, many are working with visiting nurses or hospice and need to grasp basic medical concepts and caregiving techniques. Yet all too frequently caregivers don’t understand the disease symptoms they are hired to monitor. Overtime pay might reflect their long hours, but the consumers who’ll wind up paying more should also be able to raise their expectations.
Much has changed since the “domestic worker” label was minted in 1974. There weren’t an estimated 9 million individual Americans over the age of 65 being cared for at home. Nor was that number predicted to grow as it is today: every 8 seconds a baby boomer turns 65, and each year 1.5 million people turn 85.
This means the number of in-home caregivers will have to explode from today’s 1.9 million to at least 3.2 million, and a staggering number of seniors will soon be receiving poor care.
Improving the system will clearly hurt financially. Families will have to pay more. Agencies’ profits will take a hit. Caregivers may find their schedules reconfigured. Their job prospects might be redefined.
To help share the pain, caregiver agencies need to rethink this broken model and envision an entirely different, higher-end caregiver: one who is educated and trained to use home telehealth technologies, which can both improve quality of care and keep agencies profitable.
Second, families urgently need to create viable care plans before a crisis hits. Aging boomers who want to age at home must also create an appropriate financial plan.
As for caregivers, they’re caught in the middle of a broken system and aren’t to blame.
A state as influential as California could do something groundbreaking instead of mimicking initiatives by Massachusetts and Illinois. For example, if it used the Sunset Provision in AB 241 to remove the “domestic workers” label and legislate higher training standards, then both seniors and caregivers may stand a chance.
Rosanna Fay is a former high-tech marketing executive turned aging-in-place consultant after her experience in helping her own parents. She is the author of “Careless Caregivers: True Eldercare Stories.”