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Lynn Wenzel: Opportunity in the coming age tsunami

Lynn Wenzel
Columnist
Lynn Wenzel
John Hart/jhart@theunion.com | The Union

By 2035, the number of Americans over the age of 85 will double to at least 11.5 million, according to the March 2015 issue of the AARP Bulletin; those over 60 will number 92.2 million in 2050.

The population of residents over the age of 60 in Nevada County has increased by 5,500-plus since the 2000 census. We can bemoan the aging of the county and try to come up with solutions to keep or draw young families here, but the truth is, the percentage of elderly in Nevada County will continue to increase.

This is not a calamity. On the contrary, support services for elders can provide new and continuing employment for hundreds of residents that will benefit families, cement stronger relationships within generations, and, hopefully, allow elders more dignity as their lives come to a close.



Meeting a fast-growing need

The political arm must advocate for better support and higher pay for care givers, helping to raise community consciousness that the role of caregiving is one of the most important in our society — one that allows us all to play out and, eventually, end our lives with dignity.

Personal care and home-health aides are the nation’s second- and third-fastest growing occupations, according to the U.S. Bureau of Labor Statistics. But here is the caveat. This has not led to higher pay or benefits for workers. About 48 percent of home health care workers live in households below the federal poverty line and are on public assistance. Long hours and low pay — the median wage is $9.61 an hour — contribute to high turnover and inconsistent care.



Caregivers have been excluded from labor laws since the New Deal. According to Ai-Jen Poo in her game-changing new book, “The Age of Dignity”, this treatment is rooted in the legacy of slavery. When labor laws were passed in the 1930s, southern members of Congress refused to sign on to the labor law package part of the New Deal if domestic workers —largely African Americans — were included. Consequently, this workforce was excluded. Finally, in 2013, the U.S. Department of Labor released a regulatory change that eliminates the exclusion from the Fair Labor Standards Act, so that nearly two million home care providers were finally covered under minimum wage and overtime protection as of January 1, 2015. Caregivers can thank the National Domestic Workers Alliance for that!

The other and most obvious reason caregiving is undervalued is that it, along with child rearing and home making, has always been thought of as woman’s work. According to a new report from the National Employment Law Project (NELP), women, the vast majority of home-care workers, are 54.7 percent of those who make under $15 an hour. Though essential to the healthy functioning of society, caregiving has not been counted as part of the gross national product or as worthy of monetary remuneration. The low value of caregiving does not result from a lack of need but rather, from a culture that devalues any profession where women make up the majority of participants.

Six states, including California, are working to develop more rigorous standards for training and assessing home-care workers. The Elder Justice Act, approved by Congress as part of the Affordable Care Act (ACA), called for spending $500 million to help state and local adult-protective services detect and prevent elder abuse. Nice — but Congress has yet to authorize any money for the program. In 2013, the Obama Administration approved regulations that would require home-care agencies to start paying overtime to their employees. But the home-care industry filed suit and a federal judge in Washington struck down the new rules.

Medicare, with its fee-for-service setup, does not cover progressive chronic conditions common to elders, such as arthritis, that require long-term continuity of care. Furthermore, much later-life medical care focuses on costly, high-tech lifesaving procedures when what is needed is palliative care. Medicare does not pay for it — instead elders are forced to repeat regular visits to emergency rooms. It is this type of mostly unnecessary medical care, costing billions, that eats up 70 percent of Medicare’s budget, says Poo. In Nevada County, In-Home Supported Services (IHSS) provides care-giving services to elders over the age of 65 so they can remain at home. It is financed by state, county and federal funds to those on Medicaid and the services can be provided by contracted care providers, friends, neighbors or relatives. Depending on need, clients are eligible for up to 283 hours of IHSS a month. Also available from IHSS are a Senior Outreach Nurse Program and a Social Outreach Mental Service. These supplemental programs help keep elders in their homes and out of emergency rooms!

Employment, economic opportunity

According to a 2012 report by the American Journal of Medical Quality, the projected national deficiency of RNs in the year 2030 will be more than 900,000. By 2030, the nationwide rate of geriatricians to the elderly will drop to one for every 3,800 older Americans! Both of these professions can only grow in Nevada County. So, while there are obviously huge challenges currently and going forward, Nevada County should be preparing and planning for positive increases in such professions as nurses, geriatricians, home care providers and community outreach workers.

In Nevada County, School of Care offers Certified Nurse Assistant training and Home Health Aide training for those looking for employment in the home care fields. New businesses could include support for health and daily living aids such as electronic alert systems, lift chairs, hearing aids, blood pressure monitors, orthopedic aids and elder fitness specialists. The need for these businesses increases in place.

The political arm must advocate for better support and higher pay for care givers, helping to raise community consciousness that the role of caregiving is one of the most important in our society — one that allows us all to play out and, eventually, end our lives with dignity. The U.S. Bureau of Labor Statistics expects the workforce to grow by more than 1.6 million direct care workers by 2020. There is no reason Nevada County cannot participate in this growth. But, in order to pay the wages needed to support caregivers and their families, we need to consider cutting in areas such as incarceration costs and wasteful duplicate administrative spending. We must allow negotiation of lower prices for drugs. Medicare is expressly prohibited from negotiating lower prescription prices with drug manufacturers. Why not allow Medicare and Medicaid the legal right to collective bargaining using the purchasing power of millions of patients to lower prices? According to Poo, the U.S. would have saved $600 billion between 2006 and 2013 if Medicare were allowed to negotiate directly with drug makers. We need to stop allowing the big pharmaceutical corporation lobbies to set laws. They are not in it for elder patient rights. They are in it for profit. Let’s change this!

Security for our seniors

In order for a support system to work, Social Security must be secured. Currently, SS has enough income and assets to pay 100 percent of benefits for the next two decades and 77 percent thereafter, according to the Social Security Administration. One way to increase revenue is to raise the payroll tax cap to at least $300,000. Right now, the cap is $106,800. Why shouldn’t those making more continue to pay into the system?

Medicare and Medicaid must be secured and strengthened. The Program of All-Inclusive Care for the Elderly (PACE), a patient-centered pilot program funded primarily by foundations, is now a joint program of Medicare and Medicaid operated on the state level. California is a participating state. The object of PACE is to provide preventative and ongoing care in order to keep elders out of expensive state care in nursing homes and hospitals. Poo suggests we set our sights on a new national program similar to Social Security that supports home- and- community-based care. Regardless of income or assets, every American would be included in this plan, paying into a fund they can tap into later in life when they need home care. She also suggests providing Social Security caregiver credits for those who must leave the workplace to provide care to their loved elders. “Fight for 15,” a national coalition of workers, currently advocates raising wages of funded home care workers to a minimum of $15 per hour. It is in all our interests to support it.

The right to age with dignity, comfort and independence should be a universal one. The elder boom is an opportunity to change our thinking and increase job and business opportunities right here at home for the betterment of all. Let’s walk our talk and show our elders the appreciation, respect and care they, and we, deserve.

Lynn Wenzel, who lives in Grass Valley, is a member of The Union Editorial Board. Her opinion is her own and does not represent the viewpoint of The Union or its editorial board.

SOURCES — United States Census, 2000, 2010; mynevadacounty.com; Tamaran Cook, Program Manager Adult Services, IHSS; capitalandmain.com/”hanging on in Eldorado”; Nevada-Sierra Regional In-Home Supportive Services Public Authority; The Boomers Are Coming: Shifting the Health Care Paradigm by Jerry L. Rhoads; The Age of Dignity by Ai-Jen Poo; AARP Bulletin, March 2015; The New York Times, “In Race for Medicare Dollars, Nursing Home Care May Lag” by Katie Thomas, April 15, 2015; Feministing, “Fight for 15” April 2015; Nevada County schoolofcare.org .

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