Home care aides

Last month US President Barack Obama ordered the labor department to look into the salaries of home care aides or people who help to care for the elderly and the infirm. At present, employers of home care aides are exempted from paying the workers a minimum wage and overtime pay.

I’m writing about this issue for two reasons. First many Filipinos in the United States (and other countries) work as home care aides and, secondly, here in the Philippines we have our own growing senior citizen population, many of whom need home care aides.

Obama’s order comes after a long drawn-out battle waged by home care aides to improve their pay. In 2002, an elderly home care aide, Evelyn Cook, filed a lawsuit to overturn the exemption of home care aides from the minimum wage and overtime pay. The courts ruled against her and she died in 2009 at the age of 74, still earning $7 an hour and no overtime pay, although she often worked 24-hour shifts.

That $7 hourly wage should be put in context.  Based on a 40-hour week, that’s about $1,020 a month or $12,240 a year. In 2010, the poverty threshold for a single elderly person was $10,458. It’s hard to imagine how Cook managed when she was younger, raising five children as a single mother. No wonder Cook was reported to have worked on multiple jobs, and 24-hour shifts.

The reason home care aides are exempted from the minimum wage and overtime pay is that they are classified, together with babysitters, as providing “companion services.”  They are not seen as health professionals or even semi-professionals and are therefore given the bare minimum.

But with the graying of America’s populations, it is becoming clear that these home care aides are more than companions. They are supposed to help the elderly with six ADL or activities of daily living: bathing, dressing, transferring, using the toilet, eating and walking. Then there are six more IADL or instrumental activities of daily living: light housework, preparing meals, taking meals, shopping for groceries and clothes, using phones and managing money. Just looking at those 12 activities shows there’s a world of a difference between babysitters and home care aides.

If the home care aides are granted minimum wage and overtime pay, it will be a boon not just for them but also for the patients. Their low salaries translate into poor quality of care because of low motivation, overwork (from taking on extra jobs) and rapid turnover as the aides look for better-paying jobs.

Filipino elderly

Let’s look at the situation in the Philippines. For a population of about 95 million, with 4 percent over the age of 65, we would have 3.8 million senior citizens, certainly not a small number. Not all would require home care aides.  One US study estimated about 6 percent of those aged 65 would need home care aides but the figure jumps to 20 percent among those aged 85 or older. We need to do our own study for the Philippines but I am certain our figures will be similar, which means thousands of elderly needing assistance for daily living.

Notice how the term caregiver, referring to hired assistants, is now falling from disuse. The reason is that technically, a caregiver is anyone who provides care for a patient and in many cases in the Philippines, this is a relative. There is a gender bias here, with women relatives more likely to be asked to give up their careers and personal lives to provide this home care.

Relatives are not necessarily the best persons to provide intensive care for the elderly. Besides not being properly trained for their responsibilities, they have ambivalent feelings toward the patient, feeling obligated and yet harboring some resentment at having to give up so much of their own lives. Not surprisingly, relatives “volunteered” into this role burn out more easily.

The term “home care aide” is used to refer to someone from outside the family, but who is not a professional like a nurse or midwife. At the same time, home care aides should, ideally, be provided some formal training. In Canada, they also have to have an equivalent to two years of college.

It is important, certainly, for family members to provide care for their elderly but, when possible, someone from outside should be hired. Patients in critical condition, for example someone who just had a stroke, will need a special nurse.  Later, as the patient recovers, a midwife can come in. And for the elderly who basically need assisted living, for example those with Alzheimer’s and other dementia conditions, a well-trained home care aide can do very well.

Such services are not cheap. Special nurses are paid P1,800 for a 12-hour shift. Midwives go for about P500 to P700 per shift. Home care aides (or “caregivers” in the Philippine setting) vary tremendously but a good one, with proper six-month training, gets about P500 per shift. There are “colorum” special nurses, midwives and home care aides who will go for lower pay, but all I can say is you get what you pay for—with great risks, including abuse of the patient.

For economic reasons, many households end up getting a helper, sometimes with very little formal education, to take up the tasks of home care aides. They’re paid a pittance, P3,000 a month if they’re lucky. I once met one who was unpaid and only offered free board and lodging for her family.  She was literally on 24-hour call, the Lola calling her and her husband (who had outside work as a driver) in the middle of the night several times for food or toilet assistance.

We need studies to project our needs in this area and legislation not just on the salaries and work benefits for the aides, but also on their training and certification. We should avoid the disaster that came with those diploma mill caregiver institutions that sprouted on every corner, drawing Filipinos hoping they could work overseas. The diploma mills have closed down while thousands of their graduates are jobless, which is just as well since many were so badly trained they would have contributed to early deaths of their wards.  I speak here from experience, having interviewed some of these graduates, who couldn’t even understand medication doses, or do a blood pressure measurement.

The bottom line is that relatives must be part of the caring team with health care aides. My mother has a midwife and a trained caregiver rotating for day and night shifts, but I still turn down invitations for dinners (including the Inquirer’s anniversary party) or prolonged out of town trips because I consider it to be important to get an update from her carers, and, more importantly, to be at her side at the end of the day, even if for short moments.

I know, too, I am still fortunate, being able to be in the Philippines and with her. Too many Filipinos have to work overseas, ironically providing care for other nations’ children and elderly, while leaving their own behind, home and alone.

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