Caring for Elderly: Undervalued Work

By , Ms. Glasse is the national president of the Older Women's League.

WHAT kind of care are family members likely to get when they become old or disabled? Can the availability of decent, affordable care be counted on? Are the people who provide that care experienced, properly trained, and paid fairly for their work? Care-giving is a critically important issue to an aging society, and in recent years the Older Women's League has become the preeminent authority on unpaid care-giving. Our experts have documented what many of our members already knew: that the burdens and stress involved in caring for chronically ill loved ones can jeopardize the physical and mental health, savings and earning power of the care-giver. We have become a strong voice urging employers to make leave available to workers who must care for a relative, and urging policymakers to support respite care to help unpaid care-givers.

When the Older Women's League launched a research and public-education project early this year to assess the status of paid care-givers, we suspected that we would find a problem. What we found was even more serious than we anticipated: The work of long-term care workers, like paid care-givers, is grossly undervalued.

This is a serious concern for most Americans, and the evidence is alarming. Many of the people who are paid to provide custodial care to America's chronically ill are in dire straits themselves. The workers who make beds, give baths, see that medicine is taken, and otherwise care for the elderly and disabled are often struggling themselves just to survive.

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The US has approximately 1.5 million long-term care workers - people who work as nursing aides in nursing homes or as home health-care workers. Nearly all are women, usually middle-aged, and a disproportionate number are African-American. They receive little or no training as they care for a rapidly growing and increasingly needy population. Typically, long-term care workers are paid at or near minimum wage; only about half have employer-sponsored major medical insurance and few have pensions.

With poor pay, few benefits or opportunities for promotion, little training, and difficult working conditions, the turnover among long-term care workers is high. Tales of interviewing for jobs and beginning work on the same day are commonplace.

When aides are inexperienced, the quality of care for the frail elderly suffers. The exploitation of long-term care workers endangers the patients for whom they care.

Many parents, spouses, and siblings are being cared for at the end of their lives by overworked, underpaid, undertrained workers. And middle-aged and older women are being forced to take low-wage, dead-end jobs at precisely the time in their lives when they should be planning and saving for their own future.

America's midlife and older women find themselves on both sides of the health-care equation: first, as poorly paid long-term care workers and unpaid care-givers; and subsequently as the impoverished recipients of nursing-home care. The majority of long-term care workers are midlife women who are the sole support for their families. They are paid so little that they are likely to end up in poverty themselves.

It is time to face the hard facts. Most American families are likely to face chronic illness at some point. If quality care is to be available to loved ones, the search for a way to pay for it should begin now.

The current shortages of long-term care workers in the Northeast and the West portend what the entire nation is likely to face in coming years. Unless pay scales and work incentives improve, the problem can only get worse. Congress can help. Increasing the minimum wage, requiring employers to provide health insurance and pensions, and supporting pay equity will help end the exploitation of long-term care workers.

This situation cannot continue unchecked. America is on the brink of a full-blown crisis in care-giving for the chronically ill. An exploited, overburdened work force is caring for the frail, the sick, and the elderly. We must find a way to compensate them fairly for the work they do.

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