Mayoral Musings: Undervalued Workforce

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Home health aides—some 39,000 statewide—make a huge difference in the lives of our families.

Generally, I don’t have as much time to read as I would like, so I’m left scanning headlines and picking out a few articles here and there—sort of like grazing—to stay informed on issues and trends locally, statewide, and nationally. Naturally whenever anything mentions New Jersey, I look a little closer. Recently, it was an article in the magazine New Jersey Monthly by Tina Kelley about home health aides.

I was surprised to learn that there are upwards of 39,000 home health aides in the Garden State. That’s a sizable number for one job category, especially when you consider the fact that there are only about 14,000 primary care docs in the state. Throw in specialists, and that number comes to roughly 28,800, still well short of the number of home health aides in New Jersey.

The piece focused on the daily and weekly struggles of home health aides, most of whom are women and women of color at that. This is not surprising since it is one of the few industries open to individuals lacking any credentials or the resources to get them through a college education. While I don’t have any stats on this, I imagine that many home aides are single mothers barely making it from paycheck to paycheck.    

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If the numbers are right, the average home health aide in N.J. makes between $21,000 and $23,000 per year (about $10 per hour) working full-time, which translates into a fair number of home health aides needing public assistance of one sort or another to get by. In addition to low wages, many home aides lack medical insurance or the ability to pay for insurance even when it’s available.

What caught my attention as much as the numbers themselves is the fact that many home health aides are part of the most difficult, profound and intimate moments of their patients’ lives. What value one attaches to this work is a matter of perspective, I suppose. 

Those who work as home health aides are the difference between someone retaining a measure of dignity, however small it may be, and losing every last trace of it.

On one hand, when some think “home health aide,” they think about changing adult diapers, emptying bed pans, steadying walkers, sponge bathing, feeding patients, and light housekeeping in the patient’s home. Viewed in that light, the work is considered menial, appropriate for those with little in the way of skills and certainly not worthy of those with an education and the “chops” to have a real career. 

But looked at in another light, the home health aide is often the difference between someone’s parent being institutionalized in a “facility” or remaining in the comfort of their own home. Those who work as home health aides are the difference between someone retaining a measure of dignity, however small it may be, and losing every last trace of it.

Not all home health aides are good. I’ve heard horror stories over the years about aides stealing from patients, neglecting a patient’s needs, or otherwise acting abusively toward a patient. But these stories were representative of a small number of aides. I’ve heard far more stories about aides filled with compassion who go the extra mile for their patients, developing a relationship that goes beyond that of caregiver and client.

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What value should we attach to a competent and compassionate home health aide at a time when thousands of us baby boomers reach our 65th birthday each and every day—entering a season of life when some will lose their independence and/or dignity? As a society, we might want to reconsider the low wages we insist on paying aides and celebrate them at a time when our population is aging out and will soon need their services in a big way.

Regardless of the reasons, more of us than we might ever care to admit won’t change an adult diaper or do any one of a dozen other time and labor-intensive tasks required for a parent or other aging loved one who is no longer able to care for themselves. If that’s true, then we can’t farm out this work and then undervalue those who do it. Yet that is exactly what happens and it doesn’t seem right.

And no, the work does not require an advanced degree and it’s not rocket science—being a good home health aide is not technical so much as it is intuitive—a product of empathy, compassion, and character as opposed to extensive training. So what price do we put on such qualifications in the most difficult season of a life? 

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