This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Michigan, like the rest of the nation, faces a dangerous shortage of caregivers. Older adults and people living with disabilities are increasingly unable to have their basic needs met. Many cannot depend on getting three meals a day, getting to the bathroom on time, having a regular bath or shower, or getting out of their beds in the morning. Even when they are enrolled with home care agencies or living in a nursing facility, staff shortages imperil their care. And while extended families often cared for their loved ones in the past, today adult children often move far away from parents or believe older family members are “better off” in a nursing home, despite the fact that the majority of older adults wish to age in their own homes. 

The Marquette-based nonprofit Caregiver Incentive Project (CIP) is working to create solutions to Michigan’s alarming caregiver shortage. According to CIP’s website, Michigan is now short more than 34,000 caregivers – a shortage that the website says “may reach crisis levels” as more Michiganders age. CIP supports in-home caregivers, including both family and professional caregivers, throughout the Upper Peninsula. CIP offers caregiver training and connects caregivers with people who need them.

“The training is what I know from my experience,” says CIP founder Eric Paad. “We live this every day. Our daughter, Dorothy, she’s disabled. When my wife and I started looking for caregivers to help us care for our adult disabled daughter — because we’re going to leave her behind someday — I literally was just sick to my stomach at how broken and ugly this system is.”

Training addresses caregiver shortages

The in-person CIP caregiver training includes 16 hour-long modules covering basic caregiver skills such as bathing, dressing, toileting, and assessing medical emergencies; communicating with the disabled, elderly, or medically fragile; basics of dementia care; and what to expect as a caregiver. Participants receive a stipend to cover costs like child care, missed work, or transportation that they might incur while attending the classes.

“Right now, most caregivers are hired sight unseen and given an address to show up to tomorrow morning. That’s their first day of work, and they’ve been set up to fail,” Paad says. “We want to prepare the basic caregiver, whether they are family or they are looking for a paying job, basically empowering them to be ready for the job.”

During the training, a doctor of physical therapy teaches caregivers a hands-on module on how to use proper body mechanics to transfer a person from, say, bed to a wheelchair without hurting themselves. A lawyer specializing in elder law covers ethics in caregiving, as well as the signs and symptoms of adult abuse and neglect and how to report them. Other modules cover CPR, infection control, HIPAA regulations, wound care, and how to use Narcan.

“A lot of times, the elderly accidentally overdose because they don’t remember when they took their medications,” Paad says. “At the end of the training, we have some care companies come in and talk about potential employment, companies that we’ve vetted, because there’s some horrible companies out there that I wouldn’t let care for a dog.”

One reason for the shortage of professional caregivers is low pay. Paad explains that while Medicare and Medicaid may increase reimbursement for caregiving services, no regulations require those increases to be passed on to the people doing the work. The lack of these and other regulations leaves many caregivers earning minimum wage, working hectic schedules, using their own vehicles to visit patients, and receiving few benefits.

“I’ve talked to state lawmakers,” Paad says. “One of our lawmakers said, ‘We hope that companies pass it on to the caregiver.’ Well, hope don’t work. Most of these companies, there’s no pay for further training. There’s no [increased] pay for longevity or experience.”

Dorothy Paad: An independent, successful contributor to her community

Dorothy Paad.Dorothy Paad’s experience shows how people with disabilities can succeed when their needs for a competent caregiver are met. Born with cerebral palsy and requiring a wheelchair, she lives independently in her own apartment. She works as an instructional coach for the Northern Michigan University (NMU) School of Education, and recently published a children’s book, “Dance Your Dance, Sing Your Song.” As a student at NMU, she studied dance and performing arts, appeared in university productions, and sang with the university choir. And she’s a spokesperson for CIP. 

“I’m lucky in that I’m what’s called ‘self-determined,’ so I can hire my own care staff to come care for me,” Dorothy Paad says. “A lot of people have to go through caregiving agencies where they pick the caregivers for you and there’s no consistency. I’m lucky in that I have the same caregiver every day that I need care. I’m lucky that I’m cared for in my own home. A lot of people are cared for in group facilities where there’s not enough staff to meet the needs.”

Dorothy Paad is quick to relate horror stories of caregivers who have no training, caregivers working for agencies that overlook criminal background checks, and caregivers who simply do not show up. That’s why she considers CIP’s work to be vital.

“For me, having a reliable caregiver makes the difference between living and existing,” she says. “I volunteer out in the community. I do a whole bunch of different things. I’ve been to college. All of this is made possible because I have a reliable caregiver. Because of her, my mom and dad can sleep at night. They know that I’m getting good care.”

Resources help caregivers avoid burnout

In addition to building the caregiver workforce, CIP equips family members and friends to care for loved ones — and not just through caregiver training. CIP provides connections to caregiver resources that help these caregivers not only provide good care but also take care of themselves. The CIP website provides instant access to many of these resources, listing vetted caregiving agencies, offering one-on-one support, and sharing links to videos and blog posts on topics helpful to family and professional caregivers alike.

“Having those resources helps them to eliminate burnout,” says Kara Vernon, CIP secretary and Dorothy Paad’s former caregiver. “It’s really stressful to care for a loved one. You need what you can to support yourself through this very emotionally and mentally taxing job.”  

Vernon now cares for her grandfather, who has been diagnosed with Alzheimer’s disease.

“These resources are already giving me what I need,” she says. “I know who to turn to, what to expect, and where I can look for help when the time comes that we will need more help taking care of him.”

By creating a better pathway for in-home caregiving as a career, offering resources for family caregivers, and helping those who need caregivers to understand the system and connect with resources and reliable agencies, the CIP has created a model that addresses the caregiver shortage today while laying a foundation for better systems of caregiving in the future.

“My wife, my daughter, and me, we live this,” Eric Paad says. “All of us are going to be a caregiver or need care someday, and we just don’t know when. It’s a life skill that should be taught to everybody.”

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children’s books. You can contact her at [email protected] or www.constellations.biz.

Photos courtesy of Eric Paad.

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