Althouse: Home health care worker "is absolutely the bottom rung on the ladder" of jobs.

২৯ আগস্ট, ২০১৭

Home health care worker "is absolutely the bottom rung on the ladder" of jobs.

Here's a NYT about why and what might be done about it. It's easy to understand why, but the suggestions about what might be done are not encouraging. It's hard to get higher pay for work that is what healthy people do for themselves and what strong, traditional families have done for each other.

The article stresses that these jobs are being done by immigrant women, but more immigration is not discussed as a solution. I think that's because the idea is about making the job a good job that more people would want to do. If it were an article about immigration, I suppose it would get counted as one of those jobs Americans won't do.

৮৭টি মন্তব্য:

Oso Negro বলেছেন...: We have had long had public health campaigns for one noble purpose or another - smoking, obesity, seatbelts, etc. Perhaps a public health campaign illustrating the dangers of getting old without a family to care for you?; ২৯/৮/১৭, ৭:৪৯ AM
rhhardin বলেছেন...: If there's a problem with supply and demand, there are regulations at work.; ২৯/৮/১৭, ৭:৫৩ AM
Sebastian বলেছেন...: "what strong, traditional families have done for each other" There you go again, asserting white privilege. What we need is white people paying for minority women to take care of nontraditional minority families.; ২৯/৮/১৭, ৭:৫৬ AM
Hammond X. Gritzkofe বলেছেন...: I fixed that problem at my place. Cut the bottom rung off all my ladders.

Funny thing, next day there was still a bottom rung. Had to cut those off also.

After a couple of weeks I had no ladders at all.; ২৯/৮/১৭, ৭:৫৬ AM
নামহীন বলেছেন...: If there is sufficient DEMAND the SUPPLY will follow. An immutable law of economics. If you can substitute semi-captive immigrants to do the job the compensation and job description will never be adequate. Same as the complaint about teenagers not wanting to do summer jobs when, in fact, they have been driven out of those jobs by low paid immigrants or visa carrying foreigners.; ২৯/৮/১৭, ৭:৫৬ AM
Ann Althouse বলেছেন...: Ladder is the wrong metaphor because it implies that you will be using the bottom rung to get started climbing. But there is no climb out of this job — no career path that you take by starting here.; ২৯/৮/১৭, ৭:৫৯ AM
Fritz বলেছেন...: We hired a local redneck woman to take care of my dad.; ২৯/৮/১৭, ৮:০১ AM
Hammond X. Gritzkofe বলেছেন...: Yeah. Young adults who got pregnant and dropped out of High School, got certified in how to take temperature and blood pressure readings. Run around in a fleet of compact cars, come to your house, check your vital signs, check out the size of your flat screen TV and the best entry from the alley. Let their boyfriend know.

But they do get a lot of work done. Medicare billing records show one person can be in a dozen different places all over town at the same time.

Your tax dollars at work - those of us who pay taxes, anyhow.; ২৯/৮/১৭, ৮:০৪ AM
Birkel বলেছেন...: Althouse,
How does that argument not apply to McDonald's?; ২৯/৮/১৭, ৮:১১ AM
Beloved Commenter AReasonableMan বলেছেন...: Fritz said...
We hired a local redneck woman to take care of my dad.

When you say 'take care of', what exactly do you mean?; ২৯/৮/১৭, ৮:১৬ AM
Jaq বলেছেন...: I blame Social Security. I am not saying that we don't need it, and that a lot of people really need it, but it certainly put the dynamite to the extended family.; ২৯/৮/১৭, ৮:১৭ AM
Jaq বলেছেন...: Every once in a while ARM gets off a good one. And by "gets off" I meant launches a joke.; ২৯/৮/১৭, ৮:১৮ AM
Laslo Spatula বলেছেন...: Combine the Health Care with an Escort Service.

People with Alzheimer's deserve blow-jobs, too.

I am Laslo.; ২৯/৮/১৭, ৮:২০ AM
Jaq বলেছেন...: Ladder is the wrong metaphor because it implies that you will be using the bottom rung to get started climbing. But there is no climb out of this job — no career path that you take by starting here.

There is such a thing as saving money, sharing apartments to cut expenses, look for other jobs while you keep body and soul together. You know, bourgeois values.

One of the things that bothers me about illegal immigration is that you get illegals doing the kind of scut work, for example around a construction site, that the guys who just didn't take to school whatsoever could do when they got out of high school, you know, while they still had a strong back, and by exposure to these jobs, they could pick up skills and increase their economic value. A pathway to the middle class. But that pathway is blocked in a lot of places, try to find a guy carrying sheet rock who is not an illegal alien. Or mowing lawns, or whatever low skill jobs were available for high school drop outs.; ২৯/৮/১৭, ৮:২৩ AM
bagoh20 বলেছেন...: People shouldn't just lay around dying. Get on with it. It's your last act. Do it with gusto, determination, and be convincing! Nobody wants to see that thing where you wake up after looking dead, becuase you were sleeping in line.; ২৯/৮/১৭, ৮:২৫ AM
Mike Sylwester বলেছেন...: এই মন্তব্যটি লেখক দ্বারা সরানো হয়েছে।; ২৯/৮/১৭, ৮:২৭ AM
Mike Sylwester বলেছেন...: I did not read the NYT article, but I have some knowledge to share on this subject.

I have worked in the administration of a New Jersey home-health-care agency for 14 years.

Practically all of the service is paid for by Medicaid. The aides' wage rate depends on the Medicaid payment.

For a long time, Medicaid paid $15.50 an hour, and the aides earned $10 an hour. The $5 difference paid for office rent, office staff, office equipment, nurses, insurance, utilities, and other business expenses.

A few years ago, NJ Medicaid reduced its payments to $15 an hour, and so the aides' wages were reduced to $9.75 an hour.

After the Medicaid payments were reduced, many agencies went out of business, because they could not squeeze any profit out of the $15 rate.; ২৯/৮/১৭, ৮:২৮ AM
James K বলেছেন...: Typical NYT snobbery, and presumption that this is a problem that requires government involvement. What government is likely to do is make it more expensive to hire this help, and consequently force more people either into taxpayer-funded alternatives or to forego the aid and end up in the hospital and costing Medicare. This is honorable work for people without much in the way of marketable skills. Butt out.; ২৯/৮/১৭, ৮:৩০ AM
Mark বলেছেন...: This sort of job is not a `pathway to the middle class'. There is no advancement in this position, no better position in this role to aspire to [beyond having a client who shits themselves less].

It's a dead end low wage job with zero future, taking care of vulnerable and sometimes easy to exploit people.

It's good to know the value our society puts in the elderly, and couldn't be clearer stated than with what we pay the people caring for them [even in `nice' facilities with high rents].; ২৯/৮/১৭, ৮:৩০ AM
Jaq বলেছেন...: People shouldn't just lay around dying. Get on with it. It's your last act. Do it with gusto,

The older I get, the more sense that makes.; ২৯/৮/১৭, ৮:৩৫ AM
rhhardin বলেছেন...: The bottom rung on the lawyer of success.; ২৯/৮/১৭, ৮:৩৬ AM
Fabi বলেছেন...: When my dad reaches that age I'm going to treat him like the noble Native Americans treated their elders -- tie him to a tree and let the wolves eat him. #CelebrateCulturalDiversity; ২৯/৮/১৭, ৮:৩৬ AM
Michael K বলেছেন...: I didn't read the article either but I do wonder if this is part of the effort to unionize these people, especially family members who are caring for their own.; ২৯/৮/১৭, ৮:৩৮ AM
Oso Negro বলেছেন...: Blogger tim in vermont said...
I blame Social Security. I am not saying that we don't need it, and that a lot of people really need it, but it certainly put the dynamite to the extended family.

8/29/17, 8:17 AM

Yep. It peeled the old folks off the family for starters.; ২৯/৮/১৭, ৮:৩৮ AM
Laslo Spatula বলেছেন...: The lowest rung of the ladder will be taken by robots.

The robots will proceed to climb the ladder.

Eventually robots will decide there are jobs robots won't do.

I am Laslo.; ২৯/৮/১৭, ৮:৩৮ AM
bagoh20 বলেছেন...: "But that pathway is blocked in a lot of places, try to find a guy carrying sheet rock who is not an illegal alien. Or mowing lawns, or whatever low skill jobs were available for high school drop outs."

Out here in the west, all the Home Depots have immigrants hanging around outside waiting to be offered work. Having needed their help a couple times, I know how it works. They often make really good money by negotiating a price for the job rather than an hourly pay. Then, they kick ass and finish it really fast, making maybe $100 in four hours. My question is where are the Americans? I would pick them over the immigrant every time for among other reasons, lack of a language barrier, but there is never a white guy, a black guy, an Asian or a woman,... never. I need simple labor help all the time around my house. It's impossible to get any white kids I know to do it. Even Hispanic citizens will, but my race has simply turned lazy and privileged. That's the kind of thing I did all though my teens: lawn work, construction help, cleaning up, painting, shoveling snow, etc. Americans truely won't do that work. I know. I try to get them to all the time. They have better things to do: sleep, play video games, watch TV, get high.; ২৯/৮/১৭, ৮:৩৮ AM
James K বলেছেন...: It's good to know the value our society puts in the elderly, and couldn't be clearer stated than with what we pay the people caring for them

This is the same false argument that's made about teachers. The value is measured by the billions of dollars we collectively spend on these services. They are very labor-intensive, and mostly able to be done by people with modest skills. That's good for everyone.; ২৯/৮/১৭, ৮:৩৯ AM
Mike Sylwester বলেছেন...: এই মন্তব্যটি লেখক দ্বারা সরানো হয়েছে।; ২৯/৮/১৭, ৮:৩৯ AM
Mike Sylwester বলেছেন...: In the agency where I work in New Jersey, at least 90% of the aides are immigrants.

Likewise, at least 90% of the clients are immigrants.

Both numbers probably are close to 95%.

NJ Medicaid has to provide so much home-health-care service to the population because the NJ population includes so many immigrants.

Most foreigners who immigrate to the USA in middle age or older eventually become clients of home-health-care agencies funded by Medicaid.

If we import foreigners to work as home-health-care aides, those immigrants themselves eventually will become such clients. So, then we will have to import even more foreigners to work as aides for the immigrants who used to be aides.

Aides commonly are women who immigrated in middle age and then stayed home as housewives for several years until all their children were attending school. While they were staying home taking care of their children, they did not learn English well -- or at all.

Working as a home health aide in the USA is the first job outside the home that such a woman ever has had in her life. She will work as a home health aide for a couple of decades at $9.75 an hour. She never will accumulate any wealth. Eventually she herself will be unable to work and will become decrepit, and then she herself will need a home-health-care aide to take care of her.; ২৯/৮/১৭, ৮:৪১ AM
Ambrose বলেছেন...: You know what this is really about - taking people who are caring for family or close friends and forcing them into expensive state licensing programs and then into Democrat-allied unions. Nothing more.; ২৯/৮/১৭, ৮:৪৩ AM
SeanF বলেছেন...: Laslo Spatula: Combine the Health Care with an Escort Service.

People with Alzheimer's deserve blow-jobs, too.

I'm pretty sure I heard a joke about that years ago. The punch line was, "Same medical condition, better insurance plan."; ২৯/৮/১৭, ৮:৪৪ AM
Fernandinande বলেছেন...: rhhardin said...
If there's a problem with supply and demand, there are regulations at work.

For example, capitalism is illegal in Texas:

Over the weekend, more than 500 complaints of price gouging were lodged with the Texas attorney general’s office, according to CNBC—including $99 cases of bottled water, gas at $10 a gallon and hotels tripled or quadrupled in price.

"These are things you can't do in Texas," Texas Attorney General Ken Paxton told CNBC in an interview Monday. "There are significant penalties if you price gouge in a crisis like this."; ২৯/৮/১৭, ৮:৪৭ AM
Dust Bunny Queen বলেছেন...: I didn't read the article either but I do wonder if this is part of the effort to unionize these people, especially family members who are caring for their own.

BINGO!!!; ২৯/৮/১৭, ৮:৫১ AM
Mark বলেছেন...: "They are very labor-intensive, and mostly able to be done by people with modest skills. That's good for everyone."

That's funny, because a lot of the wealthy send their kids to high end private schools which pay teachers significantly more than the public school.

But of course, they still spout the line that increased pay doesn't yield any benefits ... all while avoiding the low pay system for their kids. They would never lie, would they?; ২৯/৮/১৭, ৮:৫২ AM
Fritz বলেছেন...: AReasonableMan said...
Fritz said...
We hired a local redneck woman to take care of my dad.

When you say 'take care of', what exactly do you mean?

She cleans the house, makes meals, takes him shopping, makes sure he takes all his pills, drives him to Drs appointments, answers the phone and keeps him from saying yes to scams. About 8 hours a day.

What did you think I meant? Do you think rednecks are all murderers for hire?; ২৯/৮/১৭, ৮:৫৪ AM
bagoh20 বলেছেন...: Mowing lawns or other non-career work is extremely valuable - maybe the most valuable work you ever do. It teaches you the most important lesson in life: you can be productive, make money by exchanging it for your labor and pay your own way. It can give a young person a financial footing, some savings, and allow them to escape childhood where everything is provided for them by someone else. It takes a child into adulthood and makes them an individual. Think of a teenager that sits around the house and gets all his needs and money from his parents. Now think of one that works and pays for many of his own needs. Only one of those is still a child. Which one is most likely to succeed, and someday to provide for others.; ২৯/৮/১৭, ৮:৫৬ AM
Mike Sylwester বলেছেন...: One way that Medicaid squeezes the home-health-care agencies and their aides is to reduce the number of hours of service that the clients receive in a day.

For example, if a client is receiving three hours of service a day, then Medicaid reduces the client's service to two hours a day.

When the client was receiving three hours a day, the aide was earning ($9.75 * 3 = ) $29.25 a day for serving that client. After the service reduction, the aide is earning only $19.50 a day.

The money and time that the aide spends on bus travel to and from the client's home remains the same.

Therefore the aide turns down two-hour jobs where the travel expense make the earnings not worthwhile.

Would you spend one hour commuting for a two-hour job that pays $9.75 an hour?; ২৯/৮/১৭, ৮:৫৭ AM
Ann Althouse বলেছেন...: "How does that argument not apply to McDonald's?"

What argument?; ২৯/৮/১৭, ৯:০৫ AM
James K বলেছেন...: That's funny, because a lot of the wealthy send their kids to high end private schools which pay teachers significantly more than the public school.

I was talking about home health workers when I said "modest skills," but what you say isn't necessarily true. Public school teachers are often paid similarly to private school teachers. In NYC many teachers get six-figure salaries. Teacher pay has little to do with why parents choose private schools over public schools.; ২৯/৮/১৭, ৯:০৫ AM
tommyesq বলেছেন...: Mark, in my experience (relatives who teach), most private schools do not pay as well as public schools, and often require less education to get the job - e.g., no requirement of a Masters in teaching. Self-selection (primarily parents who are motivated to give their kids advantages), school selection (don't have to accept all applicants), and parental involvement (people paying good money demand, and get, better results - the administration will lean on teachers to do well and will fire bad teachers because they need to sell the school to bring in income) are, in my opinion, bigger difference-makers than teacher pay.; ২৯/৮/১৭, ৯:০৬ AM
Ignorance is Bliss বলেছেন...: Ann Althouse said...

...there is no climb out of this job — no career path that you take by starting here.

8/29/17, 7:59 AM

Birkel said...

How does that argument not apply to McDonald's?

McDonald's has an easy to see career path. You start out wiping down tables, mopping floors, and cleaning bathrooms. You advance to flipping burgers and running the cash register. Do that well, and at some point you are managing the late-night shift. At some point to can take your cash register experience to other retail, your burger-flipping to other food prep, or your managing to other business. All along you have people who are supervising your work, who can act as references for your next job.

Home health care is largely done without supervision, so it is harder to use as a references, and there are fewer places you could branch out to.; ২৯/৮/১৭, ৯:০৭ AM
Mike Sylwester বলেছেন...: If something goes wrong, the home-health-care agency will be sued. For example, if the old woman falls down and breaks her hip, the woman's children will sue the agency for all the medical expenses, all the nursing-home expenses and all the pain and suffering -- and finally for punitive damages.

Therefore, the aides have to be trained and supervised by registered nurses, who earn $25 an hour and submit expense vouchers for all their traveling to the various clients' homes.

Also therefore, the agency pays a lot for liability insurance.

Also therefore, the agencies are regulated closely the the state government. Any agency can be closed down for administrative "violations" by the government with little recourse.

That's a big reason why the agencies cannot pay the aides more than $9.75 an hour. Home-health-care agencies go out of business all the time. It's a risky, low-profit business.; ২৯/৮/১৭, ৯:০৭ AM
HoodlumDoodlum বলেছেন...: Ann Althouse said...The article stresses that these jobs are being done by immigrant women, but more immigration is not discussed as a solution. I think that's because the idea is about making the job a good job that more people would want to do. If it were an article about immigration, I suppose it would get counted as one of those jobs Americans won't do.

If the problem is that the prevailing wage is too low how would "more immigration" solve that problem? Moving the supply curve to the left by reducing immigration (shrinking the pool of available workers) would increase the equilibrium wage, assuming everything else stays constant. The equilibrium/clearing quantity would be lower, of course, so some families would have to do without (since they wouldn't be willing or able to pay the new higher price).

I really can't think of many jobs that would become more prestigious (or higher paid) by the addition of millions of low-skilled workers in the labor pool for those jobs. I mean, what problem are we trying to solve, here? If we want to increase the wages or decrease underemployment for millions of low skill foreign workers then disregarding our border and letting them all come in will help...but if we want to increase the pay and status of the type of jobs that low skill immigrants can do then importing millions of those workers is exactly the wrong approach.; ২৯/৮/১৭, ৯:০৮ AM
Mike Sylwester বলেছেন...: There is some potential advancement for home-health-aides. I know a few aides who became office workers and then even became nurses.

Those are aides who were relatively young, intelligent, ambitious and learned to speak English well. They are maybe 1% of the aides.

A typical home health aide is a 40-year-old immigrant woman who speaks little English, has no higher education and is working outside the home for the first time in her life. If such a woman gets a job at McDonald's, she will not advance there either.; ২৯/৮/১৭, ৯:১৫ AM
HoodlumDoodlum বলেছেন...: "Jobs X won't do" is such a symbol of what's wrong with our thinking--or really our lack of thought. It only takes a moment's reflection to show how silly a talking point that is.

I can think of a large number of jobs I won't do for $20/hour that I would pretty happily do for $200/hr. I'm sure the rest of you can, too. Is the job therefore one you "won't do?" No, it's one you won't do for a given wage but will do for a different, higher wage.

If the assertion is "well strawberry pickers can't be paid $15/hour because then the end product will be too expensive and no one will buy strawberries" then you've done nothing more than demonstrate that the market in question is just like most markets! Most cars aren't made out of titanium and carbon fiber not because those aren't cool materials but because the cars would be too expensive if they used those materials. Most cars aren't built by hand for the same reason! Choose your example--literally anything will work.

If the industry in question relies on below-standard wages made possible only by a pool of illegal immigrants then you've already introduced a factor strongly affecting the market. It really doesn't make any sense to then say "we can't do X (restrict immigration, for example) because it would distort the market in way Y." You've already distorted the market by your current policy--every policy you have shapes the market in some way!; ২৯/৮/১৭, ৯:১৭ AM
rehajm বলেছেন...: You know what this is really about - taking people who are caring for family or close friends and forcing them into expensive state licensing programs and then into Democrat-allied unions

...and that's it exactly. Rather than reduce government intervention to wage prices add more government control of wages and introduce more workers to that control.; ২৯/৮/১৭, ৯:২০ AM
cubanbob বলেছেন...: Why aren't able bodied people on welfare required to take these jobs?; ২৯/৮/১৭, ৯:২১ AM
Ignorance is Bliss বলেছেন...: HoodlumDoodlum said...

I can think of a large number of jobs I won't do for $20/hour that I would pretty happily do for $200/hr.

So we've established what HoodlumDoodlum is, and now we're just haggling over the price?; ২৯/৮/১৭, ৯:২১ AM
Mike Sylwester বলেছেন...: Labor unions would like to unionize home-health-care workers, but the unions lose almost every time when aides vote whether to unionize.

Home-health-care aides learn correctly that any agency that is unionized will go out of business immediately. Any aide who is voting for a union is voting to make herself unemployed by the end of the week.

The vote to unionize an agency does not increase the rate that Medicaid pays for the service. The agency still will receive only $15 an hour from Medicaid. There simply will not be enough money for the agency to raise the aides' wages and to provide other benefits that the union organizers promise.

The agencies are allowed to explain these facts of life to the aides before the aides vote, and so the aides practically always vote against the union.; ২৯/৮/১৭, ৯:২৩ AM
Freder Frederson বলেছেন...: For example, capitalism is illegal in Texas:

And that is as it should be. Capitalism is not the answer to every problem, and it is particularly harsh and ineffective during a natural disaster.

Here's an idea, maybe the Red Cross should charge for shelter space and emergency meals!; ২৯/৮/১৭, ৯:২৩ AM
Michael K বলেছেন...: "there is never a white guy, a black guy, an Asian or a woman,... never. I need simple labor help all the time around my house."

We found some guys at the U Haul place in Tucson who will do that. They are deaf but it's easy to communicate with gestures and they did a great job. There is an agency that handles the services and it is moderate cost but they did a good job.; ২৯/৮/১৭, ৯:২৮ AM
Michael K বলেছেন...: the administration will lean on teachers to do well and will fire bad teachers because they need to sell the school to bring in income) are, in my opinion, bigger difference-makers than teacher pay.

When my youngest daughter was going to private school, her favorite 8th grade teacher was a man whose wife also taught at the school. They both accepted slightly lower salaries to get away from the union and the mind numbing public school curriculum. Both had all the qualifications for public school.; ২৯/৮/১৭, ৯:৩৪ AM
Scott বলেছেন...: If you can't bring in more immigrants, then here's the answer: Lower everybody's standard of living. Then there will be plenty of people for low status jobs. Vote Democrat.; ২৯/৮/১৭, ৯:৩৫ AM
TestTube বলেছেন...: Thank you for sharing your insight on this topic, Mike Sylwester!

Question: It seems that Medicaid sort of sets a standard of what will be paid, and that is in the range of $15 per hour. Is it possible to upgrade by either kicking in a few more bucks or saying to heck with Medicaid, I will pay out of my pocket a more generous rate? Is that often done? In other words, when it comes to home-health-aides, how does one fly business class or first class or even economy plus instead of bottom rate economy service?; ২৯/৮/১৭, ৯:৫৩ AM
James K বলেছেন...: It seems that Medicaid sort of sets a standard of what will be paid, and that is in the range of $15 per hour. Is it possible to upgrade by either kicking in a few more bucks or saying to heck with Medicaid, I will pay out of my pocket a more generous rate?

There are private agencies that provide these services. My 95-year-old father is a client. They charge in the vicinity of $20/hour. As the help is medically necessary, much of it is tax-deductible, but it still ends up being pretty expensive on a 24/7 basis.; ২৯/৮/১৭, ৯:৫৯ AM
James K বলেছেন...: Self-selection (primarily parents who are motivated to give their kids advantages), school selection (don't have to accept all applicants), and parental involvement (people paying good money demand, and get, better results

Another big factor is the non-teaching resources that private schools offer: Advisors, athletic facilities, labs, etc. But you are right that a big part of it is the quality of students and parental involvement.; ২৯/৮/১৭, ১০:০৪ AM
TestTube বলেছেন...: James, how would you rate the services you receive vs. those for straight Medicaid Home health aides?; ২৯/৮/১৭, ১০:০৭ AM
Matt Sablan বলেছেন...: "Another big factor is the non-teaching resources that private schools offer:"

-- I'll be honest, for all that, the biggest benefit I got out of private high school is that a lot of the other students there had parents who wanted them to be there. Sure, there were class clowns, jokers, slackers, etc., like you'd get in public school, but there were fewer of them (by virtue of there being fewer students period), and teachers could do more hands-on time. My sister went to a public school, and did just as well as I did, so I think the individual and family life is way more telling than the public/private school.; ২৯/৮/১৭, ১০:০৮ AM
James K বলেছেন...: @TestTube I can't compare, having no experience with Medicaid-provided aides. I would be surprised if the Medicaid ones are as good, but I really don't know. Like most his age, he requires regular administration of drugs, including some injections, plus testing (he's a diabetic). The aides know the routine and as far as we can tell, do a good job. We also have a care coordinator who charges by the hour and makes sure everything is going smoothly.

Perhaps I should add that we all (his kids) live 500 miles away, and felt that this was better than moving him to be closer to us, as he is quite happy where he is. So we cannot monitor and help directly except when we visit.; ২৯/৮/১৭, ১০:১৫ AM
Ray - SoCal বলেছেন...: Automation is coming to home to home health care, probably from Japan first, since they are unwilling to import the needed labor. Driverless cars would help a lot.

Strawberry picking will be automated, lots of progress being made due to increased labor costs. CA will soon have a $15 minimum wage.

Taking care of the elderly is hard, and getting help is a blessing. My Aunt is taking care of my Grandmother, and I deeply appreciate her sacrifice. Dealing with my parents and in-laws has been a challenge...; ২৯/৮/১৭, ১০:১৯ AM
mockturtle বলেছেন...: My second career was as a home health case manager in Seattle and later in Arizona. I have always believed that home health aides are horribly underpaid and often ill-treated by the agencies as well as by some of their clients. In Seattle, very few of our aides were racial or ethnic minorities In Arizona they were about 2/3 Hispanic. As many of our clients were Hispanic, being able to speak Spanish was an asset in those cases.

These are not unskilled workers. They must be certified, which requires education and training. There is a high liability risk in their work and safety is paramount.

As long as there is an adequate supply of young women [mostly] willing to do this work, nothing will change, alas. But this is a very necessary service, as families no longer live nearby and most are working full time. However, I could write a book about the overuse and abuse of services. I have reported instances to the state, in Medicaid cases, and to Medicare only to be told the usual: "We simply do not have the resources to investigate every incident". Much as with Social Security Disability, there are people who desperately need it but there are many who don't.

My kids urged me to pursue these issues in my retirement, and I considered it, but I am really too fed up with bureaucracy to want to beat my aging head against its brick wall.; ২৯/৮/১৭, ১০:২৭ AM
mockturtle বলেছেন...: Addendum: Cases that were paid by private insurance were under much greater scrutiny. It was a PITA for us to have to justify every visit but the contrast with publicly funded cases was stark.; ২৯/৮/১৭, ১০:৩২ AM
Earnest Prole বলেছেন...: Americans, like all people, will do any job if it pays enough, with the qualification that "enough" means something different to Americans and non-Americans.; ২৯/৮/১৭, ১০:৪৩ AM
PB বলেছেন...: If you can't get enough workers, raise the wage. Don't just import workers (or let them come illegally) to depress wages. The unemployment statistic that is bandied about is BS. Look at the number of people not in the workforce and do something to get them to come in from the cold.; ২৯/৮/১৭, ১০:৪৪ AM
Jael (Gone Windwalking) বলেছেন...: ... overhauling long-term care seems within reach. Penalties for excessive readmissions are already encouraging hospitals to rethink the role of home-care aides. And Obamacare is changing the health care industry in ways that would support a better-trained, better-paid home-care work force, pushing providers to manage the overall health of patients rather than offer health services for a fee.

Saving Obamacare.

“Manage the overall health ... rather than offer health services for a fee.”; ২৯/৮/১৭, ১১:০৭ AM
HoodlumDoodlum বলেছেন...: Freder Frederson said...
For example, capitalism is illegal in Texas:

And that is as it should be. Capitalism is not the answer to every problem, and it is particularly harsh and ineffective during a natural disaster.

Yes, rationing by price is much more harsh an ineffective than mandating a too-low price and running out of the good in question. Rationing by wait time, or force (ie biggest guy gets what's left) is much less harsh than rationing by price, yes sir.

The Red Cross is largely funded from money donated by capitalists...money voluntarily given after having been earned in a capitalist system (which, you know, is so far superior to non-capitalist systems at a little thing like "creating wealth" that you don't really hear even modern commies dispute the point any more).

But yeah, capitalism is harsh and ineffective at handling crises, totally. I bet Venezuela's socialists handle crises much more humanely and effectively. Big time.; ২৯/৮/১৭, ১১:১৫ AM
HoodlumDoodlum বলেছেন...: mockturtle said...Addendum: Cases that were paid by private insurance were under much greater scrutiny. It was a PITA for us to have to justify every visit but the contrast with publicly funded cases was stark.

That's not atypical--I think you'll find that the claimed lower expenses of a public health care vs. private health care usually boils down to overhead savings from lower scrutiny/acceptance of more waste/fraud/abuse and the unaccounted-for savings from using other agencies (IRS, etc) to perform functions (billing, audit) that corporations have to do themselves.; ২৯/৮/১৭, ১১:১৯ AM
James K বলেছেন...: Also the lower capacity that results in rationing and long wait times. That's a false saving that's imposed on the patients.; ২৯/৮/১৭, ১১:২৭ AM
HoodlumDoodlum বলেছেন...: এই মন্তব্যটি লেখক দ্বারা সরানো হয়েছে।; ২৯/৮/১৭, ১১:২৮ AM
MadisonMan বলেছেন...: When Dad was alive, his Home Health Care worker was a poor white woman. She did a great job with him, cleaning, running errands and what not, and kept visiting (and being paid for the visits, still running errands, mailing stuff, etc) after Dad moved to a Care facility.

This probably does not fit the Times narrative -- but I didn't read the article as it's the end of the month.; ২৯/৮/১৭, ১১:২৮ AM
HoodlumDoodlum বলেছেন...: Meet Robobear The Japanese Nurse Robot

FP: Japan Prefers Robot Bears to Foreign Nurses; ২৯/৮/১৭, ১১:২৯ AM
mockturtle বলেছেন...: Most home health care is delivered via private agencies. It is obviously in their interest to import cheaper labor than to entice more local workers with higher wages. Both private and public entities are responsible for the health care mess we have and I, for one, don't have the answer.; ২৯/৮/১৭, ১১:৩২ AM
Mike Sylwester বলেছেন...: TestTube at 9:53 AM

... when it comes to home-health-aides, how does one fly business class or first class or even economy plus instead of bottom rate economy service?

In general, the same agencies are providing the home-health-care service, no matter whether it's paid by Medicaid or by financially-capable families.

Most of my agency's clients are Medicaid-funded, but we serve also some clients whose service is funded by private insurance companies or out of the families' wallets. The service is the same.

It's just like if you go to a family doctor who has mostly Medicaid clients. The doctor, staff and service are essentially the same for all the patients.

If you don't qualify for Medicaid, you simply have to pay more for the same service.

Keep in mind that the business is closely regulated by the state government. The regulations are strict and are the same for all the agencies.

Some agencies are certified to serve Medicare (not merely Medicaid) patients, but I doubt that the service is significantly better. The Medicare certification is a racket. The number of Medicare providers is limited, and if your agency is not already a Medicare provider then there is nothing you can do but wait for a Medicare provider to go out of business or else simply buy an agency that has a Medicare certificate.; ২৯/৮/১৭, ১১:৩৩ AM
Mike Sylwester বলেছেন...: TestTube at 9:53 AM

... when it comes to home-health-aides, how does one fly business class or first class or even economy plus instead of bottom rate economy service?

Home health aides do tasks like the following:

* Clean the house

* Do the laundry

* Change the bed sheets

* Buy groceries

* Cook meals

* Wash the dishes

* Help the client with bathing and grooming

What is the difference between doing such tasks "first class" or "economy service"?

Home health aides are not allowed to give their client even aspirins.

If the old person needs some medical service, such as changing bandages, then you need to pay for "skilled nursing", which is more expensive.; ২৯/৮/১৭, ১১:৪৬ AM
mockturtle বলেছেন...: In the agencies I worked for, housekeeping, if needed, was done by a 'housekeeper', a different job category. This is/was a Medicaid-only service. Medicare clients could not get housekeeping services other than maybe changing the bed, washing bedding, and cleaning up the bathroom after bathing the client.

The housekeepers were to do only the cleaning/cooking related to the client--not for the entire family living in the home. Imagine my fury when I visited an elderly client's home to find the housekeeper washing dishes for the family of six, vacuuming their home, etc. The children and grandchildren in the home were able bodied adults. Of course, my complaints about their services being unneeded fell on deaf ears but I ordered the housekeeper to limit her work to the client's bedroom, bathroom and personal effects.; ২৯/৮/১৭, ১১:৫৭ AM
Freeman Hunt বলেছেন...: Any job is on the ladder. Gives you a chance to demonstrate your reliability. If you get to know some of the families, you could build up some excellent references. Or, if you don't want to climb a ladder, you can stick with this work that does not pay much but does sometimes provide comfortable aurroundings, meaningful work that makes an immediate positive impact on someone, and the opportunity to work without a supervisor breathing down your neck.; ২৯/৮/১৭, ১২:৩০ PM
Rabel বলেছেন...: “Home care is absolutely the bottom rung on the ladder, but home-care workers are the people that spend the most time with the client,” said Adria Powell, who runs Cooperative Home Care Associates, a worker-owned long-term-care agency in New York.

Not if you're the President of Cooperative Home Care Associates, a worker-owned long-term-care agency in New York, with your $200,000 annual salary. Your bottom-rung cooperative employee owners are likely not thrilled with your uncalled for insult.

On behalf of the wonderful ladies who helped me care for my Mother over many years I'd like to say to Ms Powell, "Fuck you, you fucking greedy lying cunt."

The ladies would probably us e slightly different language.; ২৯/৮/১৭, ১২:৩০ PM
James K বলেছেন...: Home health aides are not allowed to give their client even aspirins.

If the old person needs some medical service, such as changing bandages, then you need to pay for "skilled nursing", which is more expensive.

That is not my experience. Maybe you are talking about the Medicaid-funded job classifications, or perhaps it differs by state. In the case of my father, his aides help with his medications and daily blood testing. I am not sure precisely what "help" means, but I am pretty sure it's more than "Time to take your medicine!" They get paid less than $20/hour.; ২৯/৮/১৭, ১২:৫৩ PM
HoodlumDoodlum বলেছেন...: Ignorance is Bliss said....So we've established what HoodlumDoodlum is, and now we're just haggling over the price?

You're not wrong, IiB! For some jobs of that sort I'd think the real difference-maker would be whether one could select the recipient of the particular service. If it was sight-unseen/take all comers (sorry) then I'd have to demand an exorbitant rate, but given a say in the selection process I'd probably name a reasonable wage.
Hey, we can all dream, right?; ২৯/৮/১৭, ২:১১ PM
mockturtle বলেছেন...: Home health aides assisting in medications must be a state by state issue. In WA and AZ, they are not allowed even to fill the medication boxes or to dispense any medications.; ২৯/৮/১৭, ২:১৮ PM
Mike Sylwester বলেছেন...: Home health aides assisting in medications must be a state by state issue. In WA and AZ, they are not allowed even to fill the medication boxes or to dispense any medications.

In New Jersey, home health aides are not allowed to give their clients even an aspirin.

It's a liability issue.; ২৯/৮/১৭, ৩:০৮ PM
Achilles বলেছেন...: "Home health care worker "is absolutely the bottom rung on the ladder" of jobs."

Ahh HAHAHAHA!

I am going to show my wife this article now. Guess what her job is.; ২৯/৮/১৭, ৩:১৫ PM
Achilles বলেছেন...: Ann Althouse said...
Ladder is the wrong metaphor because it implies that you will be using the bottom rung to get started climbing. But there is no climb out of this job — no career path that you take by starting here.

There are home health nurses, RN's, making north of 40$ an hour. There are LPN's that are in the 20-30$ per hour. Flexible hours too. My wife is working .6 FT. She sets up her patients during the day and sometimes pushes the paperwork back to be with the kids. She is in her first year making 34$ and she is currently negotiating with 3 other places trying to hire her away offering more.

Wound specialty nurses in particular do well. There is most definitely a ladder to climb and it is desperate for people.; ২৯/৮/১৭, ৩:৩০ PM
Achilles বলেছেন...: @ Mike Sylwester:

Did you have many patients offering to pay a little extra under the table for better/stable service?

The only thing more expensive than taking care of infirm elderly is paying for in home child care. I might move an old relative in upstairs to get that cost subsidized a little...; ২৯/৮/১৭, ৩:৩৬ PM
HoodlumDoodlum বলেছেন...: Achilles said...Wound specialty nurses in particular do well. There is most definitely a ladder to climb and it is desperate for people.

A close relation of mine spent a career in long term care and got WOCN certified (wound, ostomy, continence) and said it was very tough but worth it. Wound care for geriatric patients is definitely a growing field (with a surprising-to-me amount of cutting edge tech) and can be financially lucrative.

Anyway good for your wife! It sounds like she has a good plan. I know a lot of nurses and home health specialists unfortunately get back injuries (strains etc. from moving increasingly-heavy patients) so make sure she stays safe, there.; ২৯/৮/১৭, ৩:৫০ PM
mockturtle বলেছেন...: In AZ and WA, at least, a home health RN must have a four-year Bachelor's Degree in nursing.; ২৯/৮/১৭, ৪:০৩ PM
Mike Sylwester বলেছেন...: Did you have many patients offering to pay a little extra under the table for better/stable service?

If any clients tip their aides, I am not aware of it.; ২৯/৮/১৭, ৪:০৭ PM