Posts Tagged ‘generations’

Why Are There Not Enough Caregivers To Help The Elderly

connecting the dots

Why Are There Not Enough Caregivers

To Help The Elderly

   By Carole Larkin, ThirdAge Services 

Today we focus on getting help in the home caring for your elderly loved one (with or without dementia).

This is insider information taken from the leading academic journal in the United States called “Generations”. It is produced by the foremost academic and professional organization in America, The American Society on Aging. All content in their journal is researched and documented by the highest credentialed researchers in Aging topics. For more information on “Generations” and the American Society on Aging go to: www.generationsjournal.org and www.asaging.org. All information in quotation marks is directly from the Spring 2016 issue of Generations. (Volume 40 number 1)

Question: Why are there not enough caregivers to help the elderly (with and without dementia)?

Answer: There are a number of reasons why we in the United States are having trouble getting quality help, or sometimes any help at all to care for our loved ones at home.

  • There is a lack of people available to do home care jobs relative to the number of people who need their services. As you’ve heard over and over again, there are a huge amount of baby boomers now getting old enough to need care, added to the fact that people are living longer than they used to, and they also need care. Baby boomers did not have enough children to replace themselves, so there is a much lower population of people of working age (25-54) to tend to older adults who need help. “demand for direct care staff during 2002 through 2012 rose by 917,000, while demand from 2012 through 2022 is projected to be 1.3 million-a 43 percent increase. What is far less visible is a tectonic shift in the supply of the traditional source of the direct care workers: WOMEN ages 25-54. Between 2012 and 2022 the net number of women entering the workforce will be only 227,000, compared to the net demand increase of 1.3 million direct care positions.”
  • And not every person of the 25-54 years old age group is going to become a home care worker, of course. They’ll be any one of a number of other professions, like doctor, lawyer, teacher, etc. And there is a much worse shortage of these people in rural areas than in the cities, as younger people continue to desert those areas for better paying jobs in the urban areas.
  • Added to all that, the home care jobs themselves are low quality jobs. Very often the pay is low, there are no benefits like health care, or, work schedules are unpredictable and are mostly part-time. “Thus, it is difficult to recruit paraprofessionals from other low wage jobs when those jobs make fewer demands, and pose less risk for injury, or emotional and physical strain.” (Think McDonalds, Walmart, etc.)

Question: What can be done to help fix this situation?

Answer: Well, the most obvious answer is of course to give the home care workers higher pay, more benefits and a more predictable schedule. That would immediately attract more people to those jobs.

Question: Can that be done?

Answer: Aha, now we enter the heart of the matter. Well, in the past and continuing through this moment, there has been no political or societal will to change things. There has been and still is, no value given to the services that home care workers perform for us.

  • Society gets care for free from family members. The thought is why pay others to do the same job and certainly why pay them even more to do the same job? Society takes both sets of care for granted in the past, and even today. Elderly, sick and disabled people don’t contribute to our Gross National Product, so they are a negative force as opposed to a positive force in our economy. There can be no value given to those who care for them. Everyday people would have to change their minds and decide there is value in caring for our elderly, diseased and disabled as opposed to seeing it as a drain on our society. I don’t see that change in attitude happening any time soon. Do you?
  • All the groups in society who can effect change (called “stakeholders”) and who pay for caregivers have no desire to REALLY change the way things are. These “stakeholders” are “Policy makers (the government and politicians), insurers (health insurance companies), employers, and consumers (regular people).” Oh, government may hold hearings, insurance companies may issue a few long term care policies that pay towards agency caregivers, a few employers allow benefits towards caregiving, consumers complain of having no help, but don’t do anything but complain about it. But really none of those things significantly affect the status quo.
  • The government tried to improve pay for a substantial number of homecare workers by having the Department of Labor include them as part of the general workforce for the first time, giving them the right to receive the minimum wage and receive overtime pay when they worked more than 40 hours a week starting January 1, 2015.The Home Care Association of America (both home care companies paid by Medicare and/or Medicaid and home care companies paid by individuals) sued the Department of Labor to stop the rule from being implemented. They lost. The Supreme Court ruled on October 13, 2015 and set enforcement to start 30 days later.

(November 12, 2015.)

  • The companies got around the rule (for the most part) by reducing their caregivers’ hours to less than 40 hours a week, effectively making them part-time employees, not subject to overtime. To be fair, some private companies did ask their clients if they would pay overtime costs to keep their same caregivers over 40 hours a week. Few families decided to pay more money to the caregiving companies, opting to have more caregivers come to their houses to cover caregiving tasks if they had more than 40 hours caregiving time in a week. For many families with a person with dementia, this caused more confusion and upset for the person with dementia suddenly having a stream of people coming in to care for them, instead of just 1 or 2 persons a week. Either way, by homecare company choice, or by family choice, those most vulnerable were hurt. This devaluing of the person with dementia and of the caregiver is happening now, and will continue into the future because there is nothing in place to change it.

So, in summary, expect things on this front to get worse before they get better (if ever) because of a lack of people to do the job, and because the people who do the job are overworked and underpaid. In this instance, it’s fair to say that we are getting what we are paying for.   Are you ready to pay more to get quality caregiving? Think about that.



   Carole Larkin with ThirdAge Services  third_age_services_logo

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Spooky Statistics – Lack of Healthcare Staff to Meet Aging Demands

Spooky Statistics –

Lack of Healthcare Staff to

Meet Aging Demands

Do not read any further if you are wearing rose colored glasses.



Do not read any further if you are wearing rose colored glasses.

by Certified Dementia Consultant

This is insider information taken from the leading academic journal in the United States called “Generations”. It is produced by the foremost academic and professional organization in America, The American Society on Aging. All content in their journal is researched and documented by the highest credentialed researchers in Aging topics. For more information on “Generations” and the American Society on Aging go to: www.generationsjournal.org and www.asaging.org. All information in quotation marks is directly from the Spring 2016 issue of Generations. (Volume 40 number 1)

Question: How many doctors specialize in diseases of the aging (and therefore know something about dementia)?

Answer: “There have been only 7,000 actively certified geriatricians for more than 10 years.”  That’s for 46 million Americans over the age of 65 (as of 2015), never mind older adults with dementia. Geriatricians are doctors specifically trained in diseases in older adults. Not many- huh? Only “about 300 new geriatricians” are trained in medical schools each year. Not many- huh? Worse, “more than 40% “of fellowships for training geriatricians went unfilled for the last 3 years. And some current geriatricians are letting their certifications lapse.

Question: What does that mean? How does that affect me?

Answer: These are the specialists, along with neurologists, for elders with dementia (most people with dementia are elderly).  Clearly there are not enough experts for the number of people who need their expertise. And there are less in the pipeline coming up, rather than more. Why? Geriatricians pay is lower than most other doctors, and loans to go to medical school can be well over $100,000! And of course the anti-aging bias we have here in America. Look at old wrinkled bodies? Ugh- I don’t think so!

So, what are you left with? Your regular family doctor, of course, or the local clinic, or the emergency room. In other words, the general healthcare system.

Question: How much training do general healthcare system doctors get in older adult issues including dementia?

Answer: “Less than 3% of medical students choose geriatric electives, meaning most medical professionals will enter the field without any exposure to serving elders.” Also there is currently a “lack of faculty, lack of funding, lack of time in [an] already busy curricula (courses that have to be taken) and the lack of recognition of the importance of geriatric training.” In the past, in most medical schools there weren’t even courses in geriatrics at all, so if your doctor had been practicing for a while, chances are huge that they have no training in geriatrics (or dementia). And currently, there is no requirement to have any training in geriatric conditions to keep up their medical doctor certification, except in California, and that is limited to doctors who have over 25% of their patients are elderly.

Question: What does that mean? How does that affect me?


Answer: Chances are high that your family doctor and the doctors in the hospitals don’t have the knowledge that you think they do in relation to your elderly family member (especially one with a dementia). That means that you have to ask them how much actual training they have had over the years to know if you have to question their knowledge/advice for your loved one. Taking their knowledge/advice for gospel could be detrimental to your loved one’s health, if in fact they don’t know the intricacies of good care of elderly people. It can lead to medical mistakes, as they are now known. Things like misdiagnosis’s, nondiagnosis’s, the wrong medications prescribed, medications that react badly with the other medications given, too much medication, not enough medications, surgery advised when not needed, and no surgery prescribed when some is needed. The list of errors can go on and on.

Question: If my doctor doesn’t have the training what can I do?

Answer: Ask them to include a course in geriatric medicine for their next certification for their medical license.

Question: What about other health care personnel who deal with my loved one?

Answer: OK, let’s go through some professions.

  • Nurse Practitioners and Registered Nurses: In 2014 out of 3.1 million nurses there were “7,874 nurses trained in gerontological nursing”.
  • Social Workers: There is no formal gerontology certification for social workers, but there is a specialization in aging category.” In 2010 of 19,673 students, 1,318 graduated with a Masters in this category. Less than 4% of social workers have been trained to work with elders, yet 75% report they regularly work with this population”.
  • There were “2,158 pharmacists in the USA that were certified geriatric pharmacists”. They know the interactions and side effects of drugs that older adults take.
  • “As of 2015 out of 18,071 physical therapists in the USA, 1936 were certified in physical therapy specifically for older adults”.
  • In 2015 there were “18 occupational therapists certified in geriatric occupational therapy in the USA”.

As you can see, there is a severe shortage of all types of healthcare professionals trained in providing all types of healthcare to older adults, not to mention the subset of them with a dementia. You could call it a crisis, if you wish. And as more and more people enter the age group of elderly every day, it is reasonable to assume that it is going to get a lot worse before it gets better.

Question: What can I do to try and make things better?

Answer:  Get loud and demand action of the right people. Who are the right people? Believe it or not, its Politicians! Generations says (and I agree), that there is “no political will” to do anything to address this crisis. Heck, the crisis isn’t even on anybody’s radar, no matter what political party you are talking about. Yes, you may hear about the Affordable Care Act, but guess what? The Affordable Care Act doesn’t even address the issue of next to no knowledge how to properly care for the elderly or how to get professionals interested in caring for the elderly, or in training others to care for the elderly.

It seems as long as our citizens allow the politicians to define the problem as an “individual family” problem, and not a reason to come up with any answers for the problem, then no headway can be made in getting the resources it would take to increase knowledgeable health care for the elderly. It’s got to become the politician’s problem too.

How to do that? What about starting with a phone call, a text or an email to your local state and federal congressman and senator? Or maybe to your preferred political party candidate? It could be as simple as, “What will you do to address the lack of knowledgeable health care out there for our elderly? I want to know, and I vote.”


Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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Connecting Generations

By: Michelle Remold

Something I always notice when visiting a nursing home is the number of young people visiting. While I know nursing home aren’t exactly the first place young people think of spending time, I know from experience that they can be one of the most rewarding places to spend time.

Connecting generations is important. It is how stories are passed down and memories are shared. Without such connections, many memories and stories are forgotten. Schools have “foster grandparent” programs where older adults go into the schools and read with kids or help them with homework. I think something like this would be great in nursing homes. I remember thinking in high school how fun it would be to have a “foster grandparent,” I would visit weekly in the nursing home.  Growing up, I remember how excited the residents on my grandpa’s Alzheimer’s unit would be when we came up to visit. I don’t think I ever saw any other kids there visiting. I always found it a little sad and would try to stop and talk with as many residents as I could. There are school groups that need to find ways to volunteer and need to log their hours. How great would it be if one day a month they visited nursing homes and those with Alzheimer’s and dementia? They could meet in a common area, play BINGO, cards, or just talk. I have many memories from visiting nursing homes.

Another thing I think more nursing homes should take part in is a pen pal program. While interning at the Faribault Area Senior Center, I was able to visit a facility on the day the seniors met their first grade pen pals. Seeing the excitement on everyone’s faces was great. They exchanged their last letter, gifts, and some even exchanged addresses so they could continue writing to each other. When I went to college, I made it a point to write to my great-grandma. She lived in an assisted living at the time and couldn’t see very well. She would have an aid read her the letters and they would write me back for her. I later found out, after she passed away, that she would look forward to the letters and that they made her feel included; my great-uncle kept thanking me for writing to her. For me, writing letters is easy. I just write about what is going on, though part of it is just knowing that someone was thinking about you.  If young people don’t feel comfortable going to nursing homes, I think that this is a great alternative to connecting generations.

It may be a short visit or a quick note, but these things are important when it comes to connecting generations. When I look back, I cherish the notes I received from my grandparents, the stories shared by them and those I have visited, and seeing the smiles on their faces when I would stop to talk with them. My brother and I went back to visit the gentleman who was my grandma’s neighbor while she was in rehab, he loved it. My brother would bring him treats, helped him set up his Wii and would play board games with him and the other residents. These little things meant a lot to them and my brother still talks about his visits at the nursing home with this gentleman.  As I end this blog and think about why it is important to connect generations, I will end with a quote. “Life isn’t a matter of milestones, but a matter of moments.” –Author Unknown

008Michelle graduated from the University of Northern Iowa with her Bachelor of Arts in Gerontology: Social Sciences and a minor in Family Studies. She is currently pursuing her Master’s degree in Aging Studies and Nursing Home Administration from Minnesota State University Mankato.

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