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178 Chapter 14 Who Will Help Us? Advocating for Direct Care Workers as howard Gleckman and other experts suggest, remaining in our own homes as we age ultimately becomes a health care issue. If we’re healthy, the odds are decent we can age in place if we wish. But if we have problems, we need to come to grips with the fact that there are simply not enough paid caregivers in the pipeline to assist us. even for those lucky enough to have the financial resources to pay for in-home care, it will grow ever more difficult to find competent , caring help. Whether it’s home care aides, visiting nurses, or physicians who make house calls, we need a concerted effort to entice more professionals to the geriatrics field, or it will be impossible for many people to stay in their own communities as they wish. In 2011 there were already some 2.5 million home health aides, who assist people with hands-on care, checking vital signs, skin care, exercise, and medication , and personal care aides, who help with housekeeping, cooking, and companionship but do not provide health care. The majority of these workers are employed by an agency; the rest are hired directly by the client.1 according to the Bureau of Labor Statistics (BLS) Occupational Outlook Handbook, the ranks of home health aides and personal care aides will swell by 70 percent from 2010 to 20202 —and that’s before the baby boomers hit their most frail years. That figure compares to a 14 percent projection for all jobs over the decade. In its good news–bad news outlook, BLS notes: “Job prospects for both home health aides and personal care aides are excellent. These occupations are large and expected to grow very quickly, thus adding many jobs. In addition, the low pay and high emotional demands cause many workers to leave these occupations, and they will have to be replaced.” how their ranks will not only be replaced but expanded is left dangling, a mystery yet to be solved. The message to those with a fondness for older people and a desire to serve continues to be: We need you! We promise you a job! We’ll pay you miserly wages and put you through the wringer! Join us! The late Leonila Vega, executive director of the New York–based Direct Care alliance (DCa), a worker advocacy organization, talked with me in 2010 about our society’s lack of understanding and preparation for the growing Who Will Help Us? 179 numbers of frail elders wanting to age in place. “People want to stay independent as long as they can,” she said. “There’s a misperception that home care workers help clean, shop, other light activities. That’s true, they do those things, but they’re caring for older clients with more complex conditions, multiple chronic care issues, and [the clients] are staying in the home with a lot more complicated care plans. [Direct care workers] are the ones who have to keep this person safe.” The job can be both difficult and gratifying. On the one hand, aides have a sense of real purpose. They take pride and satisfaction in their important role as caregiver and companion to those who are old or disabled. “It’s one of the most rewarding jobs I’ve ever had,” tracy Dudzinski, a long-time home health aide and a leader of Cooperative Care in Wautoma, Wisconsin, a worker’s coop , told me, “to go in and the person is so happy to see you. You’re the only person they’re going to see that day. I call it feeding my need.” Yet the job is tough. aides, who are often hired by adult children, may be resented or only grudgingly accepted by the client. as BLS describes it: home health and personal care aides had a higher-than-average number of work-related injuries and illnesses in 2010. Work as an aide can be physically and emotionally demanding. aides must guard against back injury because they may have to move clients into and out of bed or help them to stand or walk. In addition, aides may frequently work with clients who have cognitive impairments or mental health issues and who may display difficult or violent behaviors. aides may also face hazards from minor infections and exposure to communicable diseases.3 Moreover even as they toil to help people who have serious medical conditions or disabilities...

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