elder care nurse playing jigsaw puzzle with senior woman in nursing home


With the baby boomers transitioning into retirement in record numbers, and their parents living longer, we’re facing an eldercare challenge that’s bigger than we’ve ever seen before in this country. Who will take care of all of the older Americans who will need medical and end-of-life assistance in the coming decades? And how will we ensure that elder citizens will be able to live in comfort and dignity during their senior years? We talk to an activist about her own experiences with the system, and learn about strategies for dealing with the eldercare challenges that face us.

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Ai-Jen Poo, co-director of Caring Across Generations, author of the book, The Age of Dignity: Preparing for the elder boom in a changing America.

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Challenges in Eldercare

Marty Peterson: Eldercare is a big issue in this country. Millions of baby boomers are reaching retirement age every year, and many of them have parents who are in need of care around the clock. Ai-Jen Poo knows only too well what kinds of problems people face when their parents and grandparents become elderly and frail. Poo is the author of the book, The Age of Dignity: Preparing for the elder boom in a changing America. Poo’s grandparents were very much involved in raising her and when her grandfather needed long-term care, they weren’t able to accommodate him at home. He was put into a nursing home that was, to say the least, unwelcoming and uncomfortable.

Ai-Jen Poo: In that nursing home he actually shared a room with about a half a dozen other people. It was a really cold environment where, on the one hand, there was like very rigid schedules around food, sleep time, but really very little care and very little attention placed on people staying there. So when I visited him there, he had not eaten or slept for days and he was terrified. He was terrified because there was a number of people in the room who were making incredible noise, like suffering, pain, and then the other half he shared a room with were almost comatose. So it was a very scary and strange isolating environment for him and when I visited him there I got a first-hand sense of it. And even though he was certainly alive enough to express his discomfort and his horror at living there, you could already tell that he was just a shadow of himself and fading away.

Peterson: Poo is also the co-director of the organization “Caring Across Generations.” They seek to find solutions to better, more compassionate care for the elderly – a demographic that is growing by leaps and bounds.

Poo: Demographics shifts that are underway where people are living longer than ever before. In fact my grandmother’s demographic of 85 and older is the fastest growing demographic in the nation. And the baby boom generation is starting to reach retirement age, so we’re about to have the largest older population that we’ve ever had. And it’s about to reach, let’s see, the statistic is that by the year 2050 27-million of us will need some form of care or assistance just to meet our basic daily needs.

Peterson: Poo says that many families with elderly members figure that the government will help them to defray costs in form of Medicare payments.

Poo: There’s this misconception that Medicare covers long-term care, or this kind of home care assistance, and it actually doesn’t. We don’t have any social programs that support long-term care comprehensively. So if you’re very wealthy, you could potentially buy long-term care insurance. And I’ve heard from people around the country that even that doesn’t necessarily cover what you need when you need it. And then if you’re very, very poor, which many people end up because of the high cost of care, then you might be eligible for Medicaid, in which case you could get support for a nursing home stay or in some states also home care. But it’s a situation where families are going broke trying to afford the care they need. And so I do believe there needs to be a whole new approach to caregiving that actually offers economic supports to families to be able to afford the long-term care for their elders.

Peterson: “Aging in place” – that is staying in your home – is often what the elderly person most wants. Poo says that the home healthcare worker population is a diverse one with immigrants and African-Americans making up a large percentage of the available help. A big problem she sees for this profession is that many of them are not paid a living wage.

Poo: This work has, unfortunately, been undervalued in our society and so despite this really critical role of making sure that our elders are healthy and safe and living well, the work itself is not compensated and does not reflect its true value. And a recent report that just came out said that the median income for home care workers in this country is $13,000 per year. Which, if you think about it, is almost unimaginable how you would live off of that, let alone support a family. So we’ve got a situation where the people that we count on to take care of our loved-ones, can’t take care of their own on the wages they currently own. And that’s one of the big things that needs to change if we’re to meet the growing needs and demands of the elder boom.

Peterson: If you have gone to an agency to find home healthcare, you might be puzzled by the low wages many of these workers receive. Poo says that some healthcare companies charge the family a high fee but very little of it goes to the workers themselves. That causes a lot of “churn” in the profession with workers leaving to find better-paying jobs. She says that training is also all over the map — a situation that needs to be changed to insure that patients receive the best care.

Poo: There actually is no training standard, so lots of agencies and lots of venues offer training and some of those training models are incredibly strong and innovative, like in Washington State. The homecare training fund is the second largest educational institution in the state after the University of Washington. And they train 40,000 home care workers per year in 12 different languages, with continuing education, really top-of-the-line training, that has elevated the quality of care that people in Washington State are receiving. And it also allows for the workforce to continue to raise wages over time. There are great models like that out there, but right now it’s all over the map because there’s no standards, there’s really no guidelines. So some agencies could hand you a three-page document where you fill out, you know, do multiple choice questions and call that a training or a passing a certification of some sort.

Peterson: Poo is also the director of the National Domestic Workers Alliance, and they are pushing to organize healthcare workers and create a better working environment, training and a better wage package to attract more people into the profession. She says that home healthcare workers are just part of the equation. There is also a need for more community-based options for older Americans.

Poo: The “village movement” started out as a group of friends getting together, figuring out how they could age well together, supporting each other in Boston. Today it’s a movement where there are over a hundred villages around the country, close to two hundred now, that are intentional communities that older adults are building together where they’re pooling resources in order to support things like reduced cost for groceries, and transportation, even sharing the cost of caregivers, and also taking care of each other. That kind of community level, neighbor taking care of neighbor, building community while we take care of each other, is exactly the kind of thing that I think is the future, is where we’re going.

Peterson: Poo says that it’s time to take a long, hard look at eldercare in America and to make some much-needed improvements. She says that families, communities and the Federal government need to make decisions now before it’s too late.

Poo: This is a conversation that has for too long happened behind closed doors, and oftentimes happens at a time of crisis. And I am encouraging people with this book to have this conversation with their families now about their future caregiving needs and how we can prepare together as families, as a community as a country to be able to meet the caregiving needs for the future in a way that enhances and uplifts all of our dignity.

Peterson: You can read the ideas Ai-Jen Poo has outlined in her book, The Age of Dignity, available in stores and online. She also invites listeners to visit her website at Caringacross.org. For more information about all of our guests, you can log onto our site at Viewpointsonline.net. You can also find an archive of past programs there and on iTunes and Stitcher. Our show is written and produced by Pat Reuter. Our production directors are Sean Waldron, Reed Pence and Nick Hofstra. I’m Marty Peterson.