Frances Jones, left; Natalie Frank, staff activities assistant; and Erma Westover at Acacia Adult Day Services in Garden Grove. (Photo by: Kenny Rivera) Credit: Kenny Rivera

Four hospital beds, a life-size model of a human skeleton and stacks of first-aid kits crowd the back of a classroom at the Ritchey Center in Santa Ana, a training site where 15 high school seniors are reviewing basic medical terms.

Helen Fe, an energetic teacher in nursing scrubs, asks, “What regulations are we breaking when we leave a patient’s record out?”

“Privacy,” a few students chant in unison.

Fe is teaching in a program that prepares Santa Ana high-school students for entry-level health occupations, which promise to offer many job opportunities in the coming years.

Despite a moribund state economy with double-digit unemployment, experts worry that there won’t be enough willing and qualified health workers, particularly for the most low-paying, high-stress occupations related to care of the elderly.

The oldest baby boomers turn 65 this year, and tens of millions more will reach that milestone during the next 20 years. Orange County, which for decades has been a retirement mecca, will undoubtedly feel the effects of this surge of seniors.

“How we’re going to care for them and be prepared for them is a huge concern,” said Cheryl Meronk, CEO of the Council on Aging in Santa Ana, a nonprofit advocate for seniors that is struggling to meet their needs.

Orange County will need 10,680 nursing aides, 7,640 home health aides and 9,370 medical assistants by 2018 — increases of 28, 48 and 24 percent over a 10-year period, according to the state Employment Development Department. Yet state budget cuts have curtailed training opportunities for those who want to work as caregivers for the elderly.

Fewer Training Opportunities

In the 2007-2008 school year, 2,621 adult students completed health, science and medical training programs at the Central Orange County Career Technical Education Partnership. But two years later after adult students began paying $1,500 for the certified nurse assistant program, that number had shrunk to 819.

The result is that workers employed to care for the elderly — jobs that often pay just above minimum wage — may be undertrained. Foreign-born workers, who commonly fill low-paid service jobs, may face hiring impediments if they are not legally employable or don’t speak English, a requirement in some situations.

“I’m very concerned about the future and the number of eligible, qualified, licensed employees,” said Diana Schneider, senior director at the partnership in Santa Ana.

According to Schneider, 50 percent of the adult applicants who try to enter nurse assistant classes at her training center are turned away because they don’t pass a basic English skills test. The center’s classes in remedial vocational English, which many aspiring nurse assistants took in the past, were also eliminated by state budget cuts.

“There’s a need for remediation training,” she said. “We have an international community in central Orange County, so people from all over still struggle with English skills.”

Culture Clashes

State law requires nursing home caregivers to speak the language of their patients, said Maureen Ardron of the Long-Term Care Ombudsman Program, which responds to nursing home residents’ complaints and reports of abuse. It is becoming more difficult for nursing facilities to meet that requirement.

Meronk at the Council on Aging recalled a nursing facility where an administrator suddenly became ill and was taken to a hospital, leaving no one on staff who could communicate with the patients.

Meanwhile, Ardron said, culture clashes can result between the elderly white residents and the non-white staff, who wheel their patients to dinner, groom them, and remind them to take their medicines.

“Most of the people that are prejudiced make no bones about telling you, ‘I wish we could get some white people in here.’” said Ardron. These comments are less common than they used to be, she added.

The situation will become more complicated as the state’s elderly population includes more Latinos and Asians. It’s already hard for one facility in Orange County to find enough Korean speakers, Ardron said.

A Difficult Job

Whomever they are serving, caregivers struggle in jobs that are physically and sometimes emotionally exhausting.

“The work is very hard, and they don’t always get a lot of kudos for what they do,” Ardron said. “It’s tough, and they see things we haven’t seen since changing our children’s diapers.”

Caring for the elderly is fraught with burnout and high turnover. Salaries for home health aides in Orange County range from $11 to $13 an hour, with nursing aides, orderlies and attendants earning somewhat better rates, according to the state’s Employment Development Department. Undocumented workers fill an unknown percentage of the jobs.

“There is a huge immigrant worker pool, but it’s working under the table,” said Tiffany Shinen, co-owner of Senior Helpers, a company in Santa Ana that screens and places health aides in the homes of the elderly. “A lot of people would be working for us if they could legally work in the U.S.”

Senior Helpers pays between $9 and $11 an hour, Shinen said. The jobs do not offer benefits and vacation, and many assignments are short-lived — “three months to a year,” she said — because the caregivers often are hired in the final stages of a client’s life.

The end of life is far away for the class of fidgety high school seniors at Santa Ana’s Ritchey Center, and some seem distracted as Fe works to motivate them.

“We’re in the medical field,” Fe reminds her students. “We are trained to be medical professionals.”

Amy DePaul is a freelance writer and lecturer in the University of California, Irvine Literary Journalism program. You can reach her directly at

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