business

Who will take care of our older adults?

Many of us are wrestling with that question. As our parents age, the vast majority of them want to stay in their homes. Currently, 90 percent of all care provided in the home is done by a family caregiver. According to the Transform 2010 report from the Minnesota Department of Human Services, for every 1 percent drop in the number of family caregivers, costs to the overall care system jump $30 million.

The average length of family caregiving is 4.3 years. But caretakers also work full time at their own jobs. In fact, one in every five of today's workers are also elder caregivers. On average, long-distance caregivers -- those who live more than an hour from their loved one -- miss 20 hours of work per month. Given that the senior citizen population is expanding as baby boomers reach age 62, how are we going to meet the increased care needs resulting from this imminent age wave?

To complicate matters, the home care industry is experiencing escalating shortages of nurses, therapists, home health aides and personal care attendants (PCAs). The average age today of nurses is 47; the average age of nursing professors is 65. There is also an acute shortage of physical therapists, occupational therapists and speech-language pathologists, as well as home care social workers.

The state Department of Employment and Economic Development has consistently listed personal care and home health aides as the fastest-growing jobs in the market. Unfortunately, typical wages for these positions are $9 to $12 per hour ... hardly a living wage in today's economy. Why is the pay so low? The agencies providing these services are reimbursed at about 40 percent of their costs by state-funded programs and cannot afford to pay higher wages. Reimbursement rates for medical assistance are set by the Legislature, and rates for Medicare are set by Congress. Adding to the low wages is the high cost of gasoline.

We need to adequately fund these programs to recruit and retain staff. But it's not enough to just add more money to the system. So where to begin?

First and foremost, we need to recruit people into elder care at an earlier age, letting young people know that taking care of older adults is a satisfying and rewarding career choice. Additionally, baby boomers can be valuable resources and part of the solution. Having the freedom to work flexible hours and having a means to give back to their communities are job attributes that help engage baby boomers in elder care.

We need to do more to support family caregivers by giving them tools such as respite services, training, mentoring and coaching and advocacy. And we should encourage employers to offer flexible work schedules.

Some changes in the caretaking process are happening already. Co-housing communities are forming in several cities in which neighbors share elder care duties and pay a membership fee for home care aides. Member-owned health care cooperatives such as Care Ventures in west central Minnesota are taking shape. In addition, there are 31 neighborhood-based block nurse programs in Minnesota.

Technology can also play a role. Telehealth service management, electronic medical records and other helpful technologies can improve service levels. A nurse using telehealth equipment, for example, can potentially make as many as 15 visits a day rather than the standard five. Electronic sensors placed around a home can be used to remotely monitor a senior's activities.

Finally, we need better ongoing training for people who do the important job of home care. Web-based education, for example, could become part of the formal training and certification process.

The task is enormous, but it can be accomplished. Collaboration and cooperation between health care systems will be necessary. Partnerships among businesses, faith-based communities, educational institutions, health care providers and families will be essential.

We've heard the adage "It takes a village to raise a child." Well, it takes a community to care for its elders. Only together can we ensure the growing needs of the marketplace. In 2004, there were 36.3 million people 65 or older in the United States, or 12 percent of the population. By 2030, the number is expected to increase to at least 20 percent of the population, or about 71.5 million.

We need to enlist that great and amazing trait that never fails -- American ingenuity -- to create a senior caregiving system that will serve us well now and in the future.