AT THE END OF YOUR ROPE?
TIE A KNOT AND HANG ON
Journal of Healing – Feb. 19, 2003
By Mary Koch

My husband had a saying about chronic complainers (people who could always find the dark cloud inside any silver lining): "They wouldn't be happy if they were hung with a new rope."

That pretty much describes my condition last week. Kathleen, who has been one of our overnight caregivers, announced two weeks earlier that she was moving to Minnesota.

Because my husband is totally paralyzed, he needs someone to care for him through the night. To keep John's skin from breaking down, he needs to be turned in bed regularly. To keep him from choking on his own secretions, he needs someone to suction his throat. To keep me from going bonkers, I need a solid night's sleep. Hence we hire overnight caregivers.

After Kathleen gave notice, I put a "help wanted" ad in the newspaper. There have been occasions in the nearly 10 years since John's stroke that I have advertised for caregivers, and we haven't received a single response. This time we were nearly overwhelmed by applicants.

I screened the phone calls, and we interviewed four women – all of them likeable, qualified, and with good recommendations. The hardest part of the process was calling the three who didn't get the job.

My complaint? The wealth of applicants was a personalized, poignant indicator of our bleak economy and job market. Home health care workers, who bear great burdens and responsibilities, are perennially the most under-paid and under-appreciated members of our work force. And now even they can't find work.

Admittedly, there are a few people who take these jobs because they can't get anything better. But most caregivers really do live up to their job titles. They really do provide aid despite low pay, zero health care benefits or sick pay, irregular hours, physical strain and general lack of esteem for their vocation.

New York Times columnist Bob Herbert, writing about home health care workers last fall, called them "the face of 21st-century poverty." The typical home health aide, he wrote, is "a hard-working woman with children caught in a system that refuses to pay what her services are worth."

The system is dictated by public policy. Most home care aides are paid through federal and state programs. In the state of Washington, aides employed under Medicaid's "COPES" program are paid less than $8 an hour with no benefits.

That's the public policy, but it's not necessarily what the public wants. A majority of Washington voters approved Initiative 775 last year, giving home health workers the right to unionize. As members of the Service Employees International Union, some 26,000 home care workers in the state approved a contract giving them a $2-per-hour raise and health care benefits.

It's unlikely they'll see that raise or those benefits anytime soon. The contract, which would cost $60 million a year, must be ratified by a Legislature that is toiling to erase more than $2 billion in red ink from the state budget.

For my husband – along with thousands of other disabled and elderly patients – paid caregivers represent the slender thread allowing them to live at home instead of in an institution. The irony is that the cost of helping people live at home is generally lower than the cost of placing them in nursing homes.

Now we hang by that slender thread. I guess it's better than being hung with a new rope.