THIS MONTH: SURVIVING THE CAREGIVER CRISIS
By Ian Ruder |
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I remember the days when I could post a caregiver ad on Craigslist, and before I could sign out, I would be inundated with eager respondents. I’d offer slightly more than the minimum wage, with flexible hours and a fun work environment, and that was more than enough to entice a diverse pool of candidates. Those were the golden days.
The last couple of times I've tried to hire a caregiver, you would have thought I was asking for volunteers on a suicide mission. Despite offering significantly more than minimum wage, my posts were received as enthusiastically as Congress proposing to cut Social Security.
We've covered the caregiver crisis facing our nation multiple times over the last few years, but there's no getting around the fact that things seem more dire than ever. So let’s first look at the crisis facing caregiving in America, and then at what we can do to make the best of a difficult situation.
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A WORSENING CRISIS
In 2015, Josie Byzek wrote a New Mobility cover story about the impending caregiver crisis. One of the main issues advocates raised was that caregiver compensation was so low — then averaging $9.57 an hour nationally — that not enough people were filling caregiver roles to meet rising demand. Fast forward a decade, and the state of caregiving wages has only gotten worse. Yes, wages have risen — to an average of $14.07 an hour nationally — but inflation has made it so that today, those wages are even less competitive than they used to be.
As one longtime advocate explained it in John Mohler’s 2023 story, “For Wheelchair Users, Finding Attendants Has Gone From Crisis to Catastrophe:”
“Regardless of where you are, it’s more difficult to fill these caregiving jobs, because other jobs in the area are paying more that are much less emotionally taxing and that have opportunities for growth. It doesn’t matter if you’re in Portland or if you’re in central Illinois, the wages down the street are still going to be higher than whatever the home care wages are. The (home care) workforce crisis was in a crisis for decades before the pandemic. We’re at a point where it’s getting to catastrophic levels.”
Add to the worsening crisis the recent congressional budget bill that is estimated to reduce Federal Medicaid spending by almost $1 trillion over the next 10 years. Medicaid accounts for more than half of the money spent on long-term care services every year. It’s hard to envision how states are going to improve compensation and working conditions for caregivers to help meet the rising demand for caregivers. And boy, is there a rising demand. As Mohler detailed in 2023:
“The needs going forward are dizzying. From 2020 to 2030, the total home care workforce, including home health aides and nursing assistants, will grow by almost 1 million new jobs, but they will have to fill 4.9 million openings due to workers leaving for other jobs or retiring. Likewise, the number of adults aged 65 and older is expected to nearly double from 49.2 million in 2016 to 94.7 million in 2060. In other words, the problem is not going away. In the future, the need will be even greater.”
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Improving caregiving support is one of United Spinal Association’s advocacy priorities. We’re working to improve working conditions to attract more caregivers to the workforce, expand eligibility for paid caregiver funding for family members, and strengthen home and community-based service policies. You can learn more about our advocacy efforts, find care support resources, and join our Care Support Working Group to collaborate with other advocates on this vital issue. |
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Finding the Right Fit
For those of us who depend on caregivers, we have little choice but to soldier on. This means being creative, being persistent and learning from those around us. I've always enjoyed writing about hiring and managing caregivers because it gives me a chance to talk with other wheelchair users to learn what works for them.
If I had to pick, the most valuable thing I've learned is that, when it comes to hiring and managing caregivers, you first need to understand yourself. Knowing your own needs, who and what work well with you, and who and what don't, can solve a lot of problems before they start.
For some, relying on family for caregiving help is the best option. But burnout is real. “A Labor of Love — Beating the Stress in Long-Term Caregiving,” by the late Richard Holicky, examines the common problems in long-term caregiving relationships and potential solutions. Some wheelchair users find long-term success with parental caregivers, but it can be a tricky transition when parents age out of caregiving and need care themselves.
Others can’t imagine relying on family, and develop business-like systems to hire and retain caregivers. Unfortunately, even if we know what we need and have systems in place, sometimes we find ourselves in situations where there are no ideal candidates, but we have to hire someone. This happens all too often, and it can lead to dangerous or nerve-wracking hires.
I first wrote about avoiding bad hires in 2012, and looking back on that article now, I think I was a little cavalier. As nice as it would be to say that the good hires outweigh the bad hires, the reality is that bad hires can leave physical and emotional scars that long outlast their tenures. Sometimes, questionable hires lead to incredible excuses, though, as Jenny Smith found in “I Was Attacked by a Cat.”
I spoke with several long-time caregivers in 2020 to try to understand the flip side of the equation, “What Caregivers Care About.” While I didn't uncover anything groundbreaking, hearing caregivers’ side of the relationship and getting their perspectives did provide some valuable insight. It reinforced my conviction that mutual respect and clear communication of expectations are at the heart of almost every good caregiving relationship. When either of these is compromised, problems inevitably follow.
As the caregiver hiring process gets ever more difficult, building lasting, mutually beneficial relationships with the good ones may be the best bet we have. |
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Caregiver-Assisted Transfer Techniques
Mastering safe, efficient transfers is one of the trickiest and most important tasks with any caregiver. Craig Hospital has put together an excellent series of instructive videos covering everything from Hoyer transfers to pivot transfers and beyond. If you and a caregiver are having any issues, these videos are a great resource to simplify this daily task. |
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