The night shift

I’m an entrepreneur redefining long term care by building an entirely new kind of assisted living housing category, by putting seniors and their families first. I’ve been documenting my research on senior care here: https://raffisapire.com/

I want to tell you about Mindy, the caregiver I’ve been training with this week as a caregiver at a residential care home. A residential care home is a home where 3–16 seniors live together and share the cost of 24/7 care for tasks like bathing, meal prep, medication management, etc. Mindy works the 10 pm — 6 am shift at the care home, earning $12 per hour. I am already at the care home when she arrives. She gives me the side-eye, not saying hi. “Hi, I’m Raffi, I’m training with you tonight”, I say nervously from the corner, where I am trying to stay out of the way.

Without making eye contact, she says, “Well, you’re not going to learn anything from over there.” I stick by her side for the rest of the night. It doesn’t take long to love Mindy, even though she tells me later, “she doesn’t do people.”

We begin our evening round checking on residents. We walk into Amy’s room, turn on the lights. “Amy, I’m going to check you”, she says, loudly and confidently. She gently pulls the covers back and checks her adult brief. You check it exactly how you think you’d check it. Amy writhes in pain, and can’t express how she feels except for excruciating gasps. Her speech has deteriorated in the past month, Mindy tells me later.

I I I I I just I I I I I I I I.

“I know honey,” Mindy says. “Don’t worry about a thing. Let God take care of you.” She strokes her hair.

I I I I I I its j j j j j j j j just I I I I I I I have so so so so so so so so much p p p p p pain.

She’s shivering and scared. Mindy lets her talk, lets her be heard, for about 15 minutes, even though her words are ineligible.

Mindy strokes her hair and her face. “Don’t worry about it. God has you. I love you.” And she gives her a big hug and a tender kiss on the forehead. I want to cry.

Next room. It goes on like this for an hour. We check their diapers, and we use the bed pad under the bed to first shift their body in the opposite direction they’re facing, and then together we turn their body the other way gently so they’re not stuck on one side all night. I can’t believe she lifts and moves 150lb+ people every night by herself. Mindy hugs and kisses every resident, and tells them she loves them. She means it. They say it back and hug her, too. She’s tender and loving. Anyone would be lucky to be cared for by Mindy.

Later, after diapers are checked, and residents are rolled from one side to another, Mindy and I sit down. She tells me how she wants to care for them like they’re her own parent. She hopes that someday, she has someone like her to care for her. Tears start streaming down her face, which I’m surprised by because we’ve only been sitting down for maybe 10 minutes and nothing in particular, has triggered the tears. There’s a lot of death, she says. So many beautiful people, gone. Last week the home lost someone, Ms. M. Caregivers like Mindy truly love their residents. The grief is a never-ending hazard of the job. There’s no support for her grief as part of her work. She just needs someone to talk to about loss and death, so I sit and listen and nod.

Later on, at about 2 am, Sam comes out in her wheelchair. She’s wide awake. “Mindy, why don’t you come to sit with me,” Sam beckons. Last week, I painted Sam’s nails, and she thanked me over and over. We chatted all day, and I remember wondering “why she was here, in this home that specializes in dementia care?” She seemed totally with it. “Who’s that?” she asks Mindy, pointing to me. Mindy joins her with a glass of ice water, and chats about her twin boys upcoming 18th birthday, something she’s already told me but regurgitates to keep Sam company.

Throughout the course of the night, I have the opportunity to learn a lot about Mindy. She works the 10 pm to 6 am shift five days a week, then she goes home to make breakfast for her boys. At around 8 am, she leaves for her day job as a caregiver. “When do you sleep?” I ask. “A couple of hours, here and there.” She earns $12 per hour. Sometimes the manager forgets to sign a check, or for some reason, a shift isn’t included in her paycheck. She makes sure they correct it, but it can be a huge bother when she has to wait for a signature and is late on bills. Who pays that late fee? Her. They’ve been making a lot of mistakes lately, she tells me.

At about 3:50 am, Mr. Waverly opens his door and tells us he’s scared, there are men trying to murder him. They’re in the bushes outside. At about 6'6", Mr. Waverly startles me. But not Mindy. Mindy tells him she’ll go check outside. “Be careful!” he says. She goes outside and comes back in. “They’re gone, I scared them off.” “What if they come back,” he asks. “They’re not coming back. I sent them out of town.” Mindy handles it with grace. About 15 minutes later Mr. Waverly comes back. He’s scared they’ll take him to jail. He also is confusing that with feeling like he is in a prison here. His son took all his money (I think this might mean he has power of attorney and put him here). He doesn’t know how he’s gonna get out, because he doesn’t have a car. And his phone is broken, so he can’t call a taxi. Mindy tells him, “Mr. Waverly, you are free to go at any time, you know that right? You can leave. This is your home and we are here to make you feel safe.” I pick up on an important dynamic centered around freedom.

There are some caregivers who work at this home, she tells me, who don’t allow residents to get out of bed at night. They need to stay in their rooms. They can’t have a snack at night if they wake up. Those are the rules. You can see how that might make you feel you’re in jail. Mindy, on the other hand, doesn’t feel that way. “This is their house! It’s their money, they pay rent. Why won’t a caregiver let them have an apple? It’s their apple.” She tries to provide them with as much freedom as they can have, which isn’t much. In a world with so few options, choice feels big for a man like Mr. Waverly. He can choose to sit with us and watch a show, have an apple, or go back to bed. My shift ends at 4 am. Now Ms. Tammy is awake too, sitting with Mr. Waverly. Mindy gives her water and a snack.

“Mindy, I learned a lot from you. You're a really special person. Thank you.” “You are too, baby! Don’t forget it.”

On my way home, I reflect on my commitment to this work: creating jobs for people like Mindy and building homes for people like Ms. Sam across the United States. I am driven to work nights, weekends, whatever is needed to build a business where women like Mindy can work full time, and not have to work an additional full-time job in the day. If we’re unfortunate enough to have parents who need long term care (statistically 70% of people over 65 will need this care in their lifetime), we all want someone like Mindy caring for mom or dad.

My experience working as a caregiver has highlighted opportunities to modernize this cottage industry. There are many operational systems, processes, and technology that can be put in place to reduce costs, allowing me to provide benefits and pay better wages to retain caregivers like Mindy.

• Automating payroll — currently, this is done by check, which leads to clock-in, clock-out mistakes that should be avoided.
• Automating grocery and supply orders — currently, they have a director on payroll whose job it is to go grocery shopping and order supplies as well as sign checks. He comes to the house to check-in, then drives to the store. Caregivers should be able to put in a request and have a manager approve it. They should never run out of gloves or milk.
• Software that increases transparency for the family — currently, adult children call a landline, which Mindy has to answer and give an update while trying to care for 7 people: yes, she’s doing alright, she had a bowel movement yesterday, her mood is ok. This should be a user interface where the family can see when mom was last bathed, had a bowel movement, and how her spirits are.
• Software that helps predict and prevent common problems, like UTIs. The number one issue is grandma not drinking enough water, yet they do not track this. Someone on a night shift has no idea how much water Ms. Sam drank earlier that day, so if she complains of a tummy ache, we don’t know why. This sort of tracking of conditions should be done digitally, and connect to their healthcare providers to identify and prevent hospital readmissions, reducing the cost of care overall.
• Online training materials — the 24 hours of on-the-job training I receive happens haphazardly and by chance, based on what residents need while I’m there. There should be a portal that teaches me how to give an insulin shot, or how to change a diaper. Here, I see it once and hope I remember how to do it when I’m here alone after training.

“Baby, you play the hand you’re dealt.” Mindy’s voice comes back in my head. She has built a home and a family better than she could have dreamed. Now her kids are getting academic scholarships to college. Caregiving is a brutal job, but its the #1 most in-demand vocational job in America. There are more un-filled job postings for caregivers than any other job. People simply don’t want to work such tough shifts for so little money. As the number of seniors over 65 doubles from 44M to 89M by 2050, and our lifespans extend from 79 on average in 2000 to 94 in 2050, we will have an even bigger unmet demand. The residential assisted living model’s healthy margins allow us to create higher-paying jobs that provide healthcare benefits and proper living wages. This business model is the first that I’ve seen that creates a real path to hiring and retaining more Mindys to meet the demand of our growing senior population, which is why I believe its the future of care. This is the hand that we are all dealt, and I’m certainly ready to play.