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Vermont caregivers say they're unvalued, underpaid, but can't walk away from their clients

A woman with long brown hair and glasses stands outside her house. Sun shines in her face, and falls slanted into a blue shadow on the home behind her.
Nina Keck
Vermont Public
Melissa Fox has worked for the VNA & Hospice of the Southwest Region for more than 30 years. She began her work as a caregiver at a nursing home in Rutland right after she graduated from high school in 1984. "It's hard to explain, but I've just always been drawn to this work," she said.

While investments in public health during the last century mean that Americans are living, on average, more than 25 years longer, similar investments in the infrastructure needed to care for an older population are lagging behind.

The shortage of direct care workers, in particular, has become a crisis. Nationwide, the median wage for direct care workers is a little more than $14 per hour. It's also known for burnout and to be physically taxing, sometimes dangerous.

These are the people you might call if your father has a catheter and needs help bathing, or your grandmother can no longer vacuum and needs help with housekeeping and meals.

“I make $18 an hour after 30 years. I can go to ALDI’s and start at $17 stocking shelves. It's very disheartening to think that that's all we're worth.”
Patti Merrill, certified nursing assistant

The people who do this work are mostly women. Outside Vermont, they’re often women of color and immigrants. They’re undervalued and overworked.

Federal data show since January 2020, 400,000 nursing home and assisted living staff have quit, citing the pandemic as well as low pay and lack of opportunities to advance.

That comes as America and Vermont ages. By 2060, the population of adults age 85 and older in the U.S. is expected to triple. But the number of adults aged 18 to 64 who could be potential caregivers is expected to remain about the same.

Melissa Fox, licensed nursing assistant for 32 years

If you want to pay out-of-pocket for this kind of help, you might call your local visiting nurses. At the VNA & Hospice of the Southwest Region, which serves Rutland and Bennington counties, waitlists for home health and personal care aids are 25 to 30 names long.

Melissa Fox is a licensed nursing assistant who’s also certified in hospice care. She lives in Pittsford and has been with the VNA for 32 years.

Her days start early, often before 7 a.m. Most mornings, she says goodbye to three cats, gets in her car and drives to her first appointment.

On this particular morning, it’s a gentleman with quadriplegia whom she visits three days a week. Before she even leaves the car, Fox checks in to work with her iPhone. The GPS tracks her throughout the day, and is used as a safeguard to ensure caregivers visit each patient on their list.

Then she grabs her bag, gloves and her mask and heads inside.

"So I help him with his catheter care. Actually, I don’t just help him, I do it because he can’t. He’s what we call total care,” Fox explains. “Then, getting him cleaned up and dressed. And then I’ll get his breakfast for him. So he’s able to come out and go through the day, and live like we take for granted, basically.”

A woman stands on grass in front of a beige home with green shutters.
Nina Keck
Vermont Public
Melissa Fox stands outside her home in Pittsford. She's a licensed nursing assistant who is also certified in hospice care. She's worked for more than 30 years with the VNA & Hospice of the Southwest Region, which serves Rutland and Bennington counties.

Fox says her work varies from client to client. Many she’s taken care of for months.

She works full-time, so she earns benefits. She also earns 50 cents per mile along with quarterly stipends to cover transportation.

Her last stop of the day is a woman who’s getting hospice care.

“I’ll be heading in to get her cleaned up. She’s a bed bath client, dementia, Alzheimer’s … not a lot of communication,” Fox says. “But she does smile. She does holler also, but she’s a wonderful person.”

Fox says most days, she sees five to seven patients and is back home to her cats by 4 p.m.

More from Vermont Public: For the thousands of Vermonters providing kinship care, a new film shows help is available

That last patient, the one with Alzheimer’s, has since passed away. Fox says letting go is one of the hardest parts of the job.

“Patients become like family, especially when we’ve spent months caring for them," she says.

She’s often been asked why she hasn’t become a registered nurse, since they earn almost twice as much an hour. She doesn’t like all the paperwork, she says, the time on the computer. She likes being hands-on, and she thinks she was called to this work, that God had a hand in it.

“I like that I’m helping people. I mean, it's rewarding, it truly is. And I'm good at it," Fox says.

After 32 years, Fox earns less than $20 an hour.

Patti Merrill, certified nursing assistant for 29 years

Patti Merrill also works for the VNA & Hospice of the Southwest Region. She’s been a certified nursing assistant since 1993, and in her West Rutland living room, she talks about the ups and downs of the job.

"For some people, you're the only outside world they have,” she explains. “So you know, they want to talk, they want to visit, and that’s the hard part, because that’s all they want to do. And you know, you can’t do that, you’ve got to be able to do your job, so you kind of have to work both of them in.”

A woman in a pink shirt stands in her garden.
Nina Keck
Vermont Public
Patti Merrill has worked as an LNA — a licensed nursing assistant — with the VNA & Hospice of the Southwest Region since 1993. She says the low salaries caregivers earn is discouraging. She makes $18 an hour. But she feels like she can't quit, because she says many of her clients live alone and count on the help.

Merrill turned 60 this year. She says her clients used to always remark that she looked much younger than her age. But next year will mark 30 years with the visiting nurses.

“You know, it's getting to the end where you’re just, been doing it so long, your body says enough," she says. "It's rough on the back. And that’s your biggest thing, because if you blow your back out, you're done. Because we lift on people. I'm 5 feet tall. And when you get somebody that's 5 feet 7 or 5 feet 8, it's hard."

Asked about the shortage of caregivers like her, Merrill nods.

“In fact, we had another one that just put in her notice," she says. "So it's like, five within the last two to three weeks. I think they're burned out. The driving, the price of gas, the lack of money.”

A woman in a pink shirt looks at her cell phone.
Nina Keck
Vermont Public
Patti Merrill stands outside her West Rutland home with the cell phone she uses for work. Merrill is a licensed nursing assistant with the VNA & Hospice of the Southwest Region, and travels to care for clients. She uses the cell phone's GPS to track her visits. The work can be challenging she says, especially with clients who have dementia who ask the same question over and over again. "You have to be patient with them, you just do," Merrill says.

“I make $18 an hour after 30 years,” Merrill says. “I can go to ALDI’s and start at $17 stocking shelves. It's very disheartening to think that that's all we're worth.”

Despite the low wages, she says she can’t imagine not going to work or protesting with a strike.

“I can't do that to my clients,” she says. “That’s the hard part. I can't walk away from them. Not right now. As much as I want to, I just can't, because some of them don't have anybody."

Merrill says most days her husband asks her if she has quit.

"He does, every day he asks me," she says. "But I’m not there yet.”

Have questions, comments or tips?Send us a message or get in touch with reporter Nina Keck:


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