My 91 year old mother lives in the dementia unit of the ABC Nursing and Rehabilitation Center. I have been either her prime or secondary caretaker for ten years. Recently, Mom developed a small sore on one of her feet which led to a bacterial infection. I found it, reported it to the aide who was responsible for Mom that day and to the unit nurse. I suggested calling the doctor to examine it. I also suggested that, perhaps, anti-biotics were necessary. And, that the first one was not working. And that she was allergic to the second one.

I purposely stress the action that I had to take to get my mother the appropriate medical treatment. I am convinced that if I had not been there, her problem would have been ignored until the infection had entered her bloodstream and her chances of recovery would have been slim.

The infection and resulting fever left her weaker and frailer than usual. After several tries, this last anti-biotic seems to have it under control. I was afraid, and hopeful at the same time, that she would pass on to a better world. But she didn’t. My mother is not unhappy, just unaware. I guess that’s the only blessing to be found in this situation.

I cancelled my recent plans to transfer her to a nursing facility in our home state because I doubt if she would survive the necessary plane and road trip. My oldest daughter, who still lives in Pennsylvania, was going to oversee her care. My own recent physical challenges have made it difficult to maintain a close enough eye on my mother’s care. I am stressed emotionally and physically when I can visit and even more so when I can not. I think I am prepared for my mother’s passing, but don’t want my lack of supervision to be responsible for it. I don’t want to see her in pain and I don’t want her drugged into a state of vegetation. I have a lot of “wants” and very little control.

My concerns regarding her level of care are partly based on my real experience with the nursing home and also on what I fear could happen. Through it all, Mom is happy to see me when I come and still grows jealous and impatient if I talk to anyone, but her. When I leave, she barely notices. She might smile when I kiss her good-bye, but the minute I am gone, she has no memory of me. I’m relieved and I’m sad to know that.

Here’s a hot-topic of the upcoming Presidential Election that may surprise all the candidates in 2008. Many politicians expect America’s declining economy to be the number one topic. Stabilizing our economic balance in the global market, directly or indirectly, certainly effects all of our chief economic concerns. Or, maybe, some of the politicians think that the Mid-Eastern War and the debate to withdraw our troops from Iraq to be the primary concern of the American voter. Also, an increasing amount of attention is being paid to methods to improve the ecological problems here and abroad. All of these issue will draw the attention of voters. But, the candidates from all parties may be completely out of touch with the prime concerns facing the average American. Our health care crisis.

http://www.usinfo.state.gov

There is no doubt that the American system for providing basic health care to its’ inhabitants is in critical condition. Because of sky-rocketing healthcare costs, many corporations contend that they can no longer provide health care security for their employees. State and federal agencies are caught between decreased funding and endless paper work. The prohibitive cost of private insurance coverage makes it unavailable to the average, middle-income American family.

Health care providers (i.e. doctors, nursing homes, hospitals, etc.) are over-whelmed with paperwork and inhumane restrictions placed on them by the insurance industry in general. People who are recovering from serious illnesses and surgeries sometimes face heart-breaking choices between their health care or their family’s basic financial survival.

The rising costs of medical care often requires them to put their homes and future financial security at high risk. Even if they are fortunate enough to have health insurance coverage, many can’t afford to pay the out-of-pocket medical expenses that their insurance carriers are not contracted to cover. Insurance companies are even rumored to pay their own employees bonuses if they are able to deny coverage to their clients!

http://www.health.usnews.com

Many white-collar workers of the baby-boom generation (those born after World War II, 1945-1963) are being forced out of their jobs. Although the primary reason given for retirement is poor health, jobs are also being handed over to younger workers here in this country, and in other nations, who are willing to work for lower wages and fewer benefits. Many baby-boomers, aged 44 years to 62 years of age, find their homes, their life-style, and their health care at increasing risk and the dream of retirement increasingly impossible to realize. http://www.chipolicy.org

In addition, while this age group is still raising children (or grandchildren), they are often caring for aged parents. There is no other issue of health care in more desperate need of repair than our elder care programs. The alternative health care programs initiated by recent administrations in Washington, DC are perplexing to most people who try to decipher the confusing disarray of competing plans. The elderly are sometimes targeted by unscrupulous insurance venders, and sold plans and policies that do not meet their special needs.

The elderly are forced out of their familiar surroundings and placed in nursing homes owned by corporations interested, not mainly in the welfare of their clients, but the profits of their company. While the staff may try to provide adequate care for our seniors, they are often unappreciated, usually underpaid, and mostly powerless to balance care for the elderly in a humane manner against the profit demands of the corporation.

http://www.seniorjournal.com

There is no meaningful, government-funded aid available to a potential caregiver to sustain them as they care for the elderly at home. Many of our senior citizens could be maintained in a more cost-efficient, personal and caring level if financial and home health care assistance could be obtained for the caregiver. Instead, in order to receive the care they need, our loved ones are stock-piled in impersonal and questionable institutions until their finances are completely depleted by the corporate-owned businesses and they, the senior citizens, are forced onto government-paid welfare programs.

Surely a country willing to spend trillions of American, tax-payer dollars to fight an oil war half-way around the world, can develop a system of health care that would provide the same medical benefits enjoyed by our public servants in Congress.

Or, should we, as American taxpayers, be expected to give up hope of affordable treatment and recovery from our medical community in order to protect our family’s future?

The questions are important and we have a right to expect our elected officials and our Presidential candidates to protect our interests over special-interest lobbyists that troll the halls of Congress looking for politicians who will bite. And, just as importantly, all citizens and voters have an obligation to be informed of each and every candidate’s stand on national health care issues. The decisions we make in 2008 will have a lasting affect on the future health of our country.

http://www.projects.washingtonpost.com

Home Care Quote offers your loved ones of all ages an opportunity to enjoy the security, peace of mind, and comfort that staying in a familiar environment provides.

Elder Care:
As our parents enter the final years of their life, they may be unable to care for themselves, or each other, or their home as they have in the past. They may also be unwilling or reluctant to enter an assisted living facility or a nursing home. Proposing significant changes can even frighten our loved ones. Their adult children may place them in even a greater risk situation by automatically deferring to their parents. After all, it’s uncomfortable to assume authority over the parents who raised you. It may even cause adult children to mentally minimize their parents inability to function as normal.
Using in-home care can lessen the fears of all concerned. The in-home, professional care giver for the elderly is there to maintain, or even improve, the quality of life of the elderly parents. Every level of care can be found from simple companionship and homemaking to highly skilled nursing care. The help you need may be a full or part-time position. The caregiver may live in or out. The adult children should confer with their parents’ medical team to determine what is in their loved ones best interest. Involving the entire family in the decision-making process may ease the stress of making the necessary changes. The professional, in-home care giver has the experience to support the extended family as well as the elderly parents. The best commitment you can make for your parents is to ensure that they are lovingly cared for as they enjoy a safe level of independence and a comfortable state of mind.

Child care:
If you are a parent returning to the work force, your young children’s anxiety over your absence may be eased by providing a way for them to remain in their own home rather than a day care center or a stranger’s home. Whether you need part-time or full time care, an energetic person who is experienced in giving gentle supervision and creative play-times will make the transition smoother for everyone in the family. A professional and loving child care worker can give your infant or toddler the emotional and physical comfort they require and a program of visual and mental stimulation that is so beneficial during their formative years. The childcare specialist can help the older children with their personal hygiene, see that they have a nutritious breakfast, get them off to school and be there to greet them when they get home. They can oversee homework, encourage physical activity, and help to make your return home from your job a pleasant experience.  

Special needs care:
If your loved one (of any age) has disability challenges, physical or mental, an in-home care giver can offer the family options that will allow their loved one to remain at home. These situations can be especially sensitive and the importance of choosing the correct care giver can not be over-emphasized. Often, the whole family is under great stress. Decisions are likely to be made on an emotional level rather than an intellectual level. A strong reliance must be placed in the hands of medical and psychological advisers, but the final choice is made by the family. The care giver  must be able to meet all the needs of your loved one. Work requirements will be more difficult, but the rewards are satisfying. The services that the “special needs” care giver provides are vital to the client and to the family. The positive effect that can be made in the challenged loved one’s quality of life, and on the family in general, make it a worthwhile option to be explored.

As medical and scientific strides make it possible for people to live much longer, care giving is sought after and much more appreciated service in this country. Statistics suggest that there are up to 25 million family “in-home” caregivers in the United States. And that number is increasing at a rapid rate. The health care work force is provided with wide and varied opportunities for growth. Demand for professionals and non-professionals have created a more flexible market place, while families are provided with more beneficent and suitable home care alternatives.�

Here’s a hot-topic of the upcoming Presidential Election that may surprise all the candidates in 2008. Many politicians expect America’s declining economy to be the number one topic. Stabilizing our economic balance in the global market, directly or indirectly, certainly effects all of our chief economic concerns. Or, maybe, some of the politicians think that the Mid-Eastern War and the debate to withdraw our troops from Iraq to be the primary concern of the American voter. Also, an increasing amount of attention is being paid to methods to improve the ecological problems here and abroad. All of these issue will draw the attention of voters. But, the candidates from all parties may be completely out of touch with the prime concerns facing the average American. Our health care crisis.

http://www.usinfo.state.gov

There is no doubt that the American system for providing basic health care to its’ inhabitants is in critical condition. Because of sky-rocketing healthcare costs, many corporations contend that they can no longer provide health care security for their employees. State and federal agencies are caught between decreased funding and endless paper work. The prohibitive cost of private insurance coverage makes it unavailable to the average, middle-income American family.

Health care providers (i.e. doctors, nursing homes, hospitals, etc.) are over-whelmed with paperwork and inhumane restrictions placed on them by the insurance industry in general. People who are recovering from serious illnesses and surgeries sometimes face heart-breaking choices between their health care or their family’s basic financial survival. The rising costs of medical care often requires them to put their homes and future financial security at high risk. Even if they are fortunate enough to have health insurance coverage, many can’t afford to pay the out-of-pocket medical expenses that their insurance carriers are not contracted to cover. Insurance companies are even rumored to pay their own employees bonuses if they are able to deny coverage to their clients!

http://www.health.usnews.com

Many white-collar workers of the baby-boom generation (those born after World War II, 1945-1963) are being forced out of their jobs. Although the primary reason given for retirement is poor health, jobs are also being handed over to younger workers here in this country, and in other nations, who are willing to work for lower wages and fewer benefits. Many baby-boomers, aged 44 years to 62 years of age, find their homes, their life-style, and their health care at increasing risk and the dream of retirement increasingly impossible to realize. http://www.chipolicy.org

In addition, while this “sandwiched” age group is still raising children (or grandchildren), they are often caring for aged parents. There is no other issue of health care in more desperate need of repair than our elder care programs. The alternative health care programs initiated by recent administrations in Washington, DC are perplexing to most people who try to decipher the confusing disarray of competing plans. The elderly are sometimes targeted by unscrupulous insurance venders, and sold plans and policies that do not meet their special needs. The elderly are forced out of their familiar surroundings and placed in nursing homes owned by corporations interested, not mainly in the welfare of their clients, but the profits of their company. While the staff may try to provide adequate care for our seniors, they are often unappreciated, usually underpaid, and mostly powerless to balance care for the elderly in a humane manner against the profit demands of the corporation.

http://www.seniorjournal.com

There is no meaningful, government-funded aid available to a potential caregiver to sustain them as they care for the elderly at home. Many of our senior citizens could be maintained in a more cost-efficient, personal and caring level if financial and home health care assistance could be obtained for the caregiver. Instead, in order to receive the care they need, our loved ones are stock-piled in impersonal and questionable institutions until their finances are completely depleted by the corporate-owned businesses and they, the senior citizens, are forced onto government-paid welfare programs.

Surely a country willing to spend trillions of American, tax-payer dollars to fight an oil war half-way around the world, can develop a system of health care that would provide the same medical benefits enjoyed by our public servants in Congress.

Or, should we, as American taxpayers, be expected to give up hope of affordable treatment and recovery from our medical community in order to protect our family’s future?

The questions are important and we have a right to expect our elected officials and our Presidential candidates to protect our interests over special-interest lobbyists that troll the halls of Congress looking for politicians who will bite. And, just as importantly, all citizens and voters have an obligation to be informed of each and every candidate’s stand on national health care issues. The decisions we make in 2008 will have a lasting affect on the future health of our country.

http://www.projects.washington post.com

Here’s a preview of what is shaping up to be an important theme of the 2008 primaries!

Broad bipartisan concern re the condition of health care in our country has escalated the debate over whether or not our country should have a universal system of health care. 

See below to check out your favorite candidate’s stand on this important issue.

* Note: Readers, please be aware that, as the contest between presidential candidates evolves, candidates may be dropped from the slate or their stated opinions may change.

DEMOCRATS:

Hillary Rodham Clinton, Senator (D-N.Y.)

Senator Clinton has proposed a $110 billion health care plan that would require all Americans to have health insurance. “Here in America, people are dying because they couldn’t get the care they needed when they were sick…. I believe it is long past time that this nation had an answer.” In her plan, Clinton said families would receive tax credits to help pay for coverage. Federal subsidies would be provided for those who are not able to afford insurance, and large businesses would be expected to provide or help pay for their employees’ insurance. Clinton said her plan would not require small businesses to take part, but will offer tax credits to encourage them to do so. Under Clinton’s plan, Americans would be offered the same health care benefits offered to Congress. To help pay for the plan, Clinton would also eliminate the Bush tax cuts for those making over $250,000 a year.

http://www.washingtonpost.com/wp-dyn/articles/A30277-2004Aug24.htmlplan

John Edwards, Senator (D-N.C.)

Senator Edwards healthcare system plan proposes to provide for everyone in the USA at an affordable price. Families with insurance will pay less and get more security and choices. Businesses and other employers will find it cheaper and easier to insure their workers. It achieves its coverage plan by requiring businesses and other employers to either cover their employees or help finance their health insurance. It proposes to make insurance affordable through tax credits and by reforming insurance laws. His plan creates “Markets” so every American shares bargaining power to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance.

www.nytimes.com/2007/02/06/us/politics/06edwards.html

Dennis Kucinich, Representative (D-Ohio)
For the second year Kucinich is a co-sponsor of HR 676 in Congress, It’s a bill to enact single-payer universal health care nationwide. The bill would expand the existing Medicare program so that every person living in the United States and U.S. territories could receive publicly financed, privately delivered health care. Each person would receive a United States National Health Insurance Card with ID number.
“When people tell me that national health insurance is the right answer but is not politically feasible, I tell them that the opposite is true,” says Kucinich. He is the only major declared candidate who advocates for a single-payer health care system so far in this race. Services include inpatient and outpatient care, emergency care, prescription drugs, durable medical equipment, long-term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment.

http://www.youtube.com/watch?v=hTgPFJnV76c

Barack Obama, Senator (D-Ill.)

Senator Obama believes all U.S. residents should have health care coverage within the next six years. “I am absolutely determined by the end of the first term of the next president, we should have universal health care in this country.” At the 2007 Families USA Conference, Obama said the U.S. must consider whether “the employer-based system of health care itself is still the best for providing insurance to all Americans” at a time “when businesses are facing increased competition and workers rarely stay with one company throughout their entire lives.” Obama did not present a specific health plan or announce how the universal plan would be funded, but said that he would be working to develop one “over the next several months.”

http://media.mesa.gmu.edu/capcon/FamiliesUSA/Conference2007/Obama.wmv

REPUBLICANS:

Rudy Giuliani, Attorney (R-NY)
Former New York City Mayor, Giuliani, has stated that he wants to move tens of millions of people from employer-based health insurance to the individual market as a way of giving people more coverage choices.
The principles Giuliani identified for health care mirror President Bush’s call for an “ownership society” in which the power of the free market could eventually shore up health and retirement security programs alike. Giuliani said he would give families a $15,000 tax credit to purchase private insurance policies and allow them to keep whatever credit remains as an incentive to purchase cost-effective plans. Giuliani makes no mention of covering everyone.

http://blogs.wsj.com/washwire/2007/06/07/giulianis-health-care-plan/

Mike Huckabee, Candidate (R-Ark.)
Huckabee believes that the health care system in this country is irrevocably broken, in part because it is only a “health care” system, not a “health” system. His plan is more of a “set of principles” that will require more of an explanation. He seems to take the typical Republican stand “no more government” but he has suggested new program ideas. For example, he calls for tax credits to help low-income people purchase health insurance but says universal health care can’t be “funded through ever higher taxes. He does not say how this assistance would be funded. He says the core of his strategy would be to shift the health insurance system away from the employer and toward a consumer-driven model putting a more vibrant health care market.

http://www.ontheissues.org/Mike_Huckabee.htm

John McCain, Senator (R-AZ)
We’re asking senior citizens now to make a choice between their health and their income. They make too much money to be on Medicare and not enough to pay for their prescription drugs. We’ve got to devise a program that when a senior spends a certain part of their income on these prescription drugs that we’ll have a state and federal match for it.
He states that, “It is simply disgraceful that 43 million Americans can not afford health care coverage. We must expand medical savings accounts, offer flexible savings accounts, provide full tax deductibility for self-employed health insurance costs, and allow tax deductibility for long-term care expenses.” McCain. also supports higher taxes on cigarettes to help defray the cost of health care. Unlike his rivals, he will focus on controlling costs, rather than reducing the ranks of the uninsured.

http://www.ontheissues.org/Health_Care.htm#John_McCain

Ron Paul, Representative (R-TX.)
Paul says, “As a medical doctor, I’ve seen first-hand how bureaucratic red tape interferes with the doctor-patient relationship and drives costs higher. The current system of third-party payers takes decision-making away from doctors, leaving patients feeling rushed and worsening the quality of care. Yet health insurance premiums and drug costs keep rising. Clearly a new approach is needed. Congress needs to craft innovative legislation that makes health care more affordable without raising taxes or increasing the deficit. It also needs to repeal bad laws that keep health care costs higher than necessary.”
“Government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government – in the form of “universal coverage” – is the answer. But government already is involved in roughly two-thirds of all health care spending, through Medicare, Medicaid, and other programs.

http://www.lewrockwell.com/paul/paul339.html

Mitt Romney, Candidate (R-Mich.)
The Republican governor of Massachusetts, like many other (mostly Democratic) health-care reformers, wants to achieve “universal coverage.” That goal is the motive for the feature of the Commonwealth of Massachusetts’ plan that is most controversial on the Right — the mandate that all individuals purchase health insurance has inspired opposition from much of the Right while mostly winning support from the Left. Romney defends that mandate in two ways: first by analogy to auto insurance, which all car owners are obligated to purchase, and second by arguing that people who lack insurance impose costs on everyone else.
Romney knows that one danger of an individual mandate to buy insurance is that it increases the government’s temptation to set forth what that insurance must include, and to expand its definition over time.

http://www.time.com/time/columnist/klein/article/0,9565,1137628,00.html

Assuming the responsibility for hiring a Home Care worker for yourself, for parents, for a friend, or any family member is serious business. Even if the need is only temporary, occasional or part-time, the person you hire will have access to everything in your loved one’s home. The potential for elder abuse is especially high if your loved one is experiencing serious memory-loss issues.

Many people prefer to begin their search using a personal reference from a friend, an associate where they work, a fellow member of a club, or from their place of worship. One, or all, of these contacts may lead you to the perfect candidate. But it will require doing personal interviews, double-checking references, and will entail time and effort that you may not have to spare.

Using a professional agency to screen possible employees may be the most efficient and safest way to get started. But, realize that there is no guarantee that the candidate has not misrepresented themselves to the agency or that the agency has done their job by running a thorough check on the candidates personal referrals, professional references or the possibility of a criminal record.

Make sure that the agency you choose has the required:

Federal and State Licensing required of the Agency

Insurance and Bonding for all Companions and Caretakers

Adequate training of all Companions and Caretakers

Another option is going to the classified ads of your (or your loved one’s) local newspaper. The risk is higher when you consider this source because anyone who can pay the price of an ad can advertise in the classifieds. Extra diligence will be required to make all of the reference, credit, and criminal checks yourself. The up-side of this method is twofold. You know that the checks have been run because you did them. And, you avoid the middle-man costs of the agencies which may mean a significant savings.

It’s very important before you begin this process to determine what level of care is needed. Do this by making a list of all the services you expect to be performed by the Companion or Health Care Worker. For instance, if you need a

Home Companion:What level of education do you require?

Will they need to provide their own transportation?

Do they need a driver’s license and/or adequate auto insurance?

What hours do you need them to work?

Do you want them to live-in the residence or out?

Will household chores such as grocery shopping, planning meals and cooking, laundry, light cleaning, etc. be required?

Are they trained and able to meet special nutrimental needs?

Are they capable of doing light to medium lifting?

Can they help to dress and groom your loved one?

Can they aid in maintaining personal correspondence?

Can they be responsible for paying bills?

Are they willing to provide your loved one with a regular regime of physical exercise?

If a Health Care Worker is needed, your loved one’s doctor or clinic will be your best source and absolutely necessary to help you determine what services will be required.

A Certified Nursing Assistant or a Licensed Practical Nurse (LPN) may be sufficient for giving bathes, injections, monitoring blood pressure, sugar levels, treating wounds, etc.

If higher skilled nursing is required, a Registered Nurse (RN) may be necessary to administer medications, provide assessments and evaluations, or whatever services outlined by their physician and State and Federal regulations.

A Licensed Physical Therapist may be needed to develop a strength training and home exercise program for serious rehabilitation.

In addition to all of your requirements, the successful candidate should be a good match on a personal level to your loved one.

Do they seem quiet or chatty? Which personality would your loved one prefer?

Do they appear clean and well-groomed.

Would their native language or accent make it difficult for your loved one to communicate with them?

Would they agree to a specific “trial period” of employment?

Would they object to video cameras in the home to give you the peace of mind that your loved one is receiving the high level of care they deserve?

Once you have successfully completed the quest of finding a suitable a Home Companion or Health Care Worker and you feel that you can trust them to perform the needed services for your loved one, don’t lose them! In order to retain this valued worker, we suggest that (after the trial period) you provide them with above-average compensation and benefits. Already there is a great demand for these types of health care providers and this demand can only increase as the bulk of our elderly population moves toward their retirement years and beyond.

Many caretakers, amateurs and professionals alike, and at all levels of education and experience, are employed at their client’s home on a personal recommendation or through professional agencies. Nursing home facilities are always looking for help. Most workers have used a combination of methods of finding work, but all of them will tell you that the burn-out rate is high in their field. If they are caring for the elderly, the disabled, or for children, in their clients’ home, the caregiver feels isolated. The stress level is high, the mental and physical demands intense, and the rewards are few.

There is high turnover among in-home care workers because they usually don’t earn benefits, vacation time or sick days. Many of these workers are recent, and sometimes, illegal, immigrants. Anna, a young Spanish-speaking woman says, “I came to this country on a student visa, but when I ran out of money, I had to find work. I worked mostly as a baby-sitter, but also as a home companion for an elderly woman. I was lucky. My employers always treated me very well. They paid me above average wages and even gave me vacation time. But, most of my friends who I met taking English language courses, were not as lucky as me. They work very hard and can’t take any time off.”

She doesn’t say it out loud , but I know what Anna means. Illegal immigrants are at the mercy of employers who can hire and fire them at will, pay them below minimum wages, and turn them in to the immigration authorities on a whim.

Anna pauses for a moment, then continues, “But one thing makes it very bad for me. Back home in Costa Rica, I finished collage and got my degree in accounting. In this country, I can only work for someone in their home. I take care of little children, but there is nothing else for me to do. I am very grateful for the opportunity to come to the US, but I decide that it is better to wait for a visa and come in legally. I just wanted to be in the United States of America so bad that I couldn’t wait. I love the US. I don’t have much opportunity in my country either. Maybe I could have won a visa in our lottery, but everybody wants to win that.”

“Tell me about your friends. Why did they come to this country?”

“Mostly, they just come to make money. They want to have a chance to make a good life in their own country, but there is nothing for them there. So, they come here. They get mostly jobs nobody else wants and they work very hard and very cheap. But they can’t say anything about the way they are treated. Many people from other countries would be happy to take their job baby-sitting, waiting on tables, or washing dishes for even less money. They have no rights and no hope.”

I guess my face is showing how conflicted I’m feeling. I feel sorry for people who are struggling to support themselves and their families. “If I had been born in Mexico or Salvador or Columbia”, I answer, “I would want to live in America, too.”

But I am thinking to myself, How can people who enter this country illegally expect to have any rights? After all, they broke our laws to get here, didn‘t they?

“All those countries you said, and Costa Rica, too…we are all Americans. Some South and some North.” Anna’s voice is soft and apologetic. “We don’t like not to be called Americans, you know.”

I met Carol, a nurse’s aid for over twenty years. By her own admission, her choices in life were limited. Carol did not complete high school, had taken only basic, required health care courses, and had worked for a variety of nursing facilities. The turn-over rate for nursing home workers is especially high. The workers tend to drift from one facility to another, hoping for an increase in wages and better working conditions. While tending to our seniors, they often working double shifts, just to make ends meet. In spite of the low pay, Carol had managed to raise her own family while caring for others.

I began a conversation with her while I was visiting with a friend. I asked Carol how long she’s been working at the nursing home and she provided me with a litany of nursing home jobs she has had and why she was forced to leave them. She cited low wages, no raises, and unhealthy or unsafe working conditions. I ask her what she likes about her job and she answered me right away. “It’s the old folks. I like taking care of them. I make sure that they’re doing okay as best I can.” Then I ask her what she doesn’t like about her job.

Carol is reluctant to speak up, but, with a little prodding on my part, she finally tells me, “The best thing to do around this place”, she says, speaking of the nursing home where she is currently employed, “is to keep your mouth shut, if you know what I mean.” Her eyes darted around the room.

I told her I don’t know what she meant.

“Well, some people like to talk about everybody’s business, but their own, if you know what I mean.” I nod my head in encouragement. “Like, for one thing, you don’t want to be calling the hospital every time somebody falls down or hits somebody else. It goes on our record, you know.”

“Your record?” I ask.

Carol snorts out a laugh and looks at me with pity for being so uninformed. “No…the nursing home’s record. If they get too many accidents, the State gets called in to investigate and then we all get in trouble.”

I find this difficult to believe. My grandmother was in a nursing home years ago, but I hardly ever saw her because we lived in another state. My first reaction to Carol’s statement is to think she has a little too much flair for the dramatic. But, she doesn’t seem the type. She’s a large woman, solid-framed and, I don’t believe, easily intimidated.

“What can you…or anybody do about it?”

Carol shrugs her shoulders. “Don’t know. Big corporations own this place…own most places now. They don’t listen to people like me. Besides, I would lose my job if I said anything.”

I persist. “Well, what can we do? I mean, the people here have families, don’t they? What if they tried to reason with the corporations? Tried to organize or something?”

Carol looks around again, checking to see if anyone is listening to our conversation. Her voice is a hoarse whisper. “The best thing, if you care about somebody living here, is to visit. Come to see them all the time. Make sure they’re clean, getting baths and stuff, and their eating okay, and they’re getting they’re meds…as best you can.” Carol leans forward and gives me a conspiratorial wink and adds, “Don’t forget you may just end up in one of these places yourself.”

I’ve been a caretaker for my mother for ten years. Mom was 91 years old this past December. She is in good, physical health. She stands about 5 feet tall now…she used to be 5′2″…and she weighs about 117 pounds. Her dark hair is mostly gray and I keep it cropped short. She used to hate her hair touching her ears. Mom’s fair skin has very few deep wrinkles or noticeable age spots. Her warm, brown eyes are covered by a thin film, but they still light up when I come to see her… even if she doesn’t know who I am anymore. Until very recently, she could set the pace for our circular hall walks in the Dementia Unit of the ABC Nursing Home and Rehabilitation Center of St. Petersburg, Florida.

In celebration of her birthday, I served Christmas-decorated cupcakes and egg nog to approximately 30 residents and a half-dozen or so members of the staff. I bought Mom a doll with yellow, yarn hair that is soft to cuddle and has no obvious, removable parts that she could ingest. My mother used to collect dolls. She did not collect them with their possible future value in mind, but because she felt they needed a home. Many were missing vital body parts and they were dressed in all types of ingenious outfits that she found at garage sales. By accident, some of them were actually collectors’ quality.

Although it’s called the Dementia Unit, this part of the ABC facility cares for mentally ill folks of all ages, too. By law, if only 25% of their clients are diagnosed as having dementia or Alzheimer’s disease, the facility can identify itself as a dementia unit. This means that those diagnosed with schizophrenia, those mentally disabled by drug or alcohol-related abuses, or those who suffer from almost any type of mental deficiency live in very close quarters with my elderly mother. This situation didn’t happen over-night.

She’s been in the “secure area” of this facility for four years. She’s on Medicaid. There are few choices for people like myself who can not afford to pay $5,000 a month…and up… for a nursing home. When she first went to ABC, she was the seventeenth client in the Dementia Unit. Most, if not all, of the clients were elderly like Mom and suffering from dementia or Alzheimer’s.

Gradually, under new, corporate ownership, the staff was reduced, and the mentally ill were incorporated into the dementia/Alzheimer’s group. Two activity areas disappeared, transformed into extra beds, and the clients living there rose from 17 to 32 people and sometimes more. While I’m convinced that the majority of the nursing staff does the best that it can, the quality of care has deteriorated. And you, the caretaker, can’t be there all the time. What you hope for is that the staff will spot and intervene in serious problems before anyone is hurt. You pray that your mother will be protected from those who don’t realize their behavior is destructive.

Nation-wide abuses by the health care industry have become an increasing problem at all government levels. Misuse of a system designed to protect the least powerful members of our society is rampant. They range from unqualified caregivers to serious Medicaid fraud. It is apparent to many victims, and the families of those victims, that the laws already in enacted in many states are not being adhered to by health care agencies or enforced by state health departments.

In the State of Washington , a woman who used to work in an adult-care home as a nursing assistant was sentenced to nine months in jail. She was charged and held responsible for not taking proper care of an ill 73-year-old woman who died at the facility. The emergency room doctor said lack of medication, liquids and food had put her into a coma and caused her kidneys to fail. The nursing assistant admitted to not properly dispensing food, water and medications. Two other employees of the care facility were charged with manslaughter and criminal mistreatment in connection with the death.

Evidence obtained by New York officials under the leadership of Attorney General Andrew Cuomo suggests “…endemic, persistent fraud and malfeasance at all levels of the home health care industry,” Mr. Cuomo has subpoenaed more than 50 home health care agencies as part of an investigation into industry-wide wrong doing. The letters requested that health care agencies disclose information about the aides they employ, including verification of their qualifications and hours billed. The Attorney General’s Medicaid Fraud Control Unit has implicated several home health care aides in fraudulent schemes.

In Florida it was discovered that investors’ profits come at the expense of patient care. A health care center in Tampa was struggling when a group of large private investment firms purchased it and 48 other homes. The facility’s managers quickly cut costs. Records show that, within months, the number of clinical registered nurses at the home was half what it had been a year earlier. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration. The investors and operators were soon earning millions of dollars a year from their 49 homes.
The aged and mentally-challenged residents fared less well. Much less well. In three years, 15 persons died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. Investors claim that the corporate structures are common in other businesses and have helped them revive an industry that was on the brink of widespread bankruptcy.

We need laws ensuring that seniors always have access to critical elder abuse services when needed the most. We need laws dedicated to protecting those who, for mental or physical reasons, can not report their own abuse. We need stronger enforcement and higher penalties for those who continue to disregard the welfare of our senior citizens.

The American Medical Association (AMA) defines caregiver as “…anyone who provides assistance to someone who is in need of care.” Caregiver health stress is a critical topic at any time, but it’s even more so now that many caregivers have the added stress of the current inadequacy of the health care industry, financial strain under a failing economy, and the seeming indifference of health insurance organizations.

Caregivers, as a whole, report poorer health than the general population. The fact that there are over 44 million caregivers in the United States qualifies this situation as a public health issue crisis. The statistics of the early death of caregivers is frightening. The AMA also says, “Studies show that 16 percent of caregivers report that their health has worsened since taking on the caregiver role, and about half of caregivers who care for someone with Alzheimer’s disease develop psychological distress.”

According to John Crews, senior health scientist at the Centers for Disease Control and Prevention, ” If one can anticipate millions more are heading for infirmity, and “overlapping” with the current dependent population, there is no “rule” to suggest the 44 million has to proportionately rise with the demand.”

But do we need a “rule” to see the likely-hood of the rising demand? The “Golden Age” of 79 million baby boomers looms on the horizon. Our present system can’t pretend it will satisfy even the most basic health care needs of American residents in the light of this potential disaster.

The days of the “extended family” living and working together to provide for the family’s financial and health care needs is over. In order to make ends meet, everybody’s working. Mom’s not home for cookie-baking or to change Grandpa’s diapers. Dad’s probably working one job to provide health care for his family and another, a second job, so he can afford the premiums.

We can only hope that the current situation will stimulate our elected officials into real action and not just more candidate rhetoric to capture votes.