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An Unaffordable Life

Posted by Flora Alexandra No Commented Saturday, June 22nd, 2013


There are so many things to talk about this week I’m having trouble deciding so I’m picking what’s on my mind this morning.  I just spent the last 4 years of my life serving as Chief Operating Officer of a company that provides long term care services in the homes of people with disabilities, mostly on Medicaid.  What I learned and experienced has left me forever changed with a new (added) mission.  Medicaid is a wonderful program.  It is the only health insurance program that comes with long term care services.  If you are low income enough, based on your disabilities, Medicaid will provide for a trained attendant to come to your home from 5 to 50 hours per week, at a schedule that you direct, to help you with whatever you are no longer able to do without assistance, and keep you out of institutional care.  Amazing.  This is a clear social win-win.  People are healthier in their own homes, it costs less than nursing home institutionalization, and people get to stay in their communities continuing to contribute, whether it’s to their families, social organizations, or in continuing employment.


Now here’s the problem.  The attendants are paid typically $8 per hour for part-time employment, no PTO, no health benefits and they have to maintain their own vehicle to get to their clients.


According to the Center for Public Policy Priorities (www.cppp.org) Family Budget estimator, in Fort Worth, a single parent with one child without employer paid health insurance and no extra money for savings would require a wage of $21 per hour to afford local rents, transportation, food, health and child care.  The wage required goes down to $15 per hour if the employer pays for a health insurance premium.  If that single adult has no children and employer paid health insurance premiums, the wage requirement goes down to $10 per hour.  And this is with no savings.


A car breakdown puts a caregiver out of work with no savings to back them up.  The results of these poverty wages are inconsistent attendance, high turnover (40-70% per year), a revolving door of caregivers for the client, high agency administrative costs for hiring, training and supervision, and a continuing need for state-provided welfare benefits (SNAP, Medicaid, housing support) by these hard working, compassionate employees.  We are mistaken if we do not think that we are already paying for complex and expensive welfare benefits to supplement these low wages when a few more dollars an hour would lift these employees out of poverty.


This is what I mean by an unaffordable life. People, mostly women, seek a career as a certified nurse’s aide or personal attendant in long term care, because they love this work and are dedicated to their clients.  I have seen caregivers save client’s lives many times, by being there to call 911 in time or because they were worried about a change in the person’s condition and checked in on them on their own time.  I have seen caregivers patiently take verbal abuse and perform personal tasks you couldn’t pay most people any amount of money to perform, because they had a deep understanding of the client’s disability and needs.  I have seen caregivers carefully thread the needle between what other family members wanted them to do, what the client truly needed and what their program permitted.  A long term caregiver may be helping persons with dementia, quadriplegia, or needing ventilator support, 24/7.  These jobs require sophisticated emotional and interpersonal intelligence, strong communication skills, as well as the ability to clean a bathroom using universal infection precautions.


But no one can really afford to live on these wages.  And our need for these services will only grow as medical technology keeps people alive and we all get older every day.  I am committed to advocating for change to allow for a living wage and health insurance for these under-appreciated every-day heroes.  No other healthcare professional is paid such low rates.  I would be delighted to hear from anyone with similar interests.  Flora Alexandra Brewer  flora@lancasterlofts.com