Caregiving Series Part 3: Seeing Caregiving From the Perspective of an Elder Concierge

For this third installment of my series on caregiving, I sat down and talked with Rachel Laws. For the past 15 years Rachel has been an Elder Concierge for her company, Living Well Services. Up until that point, her professional career was in the corporate world specializing in organizational development. She discovered, however, that she much more enjoyed helping her grandmother and a neighbor and she figured there must be a way to evolve this calling into a career. At the time, senior concierge services weren’t really a thing, so Rachel is somewhat of a trailblazer.

I looked forward to sitting down and talking to Rachel about her thoughts on caregiving. She offers a unique perspective on the caregiving crisis in this country, and I hope it adds another dimension to the assumptions we make about the challenges families are facing today and hopes for a better tomorrow.

But before we go any further, let’s first understand more about what the job and responsibilities of an Elder Concierge is.

Jody: Thank you so much for talking with me today, Rachel. Can we start out by you explaining a little bit about what an Elder Concierge is, and maybe, what it isn’t?

Rachel: There are different aspects of caregiving. I perform concierge care, where I'm helping people with everything from bill paying technology, sorting out the problems, organizing the home, helping to get services brought in, whatever might be needed. And then, of course, there's the family and friends’ network of care. And then there's that other aspect of care of having maybe a social worker or care manager. I help coordinate all that. I don’t perform personal care.

J: Are you surprised that Living Well Services has been so successful for all these years? That you helped to carve out a new industry far before anything else like it was available?

R: Based on the fulfillment and the need I saw when doing care work outside of my corporate job, I just realized there's got to be a business in this. I knew that I couldn't perform the home and personal care that is often thought of as ‘traditional caregiving.’ I didn’t have the training, the physical strength, or the interest in that. Although I have a lot of respect for that role. I just knew there were a lot of people out there that needed this kind of help, and it ended up working. I care about people, and I enjoy making their lives easier, better. And what's wonderful at the end of each day, every day I hear someone who says, thank you thank you so much for helping me today.

J: You have had a front row seat to evolving state of caregiving in this country, the Bay Area specifically. What have you seen change over the past 15 years?

R: First of all, an increase of costs for caregiving, I think when I started, you could probably get a home care person for $18 hour through an agency. We're now at $40 an hour in Northern California. So that's been an incredible arc. And of course, now we have this shortage, which is making it very difficult.

J: So, you're seeing the shortage, too?

R: Absolutely. There is absolutely a staff crisis happening. I deal with it in finding care for my clients, and my colleagues are experiencing it as well. I just recently called about four or five home care agencies to fill a short-term caregiving need—just a few days a week, four hours a day. Every single agency that I called said that is a very hard ask. Eventually I did find someone, but it was difficult. Shorter work is harder to source.

J: How has the pandemic impacted your work?

R: Well, during the lockdown, I was not considered an essential worker. So, I couldn’t go into skilled nursing facilities, residential care facilities, and assisted living facilities. I had to find ways to get the folks that are living there help. Most of my clients wouldn't allow me into their homes. So, I went and did what I could from outside, sitting in the garden paying someone’s bills for example. There was a standstill in the beginning where we were all just trying to figure things out. That lasted for about a month or two and then things started to pick up again.

J: What do you wish the general public understood about caregiving? Do you think there are any myths you can think to dispel?

R: I do. For the myths, I think that a lot of the family members of my clients and even my clients want to work with private caregivers over home care agencies because they feel they'll be saving money. And I think a huge myth is that they don't realize what's involved in hiring privately. You know, you have to be the boss. You have to do the hiring, the firing. You've got to do payroll, insurance, etc. Making sure the caregiver is properly trained and qualified. Agencies are better equipped to handle all these things.

Another myth is allowing a caregiver to be a live-in position in exchange for rent.  Managing those boundaries can be tricky. What if, for example, the client’s needs change but the caregiver doesn’t want to move out?

J: What is a piece of advice that you give to your clients or their family members if they are looking to hire a caregiver?

R: I help navigate the caregiving hiring process by advising them to build good relationships with the managers in the home care agencies, and look for staff who can really help and seek those who are responsive to what their specific needs are. There are many agencies in the Bay Area, and caregivers can work for more than one, sometimes at the same time. If a worker gets fired from an assignment from one agency, they can simply go to another agency. You may run into the same caregiver twice.

J: One thing we hear about with caregiving, in particular the senior demographic, is the “sandwich generation,” meaning, middle age folks who are taking care of children and parents at the same time. Do you see a struggle with this in any of the families of your clients?

R: It's a wide spectrum. I mean, I have clients whose children live abroad who are available by phone and maybe oversee the finances, but very little hands on work. Then I have had some clients whose children are totally unavailable. But then I’ve also had very involved, very concerned family members. I like partnering with families. They know their family member best, so that helps me do my job. And you know, a lot of my clients’ children aren’t raising kids anymore, but they are actually busy with retirements of their own. I have clients that are in their late 90s, early hundreds. And so, their kids are getting to be 78 and 80 themselves.

J: I read the story once of a couple who had placed their senior parent in a care home, but saw his health declining. They made the decision to move the parent home, with all of the care costs and logistics involved with that. For some families navigating this process is a whole new world. It’s why I want to help advocate on this topic, to educate, but also let people know they are not alone.

R: Yes, I have seen the adult children of my clients think that if they send mom to a care home or an assisted living facility that everything will magically be taken care of. Not putting these companies down, but you absolutely still have to advocate for your family member. You still have to be very involved to see what's going on, whether they're getting all their needs met. 

And they don't teach younger people about preparing for aging and how all this stuff works. Healthy, non-disabled folks my age say, ‘Hey, man, you know, retirement's going to be wonderful. We will be on golf courses and enjoying ourselves.’ And they don't have a clear understanding of the $40 an hour for 24-hour care, that they need to save for, if we are lucky enough to get there.

J: Yes, absolutely. Right. So, yeah, absolutely. I love that you're bringing attention to this matter. It's so important. How does this line of work make you think about preparing for your own future? Other than the obvious of trying to save as much money as you can?

R: One day I want to write a book on this subject, but I won't bore you with all the subject headings. I'll focus on the things around caregiving that I think are really important. One is that I want to strive to be a good recipient of care. Some people who I have encountered over the years are rude, and actively reject help when it is offered. I think that that's a symbiotic relationship, where caregivers are encouraged to feel good about what they're doing, and the recipient feels appreciation for the help they have received.

Secondly, save as much as you can in your earning years. Some of my clients are actually outliving their money. I've seen the entire nest eggs and several clients go to zero. I just recently moved to 101-year-old into a Medicaid skilled nursing facility who was living independently at home, but now can’t afford that level of care anymore.

Lastly, one other thing I've learned is to really try to simplify your life in making your environment or home conducive for receiving care. There are a lot of homes I go into that they're filled to the brim with paperwork and boxes, and no clear pathways. Paring down and simplifying as much as possible because things can change on a dime, especially health issues. And along those same lines, centralizing important documents or information so it makes it easier to find and share vital information with others.

J: Do you ever find resistance among family members in accepting that there is a new impairment with their loved one that needs to be addressed? Or maybe from the client themselves?

R: Sometimes, like if someone has suddenly had a stroke or now has Parkinson's, the question of driving becomes a big issue. There can also be discussions of the need to use assistive devices. People are filled with pride about their ability to walk. And when they're losing that, it's very hard to get them to think about using a walker or a cane or taking a ride in a wheelchair. I encourage gentleness with loved ones about this change. Yelling at them, or forcing them is not helpful. Gentle encouragement and hearing them out about what their concerns are is best.

J: I advocate for the disabled community here on Love Disabled Life and so I am wondering if you have any thoughts on how the disabled community and the elder community could work together on a common issue that affects them both?

R: Yes, a lot of my clients, the seniors, get eye diseases later in life and blindness is a major problem. They've never learned to read Braille and trying to live alone while blind without assistance is so challenging. The technology that's out there right now is not that easy to use. I think that the disabled community and the elder community with visual impairments need to come together because there are not many resources for people who have just suddenly become blind or maybe it’s just they're not talking to one another. Hearing impaired individuals have some of the same challenges. The technology is not standardized and not user friendly for someone who hasn’t grown up with computers all their life.

J: In my part two of this series, Ligia and I talked about having tiered levels of care. Do you agree that there should be different levels or distinctions between care skills and qualifications, and also how that care is compensated?

R: Absolutely. A correlation between what the work is and how much that worker earns. And also, a clear expectation for the work that needs to be done. Some medical things you would only want a nurse to do, but some other things a trained caregiver could do. Also, I’ve heard stories of how some caregivers arrive and get immediately distracted with their phones or the television. While others walk in the door and look around and say to themselves, ‘This is what's needed here… I see leaves on the deck that need to be swept, laundry that's needing doing, etc.’ They don't need to be asked. They just start working and doing it.

J: From your perspective as an Elder Concierge, kind of a hands-on facilitator in the world of caregiving, what do you see as the future of this industry, how it should evolve for the workers, and for the people who need care?

R: I think there needs to be uniformed training and licensing levels for caregivers. I think that's going to be really important. When you're hiring someone, it's really hard to know, what are the different levels of knowledge that they have. You need to know how to do showering or transferring, verses someone who is doing grocery shopping.

I also think that caregivers need protections. I think we need to make sure that they have workman's compensation, health insurance, and worker’s rights and benefits like overtime pay. As well as earn enough to make a living wage. I would hope to see caregiving costs included as part of our health coverage policies-- basically an enhanced or in-home support services to people who need it, based on income, kind of how Covered California or the Affordable Care Act is set-up.

We need to hire more workers, and that could be done through expanding immigration to train qualified workers. And lastly, we need to modernize systems that are part of monitoring processes. Things like managing care hours, but also activities like medication management and communication tools among the various caregivers that a family or client needs to frequently interact with.

J: Well this was such a great conversation. Thank you so much for sharing with me your experiences with caregiving. In your role as a concierge, you really do offer a unique perspective on all the different dynamics that are involved in the issues involving caregiving.

R: Thank you so much for interviewing me. I’ve enjoyed our talk, this is an important topic to explore, thank you for doing this.

Editor’s note: This interview has been edited for length and clarity.

This is the third in a three-part series on caregiving. You can read Part 1 HERE and Part 2 HERE.