Thirty-one DCWs share their stories: click on an image to meet a DCW

We’re part of the healthcare system so it would be nice for someone to finally recognize, these are real workers.”
Henrietta Ivey, Detroit, MI, licensed pharmacy technician, started out as a family caregiver then her paid PCA work grew by word-of-mouth. For her, it is all about the love and compassion she gives, the relationships she develops with her clients, and knowing she’s made someone’s life better.  She hopes someone will be compassionate enough to help her out one day.
          Henrietta takes pride in doing her job well and refers to herself as a homecare professional. She bristles at being called “the maid” or a “glorified butt wiper” and points out that home care and CNA work are similar. Yet, CNAs don’t get called derogatory names because they have recognized credentials and do their work in an institutional setting. They also make more money.
       Henrietta has become a staunch activist, fighting for home care workers’ rights to a living wage, benefits and more respect. She has been told by policy makers, “This is not a real job that you do. Get a real job.” to which she responds, “We’re part of the healthcare system so it would be nice for someone to finally recognize, these are real workers. We should not have to be ridiculed or disrespected because of the choices that we make on what we’re trying to do to help other people.”
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Give quality, compassionate care and demand respect.”
Ann Bilyeu, Grayling, MI, mother of 8, began DCW work 18 years ago at an eight-bed adult foster care home for persons with mental illness. It was a challenging beginning but she thought of it as an adventure. She now prefers one-on-one home care and says she will never give it up. In her off hours, Ann loves gardening, being in her home deep in the woods with her animals and family, and stargazing.
            Ann says the job is demanding and a big responsibility. “It involves feces, urine, vomit, turning people that are three times bigger than you are, changing a bed with the client in it, cooking, cleaning, helping someone who’s at end of life and trying to do your best to take care of the person with family there asking questions, and making life or death decisions. There’s so much expected of you.”  For all of this, her job title is “homemaker” which she detests. She calls herself a “very hardworking caregiver”.
            When asked how to recruit and retain more DCWs, Ann says training, training, training is critical. She has solid recommendations for agencies and policy makers. Test for critical thinking in common situations DCWs face. More pay. More respect. Management training and support. To young people considering DCW work as a profession, she says, “Talk to others. Find out the worst of it, the best of it. Give quality, compassionate care and demand respect.”
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You do not make a living. You make an existence.”
Ardith Lee, Williamston, MI, Certified Nursing Assistant, Dementia Specialist, started out doing PCA work in a hospital neurological unit. When she later worked in a nursing home, she became hooked on working with persons with dementia.  “I can’t imagine doing anything else. I have tried. I left for a while because you get tired lifting and moving and working weekends and holidays.” She missed working with people with dementia or effects of a stroke, especially those who cannot communicate well.
        Ardith attributes this special niche to the fact that when she was a child, she stopped talking for 10 years in response to some life challenges. 
          She “knows so well what it is to have this person and this life inside of me and not be able to express it. I can see in their [clients’] eyes they are so desperate to let you know something, and they cannot. I’m right there with them, and I will stay with them until we can figure out what this is and comfort them.”
​          Ardith worries about the day when she can no longer do PCA work. The wages don’t allow for a retirement fund and the work is physically demanding. “You do not make a living. You make an existence. In order to make a living you do hours and hours of overtime or you may work in a facility, an assisted living home, and do private care work in addition. There will come a time when I am no longer able to do the lifting.” She also worries about young PCAs who can’t make it on the low pay or who are not compassionate or trained. “We all know someone who is not in their best profession. There are PCAs who simply should not be. Others move on to do other work that they do not necessarily enjoy, but they are paid better.” 
          Ardith believes change will only happen if “someone of importance -- meaning someone of money or political influence -- says we need to change.  In truth, there is no one of greater importance than our elders. We need to get behind this and make a difference. I am so proud to be someone who cares for our elders. [We need] to make sure that those of us who care for them are honored.”
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I would do it for free, however, free does not pay the bills.”
Mare Martell, Grand Rapids, MI, has been doing paid DCW work for 3 years and says it makes her “blissfully happy” to be able to serve others. “I would do it for free, however, free does not pay bills.” She loves animals, has a menagerie of pets including a house chicken, and is an artist and published author. 
          Mare’s philosophy is “Love thy neighbor” in all situations, even when value systems are wildly different. The job requires a DCW to be non-judgmental. She once had a client who often used the “N” word, which was difficult for her to accept. She decided to set it aside and say, “If he want’s to be that way, that’s him, and I can’t say ‘I love you’ if I’m judging that. When you’re going into somebody’s home, you can’t make them feel less than human…whether I agree [with him] or not he’s still a human, and he’s still struggling.”
          Like many DCWs, Mare has trouble making ends meet in part due to part-time split hours, some that require driving long distances. “It is intense and exhausting…to go to one client in the morning and one in the evening, and sometimes have a third shift.” A lack of guaranteed hours related to changes in client health or DCW injuries compounds the situation. Mare recently injured her shoulder while transferring a client so is currently not able to work as a DCW.
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It still gives me the flexibility to maintain my life and take care of my children, and then also helping others.”
 Sarah Bigby, Holland, MI, Medical Assistant. Has been a DCW for 9 years. She gave it a try because it is in the medical field and offered flexible hours that allowed her to care for her young child. She stuck with it because, “It still gives me the flexibility to maintain my life and take care of my children, and then also helping others.” She states she has never had a particularly difficult client and they and the families make her work easy. She provides anything from companionship to “extreme care where they can’t get out of bed and so you do everything for them. You bathe them, feed them, try and move them around as much as possible.”  Yet, she doesn’t find the work hard. It seems to come naturally to her. She feels fortunate that the agency she works for provides vital training, support, and takes care of liability insurance.
          Sarah’s big concerns are for keeping professional boundaries because her clients become like family, and she worries that she might injure someone, although she never has. This worry is more pronounced when a client is a lot bigger than her and may not be able to assist or has dementia. She says it can be “a little nerve wracking but because I’ve done it enough times, I am constantly communicating with the client about how he’s feeling. If he is weak at that point, you don’t push it. You have to communicate with them.” Despite her skills and love of the work, Sarah thinks about leaving the field due to the low wages. After 9 years, she is making 11.75 per hour and feels she is at the top of her earning potential as a DCW. 
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It’s a calling. We’re not in it for the money.”
Jeremy Klimas and Elizabeth Peterson, Grayling, MI, live in a full house, blending families and three generations to make ends meet because one income as a DCW is not enough.
     Raised in Detroit, Jeremy joined the Air Force, did three tours of duty, one in Afghanistan, two in Iraq. He then moved north to help his grandparents while working as a police officer. He left the force to become a DCW. “It is one of the best decisions I’ve made…Just seeing the joy on people’s faces when you’re providing them help…It makes me feel like I’m making a difference.”
     Elizabeth’s mother is a DCW. “I half grew up in a local nursing home…I guess it’s in my blood.” It’s hard work. There are dangers;  verbal abuse and being physically hit. Yet she, her mother, and Jeremy keep doing it because “It’s a calling. We’re not in it for the money. It’s the relationships that you build…knowing that you were able to hold somebody’s hand while they were dying and they weren’t alone.”
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We have to prepare people for things that people don’t think really happen, but they do.”
Betty Keller, Kalkaska, MI, is a certified nursing assistant who has been a DCW for 28 years. She talks about the skills needed to be a DCW: technical skills, patience, being able to communicate with all kinds of different people and levels of mental or physical states, recognizing when a person is in trouble medically, problem solving, and for her, “forward thinking” or always thinking about “What can I do next? What’s going to make this situation better for the person?”
          It also requires “adaptability” to all possible situations. She once had to protect her client and herself with a frying pan from a violent family member. DCWs need training in adapting, knowing what to do to make each moment safe and successful, situations such as “Oh, I just walked into a home, and it’s trashed, and there’s 30 people living here, and they’re all fighting, and you know, we have to prepare people for things that people don’t think really happen, but they do.”

     For Betty, it’s not just the wages affecting the DCW shortage. “There’s lots of need out there, but location. You know, for me living in Kalkaska, to get anywhere it’s a drive. If you have to drive an hour for a 2-hour shift, then the caregiver is putting out more in the gas and the wear and tear and her time then she’s actually able to use that income to support her family.” 
     DCWs need support, especially from management. Grief counsel is just one example. In Betty’s words, “When someone passes away, I show enough [emotion] to show that I care, but I don’t show it all because this is their time. This is their process. But when I leave the house, I cry like a baby. I pray.  I ask the Lord to make sure that they feel his love…and I ask him for my own strength.”
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The first thing I ask [a DCW] is are you safe? Do you feel safe?”
Wendy Martin, Traverse City, MI, Certified Phlebotomist, co-owns Crystal Penny Inc. Home Healthcare Company with her mother who is an RN. She worked as a quality automotive engineer for years. Then the recession hit, she was laid off and not sure what to do next. Her mother proposed moving north to help her with the company, which is where she has been ever since. Drawing on her engineering background, Wendy handles the whole business side. She feels most comfortable with spreadsheets, billing, payroll, writing operation instructions, and scheduling but as clientele grew, so did her need to step in and do DCW work and she discovered a love for working directly with people. She learned the technical skills from her mother, seminars, and attending a comprehensive DCW training program, Building Training…Building Quality. She now serves on the IMPART Alliance Advisory Board.
          Wendy has seen and dealt with just about everything, both good and bad, and has learned to stay calm and do creative problem solving to protect the DCWs as well as clients.
She understands that DCWs often go into unknown situations, are in the home alone, and need support.  She says, “My phone’s on 24-7. Every employee knows if there’s a situation, to call. We have policies and procedures in place for certain situations where if any of my employees feel that they or the participant is unsafe, there are emergency plans that we set up with the families. The first thing I ask [a DCW] is are you safe? Do you feel safe?”  She schedules DCWs so that there is consistency in the home, takes pride in providing person-centered care, and states it’s all about building good relationships, which allows DCWs to notice small changes and avert disaster.
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Why do I have to go from the house to the house? Because I want to help. I need to help somebody.”
Therese Mukarushema, Lansing, MI emigrated c. 2004 from Rwanda where she was a nurse. Now a U.S. citizen, she at first had difficulty finding work and faced racism, discrimination, and ignorance. “Some people treat you like you are from the junk in Africa. They ask you, ‘Did you live with animals?’” Then she found home care and now works for an agency, a hospice, and private clients.
     When asked what she would like to say to policy makers, she says, “Ask your country to have love. We have to live like family in this country. Why do I have to go from the house to the house? Because I want to help. I need to help somebody. They can come help me like I help them, and we can work together, and the country will be a paradise.”
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person-centered care 'always revolves around the client and their wishes, not mine.' ”
Jennifer Lugo, Kent City, MI, is a Certified Nursing Assistant who is both a paid DCW and a family caregiver. She started caregiving as a teenager, with her maternal grandmother, who had cancer. She also watched her aunt take care of her grandfather with dementia in his home around that time. In 2007, she began caring for her mother who also has dementia and lived with her until 2015. At one point, Jennifer was “going to school, taking care of three kids, working third shift at a nursing home, and taking care of my mother. It broke my body down so I eventually had to stop doing all that.” Her mother now lives in a nursing home. Jennifer just completed her Associate’s degree, is writing a book, and advocates on behalf of DCWs as skilled professionals. 
        Jennifer says person-centered care “always revolves around the client and their wishes, not mine.”  She believes the role of the DCW is pivotal and mandatory training is critical, for CPR, body mechanics, use of lifts, etc. “A few seconds can be the difference between life and death with a person.” She worries about the impact of DCW turnover on her clients. “I can’t imagine what that would be like. In the morning you got one [DCW], and at night you got another one, and the next day you got another one.” Jennifer talks with passion about the need for training standards, insurance coverage for home care work, and higher wages. She loves the work but at $10 an hour, she can’t afford to do it without her husband’s income.
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I like to ask him questions about when he was a little boy or how his parents met and it seems like he is happy to talk about those things. ”
Eva Sharpe, Lansing, MI is a family caregiver, raised among an extended family of primarily Mexican descent that modeled caregiving for elders. She started helping her grandmother when she was age 12 and now cares for her uncle who has mild dementia. The family respite it provides makes home care possible. Family caregivers differ from non-family DCWs in many ways, particularly the shared history, emotional ties without professional boundaries, and the dynamics across relationships and generations.
          Eva often teared up as she relayed family stories told to her by her uncle and others. “I don’t know if I’m just helping him pass the time but I like to ask him questions about when he was a little boy or how his parents met and it seems like he is happy to talk about those things. You know, he helps me too because…when he’s gone, who can I ask about those things? I mean you’re saying that I’m doing good stuff but I feel guilty. I don’t want to accept praise because it’s so good for me and my kids get a chance to meet him. They’ll never know his sister, but you know, they’ll know him.” Eva told the story of her uncle playing Mexican songs on his guitar. She videotaped it to show her girls someday. “It’s nice to have these worlds—not colliding, but you know, overlapping.”
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There’s always people that need male caregivers. It’s a very high-demand [job] but a lot of men don’t want to take care of people or…they don’t like the pay.”
Richard Dusenbury, Ferndale, MI has been a DCW since age 20 when he took care of his grandmother. He is a certified nursing assistant, medical assistant, photography buff, speaks fluent French, and does mission work in Ghana with his church. He’s a DCW because he likes people, it reflects his Christian values, it allows him to engage in meaningful work within his own health limits, and “If you’re taking care of people that are less fortunate than you, you feel a lot better about your own situation however bad that may be at that time.”
          Richard worked for years with the Army while owning an adult family home after which he and his then wife maintained one client who lived with them for 23 years. He’s also worked for different agencies including one for people who had committed “sexual crimes but had too low of an IQ to be put into jail so they put them in homes and they were watched one on one.” He says he never takes a female client because “I don’t want to put myself at risk for any kind of sexual abuse [claim]. Professionally, it would be career changing, career ending.”
At times, male clients are assigned to him because they have been inappropriate with female DCWs.  “There’s always people that need male caregivers. It’s a very high-demand [job] but a lot of men don’t want to take care of people or…they don’t like the pay.”
            Richard has faced danger and injury multiple times but for him, unjust accusations by family members of a medical error or of stealing is one of the hardest aspects of being a DCW. In addition to jeopardizing his job, he says, “I take it very seriously. It’s difficult because [family] may only come to see their parent once every month. You’ve been taking care of that person every single day. You know what’s going on with that client better than the relative does, and you’re not given any credit for that. You’re told that you messed up this, you messed up that. Why are you doing this? Why are you doing that? That really hurts because you’re trying really hard and are then told that you’re not doing a good job by somebody who’s never even there.”
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Why can’t a homecare worker get as much pay as any other healthcare profession?”
Manila Freeman, Detroit, MI, retired from the Detroit school system as a GED specialist. Like many DCWs, she started as a family caregiver, caring for her brother, a disabled Veteran with multiple needs. After he moved in, she learned that “an agency” had signed him up for assistance and made her the paid homecare worker.
         In her words, “I did the duties, and then the check came. I saw how small the check was…for helping him to make sure he could do his personal needs, feeding, staying on the special diet, lifting, helping him to walk...I had a full-time job, I was working part-time, my son was in school, my mother had moved in with me. I got a rude awakening.”
          Manila is now on a mission “to see why can’t a homecare worker get as much pay as any other healthcare profession? Even when you’re doing companion work – you’re on all the time – you have to be.”
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You have to have that and the ability to be a chameleon, fit in into any environment, any class of people, any religion, any physical need…or you will fail at this job.”
Kelli Holmgren, Battle Creek, MI started as a Certified Nursing Assistant in 1993 after a few tries as a “factory rat”. She discovered she “can’t do the mundane things over and over and over. It’s just not me. I fit helping people.” She is now a “rehab home health aide” who can make it financially, with full-time hours. She enjoys time with her kids and bow-hunting.
            Kelli prefers working one-on-one with people and their families, particularly those in hospice who are facing death. Families often express deep gratitude but she says they can also be the biggest challenge in home care work. “You get blamed, for anything. You can come in and say one thing that they didn’t want to hear and all of the stresses and all the pressure, they blow up and you’re the brunt of it. [One person] blew up on me, cursing and yelling, and as she’s cursing and yelling, she’s also telling me that it’s not about me but it’s like, okay… but it kinda is ‘cause I’m the one standing here.”
     Kelli also finds the danger a challenge. “We’re in the home alone. We have no protection. A cell phone, that’s not gonna help me a whole lot, I mean if someone goes on the attack, what do I do? I can call 911, and hopefully they get there quickly before anything bad happens. I don’t think people understand how difficult it can be. I’m the only one there. I’ve gotta roll, turn that person, help that person stand up. And oh, my, lord, dogs! People always say 'he doesn’t bite.'  Well, does he know he doesn’t bite? His hair’s standing up. He’s showing me his teeth.”  Despite these drawbacks, Kelli says she can handle it because she has good problem-solving skills. “You have to have that and the ability to be a chameleon, fit in into any environment, any class of people, any religion, any physical need…or you will fail at this job.  I can go into a home where they don’t know me and make them feel comfortable on the first visit.”
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I can’t think of a better job to do while I’m in college that I would enjoy as much.”
Aria Porraz, Kalamazoo, MI,
self-identifies as Hispanic and is an education major at Western Michigan University. She has been working as a DCW for 2 years to pay rent while in college, plans to work with children, loves animals, reading and yoga, and works full-time for a home care agency that provided training on specific topics such as dementia.
            Aria likes the agency because they pay $10.75 per hour with health insurance benefits, give her FT flexible hours, and show appreciation with monthly awards and thank you cards. She says it’s a great job for college students. “You get to meet a lot of different people. A lot of the clients that I have were educators themselves. I get to listen to their stories and will be able to apply that into my future work. It’s very rewarding. There are hard days but it’s nothing that you can’t get past, and the relationships that you form are what keeps you coming back. I can’t think of a better job to do while I’m in college that I would enjoy as much. Working in a restaurant or retail, it sounds boring to me. So, yeah. It’s fun work.”
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It’s just as important as the fire department. It’s just as important as nursing.”
Heather Zielinski, Belmont, MI, a certified medical assistant who self identifies as Cherokee, loves to read and learn about history and other cultures, and feels working with people who are dying is a privilege. She has been “screamed at, spit at, sworn at, swung at, stuck with a needle, worked with a convicted pedophile, and witnessed drug deals.” She considers Direct Care work comparable to an essential service, preventative care that keeps situations from “going south”. “It’s just as important as the fire department. It’s just as important as nursing.” It’s also hard work, physically, emotionally, spiritually. “Sometimes when you work a 10-hour week, it’s 20 to 30 hours for a normal person because you get invested in these people. It’s draining and it’s joyful all at the same time.”
            Heather would like the public and policy makers to know that recruiting and retaining DCWs requires higher wages, supervisory support, and help with grieving when clients die. She also talks passionately about the need for culture change. “There’s a huge gap between the young people now, and the seniors, and if you don’t stop and listen, you’re not gonna hear their stories. We’re gonna lose the past. It’s just gonna go bye-bye, and nobody’s gonna know about it. There’s so much to learn from them.”
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I really wish I had had that training before I began this work as I believe I would have felt more informed, confident...”
Sue Fierro, Lansing, MI, has been in home care for over 20 years. She entered the field because it seemed like a good fit with her desire to help people and it didn’t require a college degree. Her first experiences were frightening because she was sent to homes without sufficient training to care for clients with high-level needs. She eventually went back to school, earned her medical assistant certification, found work in a medical office to have a steady income and higher wages. After 10 years and many requests from patients who were looking for trained caregivers, Sue decided to leave office work and get back out into the community to support others         
        Sue has become a strong advocate for DCW training as she went through a comprehensive DCW training program in 2009 with the B.T.B.Q. [Building Training…Building Quality] program. In her words, “That is the training I needed 15 years before. It took me through so many different aspects of being a home care provider and taught me the skills and awareness I needed and wanted to help keep the clients and myself safe while working together. I really wish I had had that training before I began this work as I believe I would have felt more informed, confident and I would have stayed working in this field on a full-time basis.”

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If that snow comes and you’re stuck on your own…you’re rough and tough…you’re gonna be able to do this…because we’re women and we’re strong.”
Shelia Wedell, Escanaba, MI bubbles with life. She raises doves, is active in church with bible study and teaching Sunday school, has taken up gardening, and loves time with her grandkids. She is a self-described people person, confident, entrepreneurial, and boisterous. She got into DCW work at age 10 when she started a “pooper scooper” business, cleaning up people’s yards to raise money for 45 records. Some of her older clients started asking her for help with home care and she’s been doing it on and off ever since. She soaks up her client’s life stories. She also relayed unjust accusations of theft, sexually inappropriate advances, and devastating grief when a client dies. She wants DCWs to get training, credentials and respect.        
          Shelia has a rich appreciation for ingenuity.  “It totally turns me on when people MacGyver stuff and it works. Whoever invented that squeezey stick with the grabber on the end, wow! What an amazing thing to not have to stare at things that fell on the floor all day long until someone comes.”   She applied her own creative problem-solving skills to help a client trapped by a snow storm. She walked a mile to get to her, made meals to last several days, set up drinking water, and rigged up a system that she calls “piggy backing depends” so that her client could stay dry and not have skin breakdown. She said she tried to be brave for her and tell her, “If that snow comes and you’re stuck on your own…you’re rough and tough…you’re gonna be able to do this…because we’re women and we’re strong.”  The woman received more help in time to divert a tragedy and, thanks to Shelia, survived.
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If you don’t recognize homecare workers now, then who’s gonna take care of you?”
Vernette Mahone, Detroit, MI, graduated from high school while raising two children and went on to become a certified Computer Technician.  During this time her mother became ill and Vernette was determined to take care of her, but it was hard as a teen mom working and attending school.  She has done PCA work ever since and says, It’s not a job. It’s a lifestyle. Like many PCAs, she’s not in it for the money, but feels the impact of work conditions she calls “horrible”.
      “To be told you’re insignificant because you care about people…to be not recognized as a professional, that’s heartbreaking. How do you have to be told that you have to make a decision on buying your kids some shoes or putting food on the table?”
Vernette has become an activist. “We are the champions…we will continue to let it be known that homecare workers are important. If you don’t recognize homecare workers now, then who’s gonna take care of you?
Providers share a universe of stories that make up a Universal Caring Economy. Home-based care providers, while not recognized appropriately, are a vital part of the care team. In this day and age we face a shortage of providers. To end this crisis and help the new workers, seasoned workers should unite and mentor a new generation of workers, share their experiences, offer support, and strategize on how to improve terms, wages and working conditions for the care team in both home and hospital settings. It’s our time to stand together as a united force to strengthen our communities because our work is key to providing a better quality of life. We can change the mindset of those who lack knowledge about what we stand for and our desire for caring that includes everyone. It’s our time to be visible and heard. We can achieve this.”
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We need to have people that are trained, willing, and able to help.”
Maria Cosper, Lansing, MI helps care for her 87-year old father-in-law who has lived for 8 years with her and her husband. He still drives and is fairly independent. She also helps her husband’s mother and step-father who live next door. Her mother-in-law has Alzheimer’s disease and needs 24-hour care. In addition, she and her daughter, Eva, help care for her cousin’s father, who is “well loved”, to give her cousin respite.
          Maria often became emotional talking about her relatives. “I still hold a lot of respect for my father-in-law and it’s difficult to see his decline.  He’s still doing pretty well but he’s not the man that he used to be and to see that in his eyes, in his behavior, and to switch roles, it’s all difficult. But we’re so glad that he’s here and that we’re able to help him in his final years.” She described a big close family with nearly 70 cousins. Her mother’s family were migrant workers, born in Texas. They would follow the crops. She says she can’t understand how there can be older people with no one to care for them. “The example that I saw in my family and other Mexican families was that when the people got old—grandma and grandpa and uncle, if they couldn’t take care of themselves then they just moved in with family.”
         Maria doesn’t identify as a caregiver. “Just a daughter-in-law and niece.” She acknowledges that training on dementia, body mechanics, and handling certain situations would be helpful and concern about being strong enough for some of the physical activity. She’s grateful for a friend she hired to provide DCW help and without whom she says she would be overwhelmed. And she would like policy makers to know “there are many families out there who would like to keep their elderly at home for as long as possible but it’s very difficult without a lot of support. There needs to be a different mindset. We need to have people that are trained, willing, and able to help.”
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I became a home care aide so that people could stay in their own home.  They aren’t ready for a nursing home and just need a little help.”
Diane Wine, Portage, MI, is 71 years old and enjoys life, pastel colors, Mackinaw Island Fudge ice cream and time with her grandchildren. Her 9-year-old granddaughter says, “Grandma makes me laugh.” 
          She started out as a hospital candy striper then worked for 25 years at the hospital as a DCW in different departments including the pharmacy. She retired in 2009 then went to work part-time for a friend who opened a homecare business. Ten years later, she still has a client from that time. She started out at $9.50 per hour and now makes $10 per hour.   
          Diane talked about her calming effect on people, her skill for deescalating potentially dangerous situations. Every situation is different. “If someone would become agitated, you just kind of have to back off. You try to talk to them and calm them down. You have to be prepared, if they’re going to hit you. It’s just a matter of blocking that hit… Here again, you gotta feel out the patient to know what to do.” Diane says Direct Care work requires diplomacy skills, something she believes all DCWs should have. “I became a home care aide so that people could stay in their own home.  They aren’t ready for a nursing home and just need a little help.”
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In homecare, you gotta improvise a lot. You need to be the nurse and the doctor, and the floor manager…and figure all that stuff out as you go.”
Damien Sheppard, Lansing, MI.
Age 37, Damien has a degree in biochemistry, works as a lab manager in a plant biology lab, is an avid bicyclist, gardener and reader. He values the relationship with his clients, the flexibility that allows him to work around his lab job, and feeling that he is contributing to society in a meaningful way.
           “Without me, [my client] would have a much lower standard of living…and his wife would have to go back to doing the home care. It wasn’t a tenable situation.” He says his client might have been able to stay at home for a short while but not for very long.
          Damien worries about risk of client falls, inadequate wound care and grief when a client dies. He is an advocate of home care but laments the lack of resources. “An institution offers so many more resources. You have an RN on staff on call, a physician on call, all those things that help you get through sticky situations. In homecare, you gotta improvise a lot. You need to be the nurse and the doctor, and the floor manager…and figure all that stuff out as you go. The background that most of us have makes that difficult.  An example is where you might have a small wound that if it’s not taken care of might fester into something where an infection could set in.”
Damien would like to stay in homecare but eventually needs a job with a living wage so that he can plan for retirement. “You’ve gotta increase the pay, and that really needs to come from the state. Without that, it’s just not feasible. It’s not a tenable goal to increase the workload by what, 30,000 individuals? No. Without help from the state it’s just not possible because the work is rough, it’s really difficult, the pay is relatively low, the training isn’t great. Without that, it’s just not gonna work.”
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In-home healthcare, sometimes they don’t have new clients all the time, so you’re kinda stuck there for a while without any clients. You can’t count on the income.”
Mellisa Bobnock, Iron River, MI., Certified Nursing Assistant, enjoys being at home with family and gardening. She has been a home care worker with the same agency for 16 years. She got into it because she wanted to help people, enjoyed working with older adults, and discovered she loved the one-on-one care and relationships that develop. She has also done some work in an assisted living facility where the advantage is that “if the client passes away or goes in the nursing home, you still have your hours. You don’t lose your hours. In-home healthcare, sometimes they don’t have new clients all the time, so you’re kinda stuck there for a while without any clients. You can’t count on the income.”
          Melissa seems to take everything in stride, no matter what the situation. She provides assistance from companionship to what she calls the “top priority” clients, those who are bedridden and need the most help. She’s often called in on the cases that others think are tough yet she says the job is “not tough, it just takes a lot of patience and being the “right kind of person” which she defines as nice, caring, dependable, and easy going with a good attitude. She recalled one client that the other DCWs thought was mean. “They say he’s mean, but he’s not mean. They say that it’s too much work ‘cause they gotta do the Hoyer lift and stuff like that. You gotta do a range of motion on him, and turn him in bed but it’s really not hard. I mean once you get used to doing it, it’s just like not working. You go there, and you just do it.”
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You have a warmth that very often turns into love for them, and you’re going to want the best for them.”
Martha and Hellen Kwant, Lansing, MI. Mother and daughter are both home care workers. Martha, a retired social worker, says, “Momma taught us from being knee high to boll weevils that we take care of the elderly…You have a warmth that very often turns into love for them, and you’re going to want the best for them.”
     Born in Columbia, Hellen is age 83 and has one client, also age 83. When asked why she does this work - Hellen says, I think in the love that I can put with them, and the help that I can do to make it easy for them…You’re faced with so many different kinds of older people—handicap or sick or whatever…you try to help…it’s natural. I think it’s a gift that I have.”
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You feel like you should be able to leave your job and leave all those emotions behind, but it doesn’t always happen. Sometimes you take that with you.”
Alisa Curtis, Traverse City, MI. A member of the Odawa nation, Alisa started in DCW work 8 years ago when her parents needed more help and her mother was diagnosed with pancreatic cancer. Like most DCWs, Alisa states the wages are too low. Other household income makes it financially possible to work as a DCW. “Sometimes I feel like I’m doing really well financially, and other times not so much because your client passes…You’ve had steady hours for a long period of time, and then all of a sudden, those hours are gone.”
               Alisa loves hospice work but often finds the grieving and family dynamics hard. One client said, “I only want you here. I can only trust you.” But the family said “No. We’re taking over from here. It doesn’t matter what he wants. You know, we’re in charge.” “You feel like you should be able to leave your job and leave all those emotions behind, but it doesn’t always happen. Sometimes you take that with you.”
          Holding back tears, Alisa said “It makes me feel sad because when people are at that point in their life, you know they’re at the end, they might ask you for forgiveness or tell you some secret maybe they don’t tell anyone. I guess that’s the part that’s hard when the family doesn’t see what you’re seeing.”
          She also loves how each day and each client is different. “It’s never boring! I don’t know if I could necessarily just sit and do the same thing every day”.  Alisa recognizes her skills with staying calm and dealing with difficult situations such as inappropriate sexual advances. She states her years of experience and training have helped her be a better, more patient DCW and recommends that young DCWs shadow somebody with more experience because “some people if they’re put into a situation they’re not familiar with, it may scare them off.” She also recommends standards and oversight of home care agencies to avoid those that are just in it for the money.  “It’s more than just a business…making profit. It’s somebody’s life.”
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...ultimately, it’s a life you’ve got resting on your shoulders when you’re taking care of someone.”
Rachel Esch, Lansing, MI was a Miracle Network Child, born in 1989 with a bone disorder called Hemihypertrophy. Her medical costs were covered and the nurses inspired her own desire to be a nurse. She is a certified nursing assistant, nearing graduation from nursing school and works as a PCA for income and experience working with people. She is an artist, dog-lover and avid reader.
               Half Mexican, her current client is Mexican, U.S. born, and Rachel says “That little bridge helps. You know—he’s got the tamale stories, and we’ve got the tamale stories, and he asks about my grandma and then I tell him [her name] Casteo and he’s like, ‘Oh, Casteo, yeah.’”
          Rachel believes PCAs need to have good observation skills. “You can prevent so much terrible big things if you can notice some of the little things early. It’s a preventative…like noticing the little red spot on their tailbone, it could turn into a pressure ulcer, and those can go deep as your bone, and they’re terrible and take a long time to heal and can lead to all sorts of other problems.
          Not all caregivers are cut from the same cloth. Some of them just show up, stick somebody in a chair, and call it good but the ones that are doing a good job are watching out for that little snowflake before it becomes an avalanche. Those things matter. I mean, ultimately, it’s a life you’ve got resting on your shoulders when you’re taking care of someone.”
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We have a few stretches that during the winter many times that highway will be closed because of the wind. The drifts. You find other ways.”
Diane Saari, Kingsford, MI and
Donna Aberly, Crystal Falls, MI.
          Both women have been DCWs for over 20 years. They entered the field to supplement their husband’s income with some “extra money” and have no plans to quit because “It makes us happy.” In their early 70s, they still provide a full range of care from companionship to heavy lifting. They face diverse situations, never really knowing what they are walking into, but have learned to take things in stride.
         They each have stories of clients who threatened them, accidently set their clothes or the house on fire, unjustly accused them of theft, had heart attacks while in their care, or died and left them grieving. In all cases, they stress that it is their job to stay calm and it helps to have a lifetime of experience. Donna says, “First thing, you don’t panic. You just do what you have to do, and afterwards, if you have to panic, you panic. Stay calm. For me it just comes naturally.”
Providing support in the U.P. brings its own challenges: geographic distances between clients, no public transportation, and massive amounts of snow. Both Diane and Donna take pride in saying that they have always made it to every client, regardless of the weather. “We have a few stretches that during the winter many times that highway will be closed because of the wind. The drifts. You find other ways.” Diane once walked 5 miles through the snow to be with a client who lived on “a wicked little hill” on a country road. She shrugged it off by saying, “I have good boots.”
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...there’s such a high degree of responsibility or potential responsibility caring for somebody, with no vetting process and very little financial reward, for potentially life-threatening situations. ”
Kevin Kitchel, RN, Lansing, MI studied for a career in music recording, did computer work for Linex Systems, and worked for the Michigan Senate but didn’t feel passionate about any of it. His girlfriend, a nurse, inspired him to go back to school and he decided to finally follow advice that his grandmother, an anesthesiologist, had given him 20 years earlier. “If you want to help people, be a nurse.” He applied to a community college that had a work requirement as a prerequisite for nursing school. A neighbor referred him to a client who hired him directly for Direct Care work. He started without any training or medical supervision. The client told him what he needed and taught him how to do it including ostomy, decubitus ulcer, catheter, and infection care.
              Kevin was shocked at “how low the bar was set for employment, and how there’s such a high degree of responsibility or potential responsibility caring for somebody, with no vetting process and very little financial reward, for potentially life-threatening situations. This man was a quadriplegic. It was in some ways total care and I had no training whatsoever outside of my desire to go to nursing school.”
               Kevin nevertheless “took to it right away. Just even in the first day I thought this is so much more rewarding than the work I had been doing in IT. Taking care of people just feels good for me.” He and his client hit it off. Even with all of his client’s physical needs, Kevin felt what was critically important was the quality of life that their relationship provided. He listened with great interest to his client’s rich life stories of the music industry, travels, and famous people he had met. He prepared his client’s favorite foods and they experimented with menus from different cultures. This proved to be one of the most enjoyable but challenging aspects of the job since Kevin is a strict vegetarian and most of the meals centered on meat. As Kevin says, “The relationship changed from me just being a guy who show up to cook food, to being a friend and a part of his life.” 
                 Kevin eventually was accepted into nursing school and gave up DCW work. He is now a R.N. at a major hospital in the Lansing area. He maintains that his time as a DCW was invaluable. It was a path to a nursing career and made him a better nurse. It taught him empathy and patience and gave him an understanding of what people need at home once they leave the hospital. His advice to young people with an interest in health care is to try it. To decision makers, he advises raise the wages and provide training.
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