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Family caregiving vs. paid elder care

by Isabel Fawcett

Some nursing home workers and visitors to nursing homes get it. Caring for chronically ill elders, whether in a nursing home environment or in elders' private homes, is not for everyone. Some say "it takes a special person" to care for chronically ill elders. You decide.

It may have been Alexander Pope who once said, "Fools rush in where angels fear to tread." I love that quote. I am neither a fool nor am I an angel. I am a long-time family caregiver, by choice. That said, not every individual is up to the task of caring for chronically ill elders. Trust me on that. If you don't trust me, just ask any nursing home or hospital worker for the information.

Not only is direct assistive care physically demanding work, it is emotionally exhausting even for those whose heart may be in the right place. Been there. Doing that as we speak.

Paid Direct Care Workers in the Trenches of Eldercare

First things first - my hat's off to paid direct care staff who work in nursing homes and for agencies offering programs for chronically ill elders. It is a mistake to think that such workers are paid enough for their direct care work with elders, including in nursing homes. There is no amount of money that could adequately compensate a nursing home worker for providing round-the-clock care to elders, let alone in such a tightly regulated industry where the stakes are so high for all involved.

Front-line nursing home workers, including aides, custodians and nursing staff are held accountable for every spill and unpleasant odor in their assigned nursing homes. Such a high public and regulatory standard is as it should be for well-managed nursing homes in the United States. Regardless, frail and chronically ill hands, mouths, distracted minds, and increasingly weak elders' bodies regularly contribute to spills round-the-clock, whether in-home or in nursing homes.

Negligence may be a contributing factor in some instances. In other circumstances, however, staff or caregiver negligence is not the culprit when some spills go undetected. Nursing home staffing ratios, ongoing prioritizing of safety risks and unending resident health crises are just a few reasons spills in nursing homes may initially remain undetected or temporarily put on a back burner by front-line staff.

Prioritizing Issues in Eldercare and Nursing Homes

Years ago, part of my weekly business routine required me to be on-site at various nursing homes throughout my assigned territory of Texas, New Mexico and Oklahoma. I've visited so many nursing homes I've lost count.

One nursing home visual was burned into my memory for all time. The situation speaks to the issue of individuals' suitability to do whatever it takes to protect, supervise and assist chronically ill elders.

The nursing home floors sparkled when I first walked on-site and the day's operations were otherwise humming. Then, while walking alongside the nursing home administrator, I suddenly felt as if I had hit a stone wall. The invisible stone wall I had hit was the most unpleasant odor I've smelled in my entire life. Yikes!

The odor came from a nursing home resident's room where the resident's bed was covered in feces. The resident lay helpless in bed, unable to speak.

The nursing home administrator was confident and prompt, calling on staff to clean the mess and assist the resident. I stood frozen and unable to take a single step further until a direct care worker quietly walked into the room to start cleanup. Another worker followed, this time a custodian.

Neither one of the direct care workers flinched nor did the nursing home administrator. Yes, it does take a special person, I thought. After that memorable day for me, ethical nursing home staff became my everyday American heroes and heroines. They still are.

In light of such a memorable event, it is easy, and entirely reasonable for me to imagine that liquid or food spills may, and sometimes do, temporarily take a back seat to cleanup of urine and feces in nursing homes. Further, it is not a leap of logic for me to imagine the feces scenario simultaneously replicated in more than one area of a nursing home even as multiple food and liquid spills simultaneously occur throughout the nursing home. Who's on first?

Should food and liquid spills take precedence over bodily fluids and excrement if the bodily fluids potentially may infect unattended nursing home residents? Oh, let's not forget infection control measures that protect nursing home staff and residents, while we're still on topic.

Spills, on the other hand, contribute to needless slips, trips and falls for staff and residents. Decisions, decisions. Limited staffing in nursing homes clearly requires active duty monitoring round-the-clock by all staff, from front line custodians to nursing home administrators and directors of nursing. It literally takes a village in a nursing home to care for elders who are chronically ill.

Skills and Abilities Required in Direct Elder Care Jobs

If you freeze at the first hint of an unpleasant odor, can't shift gears readily, or are unable to keep a running mental tab of what all you may have left undone before the latest and greatest eldercare crisis without skipping a beat, eldercare may not be your calling.

One-to-One Care Ratio

It may be tempting to then assume that it is easier to handle caregiving if there is only one elder for whom you would be caring. Think again.

Thinking About Direct Care Job Opportunities?

Think long before committing to round-the-clock eldercare, or caring for elders for any extended period, even if you share the responsibility with another family caregiver or other individual.

Even if there is only one elder involved, the buck stops with the primary caregiver or direct care worker on duty for all of the above, including slips, trips, falls, bodily fluids and other assistive and emergency care.

There are respite services available, but respite is temporary. Respite will never be a nursing home with full staffing complement.

Think twice. As many wise individuals have said for years, "it takes a special person" to care for a chronically ill elder.

Think hard. There is not easy way out of eldercare and shortcuts are not advisable.