Perhaps greater than fear of death is fear of severe illness or disability for months or years before you expire. No one wants to rely on others for help bathing, dressing or taking medications. Yet avoiding an institution means finding someone to deliver that assistance in your home.
Who is going to provide it?
Nearly 70 percent of older seniors believe resources and services will be available in their communities to help them live independently, according to a 2012 AARP survey.
That is certainly optimistic, but likely not realistic. There are simply not enough caregivers to meet the needs of Iowans, a state with a higher percentage of seniors than most other states. And the shortage is expected to grow.
Unfortunately, lawmakers are making matters worse. The Republican-controlled Iowa Legislature cut funding for direct-care workforce programs from about $500,000 to $188,000 for the current fiscal year.
More than $100,000 was slashed for Iowa CareGivers, a nonprofit organization dedicated to cultivating a quality, caregiver workforce in this state. The money previously appropriated was used for mentoring programs, partnerships with community colleges, workforce training, stakeholder forums, public awareness and other efforts to recruit and retain direct-care workers.
"I think few realize the work Iowa CareGivers does behind the scenes to promote policies and changes that benefit workers, people served and employers. The solutions to these complex issues have been identified, tested, vetted and presented for a number of years, but rather than investing to bring to scale the efforts that hold promise, they are cut to the quick," said Di Findley, executive director of Iowa CareGivers.
Do Iowa lawmakers think they will not grow old enough for their bodies to wear out? Do they think they could not be a victim of a sudden accident, stroke or debilitating illness? Why don't they recognize the need to increase Iowa's financial investment in attracting and retaining caregivers instead of slashing funding by more than half?
Have lawmakers talked to Iowans to learn how difficult it is to find experienced, reliable caregivers?
They could start with Michael Wolnerman of Des Moines. His mother, Jennie, was ravaged by Alzheimer's for three years before she died nearly two years ago. The family sought in-home caregivers through services and word of mouth to provide around-the-clock assistance.
"Most people were great," Wolnerman said. "Some weren't. Sometimes they would just abandon her. They left her in the middle of the night. They wouldn't show up. Not well-educated on how to care for a person." One worker spilled soda and food she didn't clean up.
Although this family had plenty of money, workers did not simply materialize. Finding and keeping them was an ongoing challenge.
Attracting and retaining workers requires raising awareness, valuing caregivers as much as other health professionals and paying them a decent wage.
Home-care workers earn a median hourly wage of $10.49 per hour. Because of inconsistent work hours, they typically earn $13,800 annually. About half of them rely on some form of public assistance. While they care for others, many do not have health insurance.
All of us can help. Parents and teachers can encourage young people to become certified nursing assistants. Early retirees should consider this line of work, recognizing it is as much a public service as a job. Health insurers, including Medicaid, could raise reimbursement rates for in-home services.
An adequate, trained workforce makes social and fiscal sense. Elderly and disabled people who want to remain in their homes cannot do so if there is no one to help care for them. Publicly financed Medicaid frequently pays the bills for more expensive nursing home stays.
Elected officials are willing to give away millions in tax incentives to attract new businesses. They have taken action to lure doctors to the state and encourage Iowans to pursue teaching as a profession. They must finally be willing to invest in the workers who literally do the heavy lifting in caring for the most vulnerable Iowans.
Iowa CareGivers was founded in 1992 by Di Findley. After working as a nurse's aide for 13 years, she wanted to give a voice to direct-care workers. With her garage sale telephone and desktop computer, she started the organization in her basement. Twenty-five years later, she is more passionate than ever.
Yet state funding for the non-profit's direct-care worker programs and services was cut from about $290,000 to $173,000 this fiscal year. The Iowa CareGivers' Board and Direct Care Professional Leadership Council are equally passionate about these issues and are launching the Iowa CareGivers Endowment with contributions from two former members of the organization's board. The fund will be managed by the Community Foundation of Greater Des Moines and will support education, recognition, advocacy and research.
Contributions can be made online at iowacaregivers.org or a check can be mailed to Iowa CareGivers, 1231 8th Street #236, West Des Moines, Iowa 50265. Call 515-249-0138 to learn more about how to support the Endowment.
Des Moines Register, Oct. 5