“‘This will be catastrophic’: Maine families face elder boom, worker shortage in preview of nation’s future,” from The Washington Post, could be a description of a dystopian movie: it’s not. This is the state of State of Maine, which is the harbinger of things to come for the rest of these 50 United States. We need to listen to this alarm.
We’re facing a demographic dilemma: not enough young people to fill all jobs, even those outside of elder care. We need them now! Where do we get them? We can’t hire them because they were never born! Thus, current workers remain on the job long after it’s safe or appropriate. Results include accumulated injuries to workers who keep doing injurious jobs. Even the field of healthcare can’t find enough workers or volunteers.
The State of Maine has learned that there is no one available to fill home care jobs. There is no one to fill care facility jobs either. Professional fields have the same problem; many of the number of nurses and doctors are now older and there are not enough of them it is and there’s no one to replace them.
Medicaid pays far less than other employers, drawing the few workers away from elder care. However, simply raising wages won’t help if there are not enough people to hire!
Maine is already experiencing the results, some facilities closed altogether. Others closed admissions for months due to too few staff. No vacancies in care facilities means families must place their loved ones wherever they can. A loved one far away means a l-o-n-g commute to visit. Younger, disabled people also get caught in this care-crunch. If no one is available, some adult children try to fill the gap. Those care gaps further pressure the few remaining working adult children.
Keep this number in mind:
*By 2030, 1 in 5 Americans will be over 60.
*The number of seniors will DOUBLE between 2015 and 2050.
*The senior population over 85 will TRIPLE in that same period.
**We will need 7.8 MILLION new people to fill these jobs. Since we didn’t give birth to them; where do we get them?
This isn’t as riveting as a news story as a fire, or a shooting, that’s the problem. The numbers of affected families are there, but they aren’t collected (aggregated). This problem is spread everywhere.
We’re in a presidential campaign yet no candidate is talking about this national problem. Why? This demographic dilemma is happening one family at a time: Your family is next.
The Reuter's article, U.S wages lost to unpaid family care to hit $147 billion by 2050, describes lost wages and pressure on caregivers to switch to part time work or quit all together. These are definable numbers which the article describes well. One doesn’t hear enough about these issues and costs in the news media. I call upon anyone who knows a caregiver to insist on better public discussion on these caregiving issues/ costs/pressures.
I've always worried that caregivers also lost opportunity as well as wages. They are less likely to be offered new projects at work which can polish one's resume. They can’t take the lateral move which puts the employee in line to move up in a branch of the organization. A promotion comes with more demands on time and a different schedule. How can the working caregiver manage that? Promotions may mean a move out 0f town; how does a caregiver juggle that? So less chances to rise in a career.
In addition, caregivers suffer hidden damages to their careers.
Just taking repeated PTO (Paid Time Off) casts a shadow over one's career. Eventually, PTO runs out. When PTO runs out, the employee is left with FMLA (Family Medical Leave Act). That is usually unpaid. The employed caregiver must consider loss of income along with caregiving pressures.
I'm also a member of Society for Human Resource Management (SHRM), and read their daily dispatches. It appears that employers are more comfortable allowing the employed caregiver a block of time, like a week or two, to handle a health crisis. Piecemeal time tracking is another matter. There are some tracking systems, however, these seem to be evolving methods.
The employed caregiver may need to use her time in piecemeal form. Perhaps she takes her lunch time to supervise the elder taking medications. Her commuting time would be deducted from PTO or FMLA That's the typical shape of elder caregiving, a mosaic of times and tasks squeezed together throughout the day.
So both the employed caregiver and her employer are both carrying this process. The caregiver is doing the tasks and the HR manager is handling the administration. This produces an implicit time cost to the employer. Why would the caregiver’s boss consider her for special projects, a move, or a promotion? These would demand more of her time and the employed caregiver doesn't appear to have any time. In order to develop one's career, one must appear to be ready and willing as well as able. No employer really knows whether any employee is truly available. However, a string of PTO/FMLA requests create an image of less availability. It’s a subtle form of job “loss” that doesn’t show on the paycheck.
Only the US and England have a patchwork-to-none system for dealing with our aging population. Other European countries have created caregiving support systems. Why aren’t we looking at them?
I’ve spent most of my career working with seniors and now I’m a senior. That position allows me to see certain situations with two viewpoints, professional and personal. A recent incident allowed me to glimpse a common situation families experience with seniors but from the internal viewpoint.
The typical scenario goes like this; family member does something they think would help the senior. They do it without discussing it with the senior; just present their contribution. The senior is far from appreciative. Instead, they are upset, angry, or dismissive. The family member reports that they feel wounded, or frustrated. Families say; “I was only trying to help!” Why didn’t the senior see the value?
Ask yourself; “When I do things for my senior, am I doing it with them or to them?”
I got to experience this myself. Recently, I visited my children in New York. We rented a B&B which turned out to be awful! After confronting the agent and securing a refund, we had a sad dinner. It was late at night and the children were on their phones looking for lodging. We trudged to the hotel; I checked in and went to bed. Unbeknown to me, the children believed the hotel was “dodgy”. They stayed up to late to book another hotel! Now, I was on the hook for a bill I knew nothing about!
I woke up to a call from my daughter-in-law with this news. I had not yet showered, no breakfast, and now I’ve got to deal with this! I strenuously objected. Insight came to me in the shower (which was running very s-l-o-w-l-y). Three words stood at the center of this conflict: for, with, and to.
My children thought they were doing something for me by booking another hotel. It didn’t feel like that to me. Is that what’s going on internally when the senior objects? Does for take away another piece of their autonomy?
They didn’t do it with me. They kept silent instead of sharing their concerns about the hotel. They made financial assumptions instead of asking me questions. Their decision put me in a money bind.
I felt as though things had been done to me. Is that what’s going on internally when seniors object? Are they really mad about the item or the way it came to them? Do families need to take time to walk the senior through the process (preferably after breakfast) or find some way to engage them? I believe that for is a good thing, in the combination of with, so it doesn’t feel like to.
P.S. The next hotel had a better shower.
When families gathered on Thanksgiving day, some realized that their senior was not the same as last year. Families often respond by doing internet research. The internet is a good first step. However, some sites make outlandish claims. I saw one that offered a treatment that “cured Alzheimer’s”. There is no cure and some of these sites can offer dangerous suggestions.
Here are a few reputable sites that offer reliable information:
Alzheimer's Association. This site also has a page devoted to explaining the different types of dementia. It also lists other physical conditions or environmental conditions that can look like dementia.
American Society on Aging. It can feel encyclopedic in size. The society has done decades of research and offers reliable information. It’s a good second step.
AARP offers many programs and information for families as well as seniors. Each state has a chapter with offices in each area. Look up your state to find help in your area.
And Senior Sidekicks offers a course; Preparing to Parent Your Parent, to prepare families for the practical issues they will face as they become caregivers. Contact us about teaching this course in your church or at your job. Call (217) 787-5866 or email us for more information.
October 18th, the V.A. is starting a 36 month “look back” on gifts. This will affect the eligibility for The Aid & Attendance Pension Benefit. It has been a lifeline to afford the Long Term Care they need. The V.A. is also changing the asset limit (the amount they family can hold and still qualify) to $123,000. If the veteran still lives in the house; it’s not counted toward assets. If they are planning to sell the house, the money from the sale could be counted. However, with proper strategies, they might still be able to qualify. Some veterans can no longer live in the same house (too many stairs, too far from care) If a veteran is planning on selling the house, please contact the Veteran’s Financial immediately: 1-800-835-1541.
This is the first of a three part series about the often-heard advice to caregivers to “take care of yourself”.
What does that mean? Since elder caregiving is relatively new, many caregivers aren’t sure. Let’s begin with the word self care; it means considering yourself as part of the caregiving plan. Your health and mental well-being are a vital part of providing care. Think of your contribution in other ways: wouldn’t you take care of equipment used to care for the elder? Wouldn’t you make sure to have enough supplies on hand? Wouldn’t it be hard to provide care without equipment and supplies? Think how much harder would it be if you weren’t able to provide care? You’re the most important part.
Caregivers may believe that they should put their needs aside: no! That’s like pouring yourself out without putting anything back. Such a belief leads to caregiver burnout. Some caregivers burnout emotionally, others develop health problems, and still others find their families are disrupted. All are symptoms of burnout. Many symptoms go unrecognized. Now that you are aware, you can be alert to the influence of caregiving on your life.
Some caregivers believe that the entire task is theirs alone; not necessarily. Part of self care is letting go of that assumption. We ask for help in other parts of our lives; accountants, plumbers, physical therapists, or lawn crews. No one believes these helpers take away our responsibility; they contribute to our successful process.
What do you do in a typical day? How many of those tasks require direct interaction with the elder? Who else could do them? For example; laundry must be done. Why does it have to be you? Does it matter to the elder who does it? Letting others into the care process is part of letting go. Letting others in is part of self care.
Self care can mean admitting to yourself that you feel certain things in response to caregiving. Some of those feelings are not too “nice”. Frustration, anger, despair and sadness are all parts of the caregiving journey. If a friend came to you admitting to these feelings would you send them away? Perhaps you would listen to them and sit with them. Sadly, I meet caregivers who whisper their negative feelings if they say anything at all! Part of self care is becoming your own “best friend”. You and that self need to talk to each other. Admitting to those not-nice feelings doesn’t make bad things happen. In fact, it allows you to let out some of the pressure behind those emotions. Self care begins with recognition of one’s value, affirmation and support for the caregiver.
To learn more, take our course: Preparing to Parent Your Parent or call (217) 787-5866
Once upon a time there were two sisters. Mary built a cabin by the lake with her husband. They sold their house in town upon retirement. The other, Beth, also wanted a “cabin in the woods”. She and her husband planned to retire there as soon as their youngest child finished college.
Things did not turn out as planned. Mary developed lung cancer. She needed to be closer to medical care. Those winding lake roads were not plowed in the winter. She wrote that “The bugs never stop” at the lake. Her condition made it hard for her to keep up with such a house. Since the lake house was new, they had almost no equity yet, and they had to sell. They took a loss as they moved back to town.
Beth had a different set of problems. Her husband developed some odd behaviors after he retired. She found it uncomfortable keeping house with him underfoot. She confessed to her daughter that she was considering a divorce! Thankfully, they had not built a cabin in the woods or they would have had no relief from each other.
Her husband finally enrolled in a program and participated in local archeology projects. One day the Sherriff’s car drove into her driveway. He announced that her husband had died of a heart attack on one of these projects. Now, Beth was a widow with a child still in college! Thankfully, they had not started to build this cabin. How would she have managed to finish its construction and sale by herself? She didn’t want to live so far from town now that she was alone.
What can we learn from these sisters?
Senior depression presents several problems. It appears as “mild” even if it doesn’t affect seniors mildly. Depression symptoms may surface as physical complaints. Seniors grew up in an era when receiving mental help = CRAZY. Each of those problems presents a barrier to treatment. How does a caregiving adult child get a senior to accept the help they need? They really need it. Even though seniors account for 13% of our population, they comprise 18% of all completed suicides! Our society must take senior depression seriously. Medication may not be enough. Religion/spirituality (R/S) may be a treatment pathway that seniors can accept.
Religious and Spiritual Factors in Depression: Review and Integration of Research is a review of literature: a look at 444 research articles on the subject of R/S. All studies were reviewed for their methods. 178 studies were found to be rigorously designed and their data analyzed. Most studies found that seniors who a religious or spiritual practice did better at managing depression or facilitating its resolution. The review found that R/S beliefs may be used to cope/adapt to stressful life circumstances. Seniors certainly face those; life-changing illness, loss of career, loss of home, and loss of spouse/friends. Their lives need ways to adapt.
A second part of this study, found a lower likelihood of mood or psychiatric disorder for those who regularly attended religious services. There was one caveat; if the R/S tradition was very orthodox, the senior may feel more judged than supported by their R/S tradition. You know your senior. You know what type of R/S practice they hold. If there is a supportive faith community; try it. This same review of literature noted that “pastoral counselors spend 140 million hours (doing) therapy each year”. That’s more hours than provided by the American Psychological Association! Since it is part of the counseling media, ask for this help for your senior.
Does it help? The greatest medicine is no good if your senior won’t take it. The same applies to counseling. If it’s socially acceptable to meet with the pastor; use that method.
Health and Spirituality, examined the relationship between health and spirituality. Researchers found that the modern, western era’s response to illness/depression was a departure from other cultures and most of history. In other times, religion was considered an integral part of healthcare. Major illnesses focus the patient’s attention on ultimate meaning, purpose and transcendence. The Nurses’ Study found that women who attended weekly religious services had a lower mortality rate that those who never did. Regular religious attendance was associated with a lower rate of depression. Wow! Does our society need to return to an integrated/ whole person strategy to effectively treat seniors? I believe we should.
Have we become too quick to provide pills to our seniors? The Center for Medicare and Medicaid (CMS) has a “rule of 4”. If the senior is taking more than 4 kinds of pills, their risk of medication conflicts and issues increases. While medicine might be helpful, other strategies could make a difference without raising further medication conflicts.
How many pills is your senior taking? Is it a constant battle to get them to take medicine? I suggest you discuss the idea of trying regular religious attendance and pastoral counseling instead. As you discuss this method with the doctor, please keep this study result in mind. One study gave cancer patients and their doctors a list of 7 factors to rank when making medical decisions. The patients ranked faith in God 2nd. The physicians placed it last. Thus, it is the adult child/caregiver who must advocate for alternative approaches. Always discuss changes with the doctor. Try adding God; He just might help your senior.
Who knew that art might make a critical difference in the treatment of elder depression? In 2001, Dr. Gene Cohen conducted the first experimental study of seniors in cultural programs and its effect on general health, mental health, and social activities: Creativity and Aging.
This study has been citied repeatedly in other works and became a foundation for senior programming. As I researched elder depression, I was struck by three things in relation to this study. First, the date, Creativity and Aging was only done in 2001. We have drawn since we had cave walls. What took us so long to consider the relationship between creative arts and seniors achieving a healthier quality of life? How’s that for an outcome?
Second, the design of the study was notable because it included a control group. How else does one obtain hard data? Once the comparisons were made, it was clear; the arts make a difference. We worry about rising health care costs. Perhaps, we could lower direct healthcare costs by utilizing proven cultural programs. If, as this study demonstrates, cultural programs achieve true health promotion and disease prevention effects, why aren’t we using this method to address senior health issues?
Third, the seniors studied were OLDER that the average life expectancy! Wow, does that mean we could achieve even more positive health outcomes if we started cultural programming earlier, on younger seniors?
It’s something to think about. Medical costs are expanding the way we do things now. I believe it’s time to consider other methods as additions to direct medicine. Think about it.
When I begin discussing caregiving, some families respond; “We’ll keep it in the family.” Others comment; “We’ll do it the way our parents took care of their parents”. Caregiving traditions are fine. However, today’s caregiving is different in a number of ways.
These circumstances mean caregiving is a more complex, longer-lasting process working very differently than in previous generations.There are many legal and financial implications for elders and their families as they enter the newest phase of life; the caregiving phase.Our employer’s expectations have not kept up with these demographic changes. Our care systems have not caught up with the need for caregiving support. Our health systems have not even tracked the impact of elder caregiving on the adult children trying t0 shoulder this responsibility. Expecting do-your-own-caregiving is laudable, it may not be feasible. We are a society in transition.
Until our society establishes the systems necessary to track, to develop and to adjust to elder caregiving, we must find other ways to fill these gaps. Professional advice on elder caregiving is as important as professional legal and financial advice. There are courses for caregivers. There are legal and financial preparedness classes as well. The courses can help but only if we take them. We decided to prepare to have babies, or prepare to drive cars. We must decide to seek expert advice to prepare us for our transition from ancient forms of elder caregiving to a modern one.
Senior Sidekicks offers a course; Preparing to Parent Your Parent.
"A Senior Moment" is written by Ms. Sara Lieber, owner of Senior Sidekicks. Ms. Lieber has over 30 years of experience in senior care.