This message is prompted by the comments made by Ivan re: salary of nursing/home health aid assistants and also the responses of some persons to Ivan. Since my Mother has been in a nursing home for the past year, I have learned much re: problems being faced by the community in need of caregivers. Mother is currently in a nursing home in Rochester, MN (she is private pay, she is not medicaid as if that would make a difference)......This skilled care facility is UNABLE to hire nursing assistants for the evening shift (it is what we think of as the 3-11 pm shift, however, I think the hours are slightly different in this day and age). I believe that these positions have been posted/advertised for more than 1 year. As a result the nursing home has empty beds (If memory serves correctly the number is 10 empty beds). Patients CANNOT be accepted for these spaces, because nursing care is not available to meet the requirements of these individuals. This is a loss to the nursing home of more than $100 per day per bed.........presenting financial crisis for the nursing home also. As Ivan commented the economy is up and individuals can (and will) accept positions at McDonald's that pay more than caregiver positions. This particular shift is demanding physically because patients need to be put to bed for the night.....lifting, moving, assisting and lots of hands on care........Volunteers cannot be used for these positions because of insurance liabilities (what if a patient were dropped by a volunteer?). Volunteers are used to assist with feeding/serving in the dining room and to help with transportation to MD appts, hospital visits, treatments etc away from the nursing home. Regulations are in place to protect the health/security of the patient....for instance a volunteer hairdresser can set and comb out a residents hair, but cannot wash hair, that must be done by staff). Seniors looking for caregiving jobs must be strong (heavy lifting). Young marrieds wanting a second job/employments want to be home with family at these hours. Ivan is facing a personal crisis, but the country is facing a crisis in this area also......we simply don't hear about it until we are faced with the need....or it is a "not me attitude". Last week I spoke with the Indiana State Board of Health (we are following through with complaints filed against the nursing home my mother was in in Indiana). The RN at the ISBH said to me......these problems occur because the industry in Indiana is in crisis state because of the lack of available staffing. Salaries are so low that employees cannot be hired or retained. Only more reinforcement for what I was hearing from Minnesota (and now from Maine). Every day I am developing more of an understanding that our problems are not just medical problems. We are so focussed on what the next drug will do that we are missing the big picture (are we not seeing the forest for the trees?). At the time that we are faced with the crisis of home health/practical nursing/nursing home space we are so exhausted by the process of attaining that position that we have no energy to fight the battle that needs to be fought in society to overcome these challenges. As PWP and families, we are so exhausted by our own challenges (physical and emotional) that we don't want to take on the complex challenges that surround us. But they are a part of PD and we are going to have to fight these battles eventually as the solitary warrior Ivan is doing this weekend. There is more to success in this battle than the Udall bill. There is more to success in this battle than having a meal with no stains down my shirt front. There is more to success in this battle than four hours of "on" time from medication or the finding the link to environment and onset age. Rita Weeks 54/9