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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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The Time Has Come

You Can Nominate Your Favorite Dementia Care Professional

To Win the 2013 Award.

Nominations End Sept 1, 2013.

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Alzheimer’s or Pseudobulbar Affect

By Carole Larkin

I wish I knew about this when my mother was alive. I might have been able to help her. She would suddenly burst into tears for no apparent reason. I’d say, “What’s wrong? What are you sad about? Are you depressed?” She’d say, “Honey, nothing is wrong. I’m not sad about anything. I don’t know why I’m crying, and I can’t stop it.” I’d naturally attribute it to her Alzheimer’s disease. But I was wrong. Now I know that it was really PBA (Pseudobulbar Affect).

PBA is a SEPARATE neurologic disease or condition where the circuitry between the Frontotemporal Cortex (where our emotions reside) and the Cerebellum (which is involved with the control of our emotions) and the circuitry between our Motor Cortex (where the initiation of movement starts) and the brain stem (where control of movement resides). It generally happens along side of other neurologic diseases or events such as Alzheimer’s or other dementias, Stroke, Traumatic Brain Injury, Multiple Sclerosis or ALS (Lou Gehrig’s disease). Its symptoms are sudden, unpredictable short bouts of laughing or crying that are NOT able to be controlled and are NOT reflective of the person’s true feelings at the time. It is estimated that 2 million people have this condition.

What can you DO about it? Well, there is an FDA approved medicine for it called Nuedexta. It is supposed to lessen the number of events or stop them completely in 80% of the people they have tested. That is good news! Also recommended is to distract the person with something else, maybe a funny story or two or a funny video, if it’s the crying aspect of the disease showing.  If it’s the laughing part of the disease showing, removing the person to a quiet place and playing some soothing music, or showing them a calming video, of nature or underwater scenes. You can give them a shoulder and neck rub to relax the muscles that tense up when people are very emotional. It also helps the person focus on the sensation of the rubbing or kneading and may serve as a distraction for them. Sometimes coaching them thru deep breathing exercises may help them get over the bout.

How do they feel about it? In one word, EMBARRASSED. Wouldn’t you? What can you do to help them emotionally?  Tell them it’s part of a disease. It’s not their fault. You understand it’s something they can’t help. It’s something that will stop on its own shortly. (Because it will stop shortly. Most bouts last only a few minutes.) You love them and you are proud of them, even if this happens occasionally. They aren’t alone in this happening, 2 million others suffer with it too.

What lessons did I learn from discovering this affect exists?

When someone is crying for a short time on a periodic basis, it doesn’t ALWAYS mean that they are depressed. Don’t automatically ask for an antidepressant or to increase the dose if they are already on an anti-depressant. (The less meds the better).

Ask them if they are sad, don’t assume they are. I know that many people with dementia have depression, just don’t assume it always exists.

Listen to what they say when they answer the question why are they crying? If they say, “I don’t know.” Believe them. Very often by the time people  reach early midstage in the diseases, they do tell you the absolute truth, as they see it, feel it and think it. Whether it matches our reality is our problem, not theirs. They are not lying to us. They are telling us the way it is to them.

Ask your doctor about these bouts of laughing or crying. Tell him about this article and use the letters PBA when you are explaining what happens. Your family doctor may not know about the existence of PBA (Pseudobulbar Affect). He can research it, and prescribe the drug, if it’s appropriate for your loved one. Side effects and tolerance must be taken into account in that decision, of course.

It’s too late for me, but it may not be for you.

Carole Larkin

Carole Larkin is a Geriatric Care Manager with ThirdAge Services. 

Carole is doing some amazing work in the area of dementia and has nominated for the “Dementia Professional of the year.”   By clicking on the logo below you will be taken to a page which will give you more information on Carole, as well as a link to the nomination page.    

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Tips For Bathing Your Loved One

With Dementia

By Carole Larkin

In hopes of helping you make bathing go easier, here are some tips:

  • Doctors recommend older adults shower or bathe a minimum of twice a week to reduce the chance of infection (especially UTI’s in women). If you can get them to bathe more, kudos to you. If not, be satisfied with twice a week, unless another medical condition demands more bathing per week.
  • To combat the “NO’s” try to make it seem as if the request is just a routine part of daily life as in, “It’s Tuesday morning. We always take our bath on Tuesday morning. Let’s go get cleaned up, and then I’ll make you a nice breakfast.”
  • Follow up on the positive reinforcement (as Bob calls it), so that your loved one does get rewarded for complying. Doing this over and over, as part of the regular routine, imbeds in your loved one the behavior you want to happen. Yes, it can be done with enough practice! ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE.
  • Or try this: Take a walk around the house with your loved one. Stop at the bathroom door.  Have everything ready (Soap, shampoo towels, washcloth, etc…) in advance, all laid out ready to go. The room temperature is warm, maybe soft music is playing. You say something on the order of “your bath is ready for you. Here, let me help you with your shirt (Or shoes, or whatever).And start helping, turn the water on in the tub and temper it and say something like “madam (or sir) you spa awaits you.”
  • If there is no other way to get them to bathe. Ask their doctor to write on a prescription pad something like this: “Mr. So-and-so needs to bathe two times a week for infection control”. Make several copies of the prescription (in case they tear it up). Show the prescription to them and say “Doctor’s orders”.
  •  The bathing should take place at the time and in the manner the person always used to bathe, meaning if they were a morning before breakfast bather, then you should have them bathe in the morning before breakfast. If they were a shower person, then they should have a shower, not a bath, unless medical or physical reasons preclude that.
  • Some persons with dementia actually grow afraid of the water, especially water coming out of a wall mounted shower head. It becomes threatening to them. If this is the case consider getting a flexible hand held shower head. That way you or your loved one can control where it sprays on them.
  • Allow your loved one to do as much as they possibly can to wash themselves while in the bath. If they can do a credible job on their own with just reminders from you to wash here and there, let them do that. Even if they don’t do a credible job and you have to redo the washing, I suggest you have them wash themselves first. It gives them “ownership” of the task and gives them something to be successful at Even if all they can do is hold a washcloth while you do everything else, let them do that. At least they are participating in the task as much as they can. The same goes for hair washing.  The same advice goes for drying themselves. Allow them to do as much as they can, even if you have to go back over what they have done. ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE.
  • Some people need to be distracted with something while you give them the bath or shower. Distractions that could be used are singing in the shower, giving them something colorful to hold and look at while in the shower (or several somethings to hold and look at) such as a squeeze ball or a shower scrub in the shape of an animal.  Whatever it is, it should be waterproof and not able to shatter in the shower.
  • Some people are extremely modest, be aware that that may be the reason for saying “NO”. Respect their dignity by allowing them to cover up with something while in the shower. Perhaps a towel or a sheet or even a poncho. Just wash under whatever they use to cover up.
  • Safety comes first. There need to be grab bars positioned for them to hold on to while getting in and while bathing. Their needs to be appliqués on the shower or tub floor to give them traction under their feet. I’m not fond of bath mats. I’ve seen them lose suction and slide under the person’s feet too often. If the person is unsteady, a shower chair is needed. I’m not a fan of using the bedside potty chair as a shower chair as well because using it in the shower tells that person that it is ok to go to the bathroom in the shower or bath. If the person is scared to get into the tub because they have to step over the tub wall, try using a “transfer board”. It is a fairly long straight plastic board that you place in the tub with one set of legs outside the tub and the other set of legs inside the tub. Your loved one sits on the outside part and you help slide their behind to the inside part (and lifting their legs over the tub wall, of course). Poof fear of falling is gone.
  • Finally, after the bathing is completed and, your loved one is dressed PRAISE AND COMPLEMENT THEM and ask them to cross off that day on a year long calendar showing the year by months. Have them do this every time. Eventually you will have visual proof that they have taken their shower or bath every Tuesday and Friday (for example) for months and that it is a normal thing to do. It also squashes the “I took a bath/shower earlier today or yesterday” protest. Nothing works like visual proof.

carole_larkin_pic_jpegCarole 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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Denial is Dangerous

By Carole Larkin

You may be past denial — Perhaps your sisters or brothers, mothers or fathers, cousins or friends (especially ones that don’t often see your loved one with dementia) are in denial. People in denial about a loved one with dementia often say to themselves things like:


  • I’ve always looked to Dad for strength and guidance. I don’t know how I can handle things without him. The thought that I have to take care of him as well as myself is too terrifying for words.
  • He’s the parent, I’m the child. It’s never been any other way and I don’t know how to change it.
  • If I ignore it, it will just go away.
  • He had a really good day today; maybe it’s not really as bad as I though. I’ll just wait until his behavior and memory get worse.
  • He’s just having a bad day. He’ll be better tomorrow.
  • If I admit that he has dementia then that means that I’ll probably get it too and I can’t face that.
  • He made me promise that I would never put him in a nursing home. That’s where I’ll have to put him if he has Alzheimer’s, so I won’t admit that he has it.

Underneath the denial:

  • Fear about the future. That’s really the underlying emotion behind the denial.
  • It’s human to deny what we find unpleasant or frightening. But when it prevents us from seeing facts and facing their implication then it will not help our loved one or ourselves.


  • Using denial as a coping strategy will always fail eventually.
  • Denial will prevent the family from taking the steps possible to “get ahead” of all the issues to follow — like starting medications that could prolong the patient at the highest levels possible for the longest time possible.
  • Denial can prevent completion of legal forms allowing your loved one or your family to be in control of medical choices, property matters and inheritance issues.
  • Denial will cause major lasting conflict within your family.
  • Denial can cause unwanted outcomes.  For example, your loved one could need nursing home care due to delayed care that could prevent the progression to the situation where only skilled nursing can care for them.
  • Denial causes stress to the caregiver — even to the point of a serious heart attack, stroke or other fatal event, leading to nursing home placement for your loved one anyway.

You can help your family member or friend in denial by:

  • Telling them that it is OK to be fearful but that it does not help your loved one or the rest of the family.
  • Help them to understand that fear is overruling logic.
  • Explaining that denial or doing nothing is actually doing something; and that doing nothing is going to cause more pain to all involved.
  • Helping them see that this is not about them and whether they will get the disease or not. Tell them that there is no relationship between helping your loved one and increasing the chances of getting the disease. It’s not contagious!
  • Helping them see that it is not about them and the inconvenience to their daily life. This is about helping someone that they love have the best care possible.
  • Letting them see that this is not about whether they like or dislike your loved one and that even if they don’t like the family member or friend, that helping is the right thing to do.
  • Be kind, gentle and calm in approaching your family member or friend in denial. Anger will only cause them to dig their heels in deeper.
  • Let your family member or friend in denial know that you will be there to support them through the time they are confronting their fear — they are not alone.
  • If you see that you are not making a dent in their denial, drop the subject. You can return to it another time.

carole_larkin_pic_jpegCarole 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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