House calls: in-home care givers from cooperative to provide vital service elderly, disabled in rural Wisconsin

Rural Cooperatives, May-June, 2003 by Margaret Bau, Dianne Harrington

Editor's Note: Ban is a cooperative development specialist with USDA Rural Development in Wisconsin; Harrington is a Wautoma, Wis.-based elder care specialist who is coordinating efforts in Wisconsin to address issues relating to long-term retention of care givers.

Karen Taylor likes helping people. Ever since she was a little girl, it seems Taylor has always been there to help an elderly neighbor with household chores, or to help a relative recuperate from a hospital stay. Nearly 3 0 years ago, Taylor decided to make this calling to help others her life's work by becoming a certified nursing assistant (CNA), specializing in providing in-home care.

Taylor swears that the elderly and people with disabilities feel healthier and more alert when they live in their own homes. "When a person can come home and sit in his favorite chair, eat his favorite home-cooked foods and get up or go to bed when he wants to, those little things help make a person happy," Taylor says.

Her observations are supported by research. As one study suggests that home care maintains the recipient's dignity and independence, qualities that are all too often lost even in the best care institutions. Through assistance with dressing, bathing, feeding, shopping, meal preparation and housework, the elderly and people with disabilities can, and do, live independently in their own homes.

In Waushara County, Wis., a new, worker-owned cooperative formed by in-home care providers is helping more elderly and disabled people remain in their homes, providing them with a preferred alternative to a nursing home while also improving pay and benefits for care providers.

Demand growing for in-home care

Besides maintaining a person's dignity and independence, in-home care is much more cost effective than institutional care. Typical annual cost for home-care services is just under $5,000, which compares favorably to the $55,000 average annual cost for a nursing home stay.

Most people want to live in their own homes as they age. In a 1998 survey conducted by the American Association of Retired Persons (AARP), eight out of 10 people over age 65 said they want to stay in their own home and never move. Most people live according to their wishes. Only 4 percent of those over age 65 live in nursing homes (though that number increases to 20 percent for persons 85 and older).

Demand for home care will only increase as the population ages, especially as the baby boom generation nears retirement. By 2030, one in five Americans will be over the age of 65. In many rural areas, the elderly already have reached this critical mass.

Critical shortage of in-home care workers

Despite the growing demand and cost effectiveness of in-home care, there is a serious shortage of home care workers and CNAs. Low wages and lack of benefits provide a disincentive for people to enter into this profession. Nationally, the average in-home care employee works 29 hours per week at a median hourly wage of $7.58. Workers often receive few, if any, benefits. Turnover within the industry is very high, between 40 and 60 percent annually.

The nature of the work can lead to a sense of isolation. Most caregivers work one-on-one with elderly and disabled clients and rarely have contact with fellow caregivers. They have only occasional contact with supervisors, other health professionals and the client's family.

Providing care is a physically demanding occupation. Care providers must move clients for bathing, toileting and positioning in and out of bed. Job-related injuries, especially to the back and neck, are a constant threat. Elders suffering from Alzheimer's disease or other cognitive impairments can sometimes physically strike out at a worker.

The work can also be emotionally draining. Some clients with Alzheimer's or those adjusting to a disability feel anger, which they may direct at the caregiver. Various cognitive impairments may cause paranoia, leading a client to accuse a caregiver of stealing or mistreatment.

At times, workers are exposed to sexual comments or advances on the part of a client or family member. Sometimes clients or their families treat caregivers as maids or domestic servants. Many caregivers also report feeling a lack of respect--that society in general does not appreciate their work. The nature of care giving requires a special disposition and a sense of calling to serve the elderly and people with disabilities. In a tight labor market, individuals can easily work in less stressful retail or service industries for similar wages. Given the low wages and lack of benefits, the demands of the job and the low status society places upon care giving, is it any wonder that home care workers are in short supply?

Meeting care needs in Waushara County

Waushara County, population 23,000, is a scenic area in east-central Wisconsin. The landscape is dotted with glacial lakes, sandy soils and ever-green forests. Few industries exist, so people make a living growing Christmas trees, working in tourism or traveling 40-50 minutes to urban areas for employment. The largest city, Wautoma, boasts a population of 2,000 and four of the county's five stoplights. In one important aspect, Waushara County reflects the future of America: one out of five residents are over the age of 65.