From Mohamed_hassan [Image], 2024, Pixabay (https://pixabay.com/vectors/family-silhouette-care-love-walk-8763098/). CC BY 2.0
There are four kinds of people in the world:
Those who are currently caregivers,
Those who will be caregivers,
And those who will need caregivers.
- Rosalynn Carter
I have been thinking a lot about the term “Caregiver/Caregiving”? What does caregiving mean? An opportunity to have meaning and purpose in one’s life to help others AND the challenges that can be overwhelming in the service of others. In healthcare, we are all caregivers from our training. For me, I have been in this role of a trained caregiver since 1991, when I became a nursing assistant at a rural nursing home, after a quick six-week training when I was 14. I made $4.25/hour for long hours and assigned to 30 residents for their ADL’s in an eight-hour shift. Of course, for those of you who know me in this room, this did not shy me away from moving into healthcare, rather, just drove me to continue my education (with support of my parent’s) to a place where I did not have to do this most challenging yet extremely rewarding work.
Shift to today and reflecting on my direct care worker role back then, a June 2024 report titled: Together in Care: Empowering Direct Care Workers and Family Caregivers to Meet Growing Demand for Care, a PHI, Quality Care through Quality Jobs, headquarters in New York and National Alliance for Caregiving, headquarters in Washington, D.C. created an Issue Brief. This has some most enlightening and frightening concerns.
They report there are: 4.8 million direct care workers. They define direct care workers as personal care aides, home health aides, and nursing assistants who are supporting older adults and people with disabilities in settings such as: private homes, residential settings, nursing homes, and other care settings across the US. That was me, back then.
Yet, still today, these jobs have poor job quality, with a median pay of $15.43 per hour and prevalence of part time hours, and this workforce relies on public assistance for themselves, with more than a third, approximately 39% living in or near poverty. They have limited access to health insurance, lack of paid time off, insufficient training, limited advancement opportunities, high turnover and shortage at a time of growing demand. Despite these contextual and structures built into the broken healthcare system, most importantly, they have lack of recognition and respect for the most important work that they do. Fast food and retail pay better with better quality of jobs.
Yet, we have a critical mass of those who will need caregiving from these folks. We all heard the stat’s about the population who is aging, but this hit home for me.
In 2016 to 2060, a 44-year spread, the population of adults 65 and older in US projected to nearly double form 49.2 million to 94.7 million, with a project 9.3 million direct care jobs needing to be filled.
That’s me in this group, in 2060, I will be 86 if I am still hanging around this side of earth as we know it without any direct family such as children, as me and my partners do not have children. We have and are planning to need the services of direct care workers, but the lack of these folks creates an ongoing discussion between me and my partner and what this might look like when our time comes to need the support.
Continuing the conundrum of my present day: both me and my partner have parents who are aging. On one hand, I feel wonderfully privileged to have all four parents still alive to support and have realized the impacts of them, impacts on me, when urgent hospitalizations for more critical exacerbations of illness have occurred, and that little post hospitalization functional changes that are never quite as good as they were before they were hospitalized. I know their need for adding more support as each day passes and trying to plan for when the need arises. Of course, this is based on my insider knowledge as a healthcare trained caregiver. To be honest, I wish somedays, this insider knowledge could be quieted in my mind, and I could float along with more oblivion as most of the world lives in.
The National Alliance for Caregivers/AARP 2020 report define “Family caregivers” defined as “ any adult who provides unpaid care of support to a family member or friend.” This report goes on to describe the demographics of these family caregivers. Approximately, 1 in 4 (24%) are aged 18-34, nearly half (47%) are under 50. More than 1 in 3 (35%) are aged 50-64, and 1 in 5 (19%) are 65 or older. With majority, 61% are women. With 1 in 4 family caregivers (24%) caring for multiple people with multiple conditions.
That’s me in this caring group for my parents and even perhaps, for my in-laws. Don’t get me wrong, I am gladly taking on the role of family caregiver. Yet, have moments of the tension of being “family” the daughter, the daughter-in-law, and push against being the caregiver part.
To link back to the beginning of my story. I am always considering the conundrum of “when it will be time to have the need for a direct care worker” to support my family, with hopes there will be one available, with adequate training, and job quality to support them.
Back in April 18, 2023, President Biden signed an Executive Order that included more than 50 executive actions to enhance care in America. This historic executive action recognizes the dual importance and interdependence of paid and unpaid caregivers and calls upon executive agencies to advance a care agenda that elevates the crucial roles of direct care workers and family caregivers.
We can and must do better for the 4.8 million direct care workers (PHI) and 53 million family caregivers (National Alliance for Caregiving) who are providing this most important and rewarding care of those need the support. As the PHI and NAC issue brief is so eloquently titled: We are all in this together in care of those who need care and those who give the care.
Back to Ms. Carter’s words, I am filling the role of a few kinds of people in this world:
I have been a caregiver,
I am currently a caregiver,
I will continue to be a caregiver,
And I am planning on needing caregivers.
So for today in the continued caregiver conundrums, I will give, and I will care.
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