Mathilde Spett of Dallas says she owes her happiness and maybe even her life to the woman who comes to her apartment in the morning and stays until dinnertime. Spett, who's 91, injured herself in a fall early this year and was also found to have diabetes. But she recently graduated from a walker to a cane and learned how to follow her diet.
She credits her home care aide, Marilyn Ferguson, for her progress. I was pretty low, but Marilyn's brought me back. We just enjoy each other's company, she said.
Tomorrow's seniors may not be as fortunate in finding someone like Ms. As boomers begin encountering the frailties of old age, the nation will face a widening care gap that experts fear will compromise the quality of home care and force people into nursing homes too soon. Americans have presumed they'd always have an endless supply of personal care aides to look after their mothers and fathers, and eventually themselves, but they're mistaken, Steven Dawson, president of the Paraprofessional Healthcare Institute.
Experts predict that the nation will need 1 million more home care workers by 2017 and as many as 3 million more by 2030, when all 78 million surviving baby boomers are older than 65. There are now about 1 million aides. The nonmedical aides, who are often middle-aged women, come into the homes of disabled older adults and help with bathing, dressing, meal preparation and everyday chores.
Unlike home health aides, they don't do physical therapy or handle medications. Many work through home care agencies, while others work directly for families. Most seniors pay out of pocket or tap their long-term care insurance policies for the in-home care, but some on lower incomes qualify for help from Medicaid.
Supply and demand The growing demand for the care will come from a doubling of the 65-plus population in the next 25 years and seniors' preference to remain out of nursing homes. Also, more families are relying on paid caregivers because more women work than in previous generations and can't attend to elderly parents during the day. Meanwhile, the traditional labor pool for home care workers will barely increase.
Immigrants will answer some of the demand, but the women who typically went to work as caregivers now have better-paying, less demanding options in other fields. The job requires a lot of patience, a tough skin and a big heart, said Bill Dombi, a vice president with the National Association for Home Care and Hospice. The median annual wage for home care aides was $17,710 in 2005, according to the federal Bureau of Labor Statistics.
That's about what store cashiers and maids make. About half of home care workers lack health insurance, the AARP Public Policy Institute says. If a caregiver has coverage, it's usually because of a spouse or another job.
Florene Murphy, who's been a caregiver for much of her 40-year working life, gets $9 an hour for most of her home care. She averaged just $4 an hour when she was a live-in aide on duty around the clock for five days each week. That job wore me out, she said.
I was afraid of becoming a patient myself. Murphy estimates she earns $10,000 to $20,000 a year, depending on the number of hours she works. She says she makes ends meet by living in a sparsely furnished, government-subsidized apartment in Dallas that costs her $80 a month.
Underscoring the stark economics of home care aides, the U.S. Supreme Court ruled in June that federal minimum wage and overtime laws, as currently written, don't apply to them.
A home care worker in New York had filed the lawsuit because she sometimes worked 70 hours a week without receiving time-and-a-half pay for overtime. If we don't find a way for people to earn a living wage from home care, we won't get the workers we need, certainly not good ones, said Dr. Larry Wright, co-director of the Caregiving Project for Older Americans, a national panel of experts studying the issue.
A sense of mission Because of the low pay and few benefits, home care aides must often explain to others why they do what they do. Almost all say they're motivated by a sense of mission. They see it as a calling.
Many have cared for their own parents and discovered how emotionally rewarding it is and then try to help other families, said Lori Nesler, who owns two ComfortKeepers home care franchises in the Dallas area. Ferguson, who cares for Ms. Spett, said she had been a teller at a credit union but found she had an interest in caregiving when she offered to help a neighbor look after his wife, who was suffering from Alzheimer's disease.
I got so much satisfaction from doing that, she said. I just had to find a way to continue. Ferguson, who works for Home Instead Senior Care, drives Ms.
Spett to the doctor, does her laundry, prepares lunch, runs errands and lifts the woman's spirits. Many home care aides say they like the flexible hours. They can work as little or as much as they like and fit their assignments around the rest of their lives.
Senzeni Achodo, who emigrated from Zimbabwe six years ago, is studying to become a nurse and paying for her schooling by caring for an older woman through the Home Helpers agency in Dallas and attending to another woman on her own. It's tough some days, but I know I need an education to get ahead in America, she said. Achodo will be one way for home care agencies to meet the growing demand for aides, experts say.
Another will be tapping older adults who want to stay active during retirement and supplement their Social Security income. We see a great opportunity for seniors caring for seniors, said Paul Hogan, president of Home Instead Senior Care. Boomers say they're going to work, either for money or personal interaction.
Mathilde Spett of Dallas says she owes her happiness and maybe even her life to the woman who comes to her apartment in the morning and stays until dinnertime.
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