INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Toward a Stable and Experienced Caregiving Workforce

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Recently, my mother received an early morning phone call from her friend, Elaine, who suffers from multiple sclerosis. On this particular morning, Elaine was desperate to find someone to help her get out of bed because her regular homecare worker had unexpectedly cancelled. My mother, almost 78, does not walk well, following a hip fracture, and considers herself fortunate to have found someone to help her with household chores one-half day a week. This woman, Jeanette, a 46-year-old widow from western Africa, came to the United States to live with a brother and find work to support her children back home. One of her children has mental retardation. My mother asked Jeanette if she would be willing to fill in for Elaine's homecare worker for the day. Jeanette confided to my mother her fears that she would harm Elaine, since she did not know how to assist her, that she would end up at the police station if she did harm her, and further, that she might injure herself. Still, she agreed, but she did injure herself trying to help Elaine get out of bed. As a result, Jeanette lost several days of work.

This is not an unusual scenario, and it illustrates many of the complex, interrelated dynamics that make up the business and personal relationships between consumers and paid independent providers who are hired either through the private marketplace or government-subsidized programs. Vulnerable consumers struggle to find reliable caregivers, while compassionate and caring workers lack the support and training they need to provide the quality care consumers deserve. This article addresses the reasons that it is increasingly difficult for consumers to find available and competent workers and the conditions under which many workers are employed in today's homecare market and provides an explanation of several mechanisms that are being used to mediate the needs and desires of workers and consumers.