Changing Public Perceptions of Direct Care Professionals

Let me take you back to 1996. I was working in a cheese factory and was notified that the factory was closing. My husband is disabled, so I needed to find a job to help support my family. There was an ad in the paper that the local nursing home was running a certified nursing assistant class. I thought, "I can do that"—I used to babysit and I do know how to change diapers. The first week was classroom instruction and the second week was instruction and skills training. After the two weeks, we took the CNA test and I passed.

The nursing home offered me a 72-hour position on second shift. I was supposed to receive a one week orientation, but that did not happen. The first night I worked, one of the other workers called in sick and I ended up working alone. I was responsible for ten residents. Toileting, repositioning, getting them up from a nap, monitoring the wanderers, getting them to the dining room for supper, and assisting those who needed help eating. After supper, I needed to make sure everyone got back to their room, toileted, repositioned, washed up for bed, or showered, and assist them to bed. Then there was charting and rounds. That first shift finally ended. On my drive home that night I asked myself, "What did I get myself into?" The training I received the previous two weeks did not prepare me the way it should have. I went back for my next shift and was lucky enough to be on the wing with an experienced CNA. She took me under her wing and became my mentor. Thanks to her, I fell in love with the job and stayed on second shift for five years.

A cook's position opened. I'm not sure why, but it paid more than doing the personal care, so I signed for the job. I figured I would still get to see the residents in the dining room, and I helped on the floor when they needed me, which happened with regularity.

After a year in the kitchen I took an office position. It was Monday through Friday, no weekends, and more money and I could still see the residents during the day. Well it wasn't long before I was doing all three jobs. Eventually this became too much and I made the difficult decision to leave the nursing home, after seven years of dedication to the residents. That was one of the hardest decisions I have ever had to make.

Leaving was so difficult because of the relationships I had built with the residents. The elders I cared for gave me more than I could ever give them. Sure, I took care of their basic needs, but they gave me an ageless wisdom. When I was able to take the time to listen they gave me history lessons (because they lived it), and life lessons. One gentleman was in the WWII, and he taught me the importance of freedom and not to take it for granted. This same fellow taught me how to count to ten in German.

Another elderly gentleman I cared for was very special to me. We hit it off from the time of his admission. The day after he passed away, his son called to ask me to be a pallbearer for him, of course I did and was honored that I had touched his life in a special way.

I remember the first time a resident died while I was working. I was scared and not sure of what to do. Remember that mentor I mentioned earlier—she taught me how to care for a dead person. She also told me that washing up a dead person and getting them ready to go to the funeral home was the last good thing I could do for that person.

I wanted to stay in the profession of direct care because I could make a difference, so I applied for a job with a home health agency. It just so happened that they had a client I could work with 40-hours a week (which I now know is a rarity in the homecare field). I was told that I would be responsible for taking care of a quadriplegic man. "Okay," I thought, "I can do that." I went in to train with another caregiver (training was pretty good with that agency). The first day I trained, I thought, "I have to do what?" Learning to catheterize him, which is inserting a tube into his bladder through his penis, was not too bad, but the bowel program consisted of manually removing stool from his rectum while he was seated in a shower chair. At least I was no longer responsible for 10 to 15 residents. I could give my undivided attention to one person.

A typical day with this client consisted of arriving at 8am, changing his Depends, dressing him, and using a hoyer lift to transfer him to his wheelchair. Then I'd prepare and feed him breakfast and help him take his medication, floss and brush his teeth, and do range of motion exercises on his upper extremities. I'd read to him from the Bible and a daily devotional. At 10am I transferred him back to bed catheterized him, performed range of motion on his lower extremities and then transferred him to the shower chair. Once in the bathroom, I did a skin check and manually removed stool from his rectum. Then I gave him a shower, dressed his upper half, and transferred him back to bed. While he rested I cleaned the bathroom and prepared lunch. At noon I dressed his lower half and transferred him to his wheelchair, then fed him lunch and performed a range of motion on his upper extremities again. Then I would shave him and clean his razor, read from the daily paper about current events, give him a snack and assist him in taking his medication, then transferred him back to bed, catheterized him, positioned him on his side and hooked up the sip and puff life line that allowed him to call for help by blowing into a straw, clean the catheter, and do the dishes, making sure I was done by 2pm. I would go home for three hours and return at 5:30pm to start the routine over again minus the shower, shaving and bowel program. I was done at 8pm.

After a year my client switched to Cooperative Care, a worker-owned home care agency. The co-op asked me if I would move with the client and I said sure. I wanted to stay with the client I knew and had built a good relationship with. But working at Cooperative Care has been a whole new experience. When I worked at the nursing home I never questioned much of anything. Now if I have a suggestion about how I think things could work better, I voice my opinion. The caregivers own the business, and we have a say in how it is run. In 2006 I took an office position at Cooperative Care because I wanted to learn more about how the other side of the business worked. I work full time in the office, but I still work in the field when a shift needs to be covered. I'm also the president of the board of directors.

Since then, I was asked to chair the board of the Wisconsin Direct Caregiver Alliance and to attend the Direct Care Alliance's Voices Institute. I cannot say enough about what the Voices Institute has done for me. The co-op started my leadership journey but the Voices Institute helped me realize that I am a capable leader and helped me hone and polish my leadership skills. I like to say that I found my voice during that week. I chair the board of directors of the Direct Care Alliance.

We all know there is already a shortage of direct care workers, and it is going to get worse as the baby boomers age unless we do something about it. So what should we do? In my opinion, a big reason for the shortage is that the profession of direct care is not respected. People look down on direct care workers and stereotype them as dumb lazy people. I can tell you we are not lazy; direct care workers are some of the hardest working people I know.

We are not dumb either. If given a chance, direct care workers are very capable people. The caregivers at Cooperative Care run a million-dollar business. We are psychologists, physical therapists, pharmacists, doctors, chauffeurs, personal shoppers, housekeepers, cooks, and most of all, compassionate souls. We care for your mother, your father, your daughter, your son, your grandmother or your grandfather. The sad fact is wages are low, and benefits such as health insurance are almost nonexistent. If health insurance is offered, it is often too expensive for the direct care worker.

I am so glad that I needed a job twelve years ago, because it led me to the most rewarding career I have ever had. The smile on the faces of the people I care for and the light in their eyes when I walk in for my visit make all the hard work and long days worth while. It also gave me the opportunity to be part owner of a business, and being part of Cooperative Care has given me opportunities beyond what I ever thought possible.

I would like to ask you to think: what can you do to change the public's perception about the direct care profession? One thing that will change the perception of this profession is the "Direct Care Alliance Personal Care and Support Credential," a competency-based test for personal assistance workers in home and community-based settings.

This country needs to respect the important work direct care workers do before it is too late. We need to make the direct care profession an appealing one. We need to pay a living wage with affordable benefits. We also need better training from the start to give workers enough skills to feel confident on the job. (Most new workers aren't lucky enough to have a great mentor like I did.) I also think if there were a career ladder or lattice with opportunities for advancement, more workers could stay in this profession.

And we need to respect the skills needed to do this job and hire the right people in the first place. Most people think anyone can do this job. I thought that myself, twelve years ago. But now I know it takes someone special. Direct care workers do not do this work because they are getting rich. They do it because they love the work and because it is the right thing to do. This is the hardest job I have ever done but it is also the most rewarding job I have ever done.