California Job Outlook – Healthcare Workers in Huge Demand

Temperature is right for Healthcare Opportunities

A healthcare career might be just the cure for your occupational woes. Whether it’s working with patients, being a key contributor in a medical office team, or opening up your own business, healthcare is a satisfying, challenging and exciting career choice. And there’s never been a better time to train for a healthcare position. With the aging of the baby boomers (those born between 1946 and 1964), a shift from inpatient to outpatient care, and the expansion of healthcare centers, the demand for healthcare workers is expected to increase in the years to come, especially in California.

Below are the fastest growing Healthcare Careers in California:

*Dental Assisting*

Average Annual Wage: $31,985

2002-2012 Job Growth: 57%

Future Career Paths: Dental Hygienist, Licensed Vocational Nurse

*Health Claims Examiner/Medical Biller*

Average Annual Wage: $31,772

2002-2012 Job Growth: 41%

Future Career Paths: Medical Coder, Insurance Adjuster

*Massage Therapy*

Average Annual Wage: $36,340

2002-2012 Job Growth: 21%

Future Career Paths: Physical Therapist, Day Spa Manager

*Medical Assistant*

Average Annual Wage: $28,890

2002-2012 Job Growth: 46%

Future Career Paths: Licensed Vocational Nurse, Medical Coder

*Optical Dispensing*

Average Annual Wage: $32,441

2002-2012 Job Growth: 23%

Future Career Paths: Store Owner, Manufacturers Sales Rep

*Pharmacy Technician*

Average Annual Wage: $33,632

2002-2012 Job Growth: 31%

Future Career Paths: Occupational Therapy Assistant, Dietetic Technician

*Surgical Technology*

Average Annual Wage: $40,178

2002-2012 Job Growth: 36%

Future Career Paths: Central Supply Mgr, Asst. Operating Room Admin.

*Diagnostic Medical Sonagraphy*

Average Annual Wage: $60,908

2002-2012 Job Growth: 21%

Future Career Paths: Physician’s Assistant, Medical Technologist

** Salaries listed above are average annual wages reported by the Employment Development Department of the State of California and do not reflect entry level salaries for the healthcare positions listed.

Key Success Factors

Do you have a genuine desire to help people? Then chances are you’ll be successful as a healthcare professional. The four other critical skills you’ll need to succeed in health care are:

o Team player. Healthcare is a group activity, so people skills and teamwork are essential.

o Compassionate and caring. Helping take care of people requires patience and a service-orientated attitude.

o Comfortable in any setting. You might be part of a huge organization or a small staff, working at the local, state, regional or national level. The possibilities are endless.

o Desire for lifelong learning. You’ll need to keep studying and learning throughout your career to keep up with the latest developments in the field.

Healthcare provides a helping hand

Healthcare professionals are essential when it comes to caring for the physical, mental, social and emotional wellbeing of individuals. Whether you’re a health information specialist or a dental receptionist, all support staff play a vital role in patient care. As an important contributor to the healthcare system, you’ll need to be able to establish trust and credibility with fellow workers and patients. Good communication skills, ability to follow directions, and strong listening ability are important, especially if you’re working in a clinical environment.

Technical abilities are a must

Technology has altered the practice of healthcare. No matter what the healthcare field, an ability to work with computers and high-tech equipment is a powerful asset. As a medical biller, you will probably be asked to help process some claims electronically. Medical clinical assistants may need to deal with an Electronic Medical Record. Pharmacy technicians often operate automated pill dispensers. But if you’re unfamiliar with such tools, don’t worry–your all-important career college will help introduce you to these concepts.

Exciting environments

Is it any wonder that shows like NBC’s “ER” and “Scrubs,” and CBS’ “Rescue 911,” have been so popular? They show the drama of medicine and the reality of life-and-death situations. Healthcare is filled with stimulating and interesting interactions. Of course, big-city hospitals bustle with activity, but even a quiet suburban assisted living facility, chiropractic office, retail pharmacy, HMO, or medical clinic have everyday drama and fascinating daily interactions. If you like a variety of tasks, work well under stress, and take pride in doing a job well done, then you have what it takes to be a valuable member of the healthcare team.

Lifelong learning

Medical-related workplaces have always been settings that support and encourage professional growth and development. Opportunities for on-the-job training and continuing education abound, and often employers will subsidize your schooling. You’ll also have lots of opportunities for advancement, so your ambition will serve you well in a healthcare profession. If you’re interested in a career like massage therapy, be assured that complementary and alternative medicines are being integrated into conventional healthcare systems, offering you even greater opportunities. No matter what your area of interest, be sure you start out at a school that provides a positive learning environment and is prepared to help you launch your career in this exciting arena.

Reality check

Although not every healthcare professional works with patients, those who do will find that people are sicker, older, and living longer, often with chronic diseases. Keeping a positive attitude is key for maintaining a cheerful office or clinic. Are you up to the challenge? Being a paid caregiver requires confidence, commitment and compassion.

The clock never stops ticking in the healthcare profession. Perhaps it’s time for you to join this financially rewarding, stable and gratifying occupation. One recent study showed that California led other states in the number of advertised healthcare job vacancies, with other regions also showing a strong demand across the nation.

One healthcare worker said it best: “Touching someone’s life in a positive way is the most rewarding work that there is.”

To request free information about the healthcare career training programs offered in southern California, visit

To request free information about the healthcare career training programs offered in northern California’s San Joaquin Valley, visit

About American Career College

For over 25 years, American Career College (ACC) has been helping thousands of students get their start in the healthcare industry. ACC offers nine healthcare training programs at campuses in Los Angeles, Orange County and Norco, California:

Dental Assisting

Health Claims Examiner/Medical Biller

Massage Therapy

Optical Dispensing

Vocational Nursing

Pharmacy Technician

Surgical Technology

Diagnostic & Medical Sonography (Ultrasound)

Medical Assistant

About A.C.I. Career College

At its McHenry Avenue campus in Modesto, CA, the College offers six accredited healthcare training programs:

Health Information Specialist

Medical Clinical Assistant

Medical-Dental Administrative Assistant

Pharmacy Technician

Massage Therapist

Medical Dental Receptionist

Dotty Zukoff is a freelance writer who specializes in writing articles on career education opportunities. She contributes regularly to e-zines and works with strategic marketing companies that specialize in lead generation marketing for career schools, including Smart Prospector ( and Effective Student Marketing (

Caregivers – Move Over, Mom is Moving in!

Mom was the youngest of 8, I am the youngest of 4 and my husband is the youngest of 3. Mom did her best to be independent as long as she could, but the day came when she needed help. This is the day most of us have either experienced or will in the future.

She lived in California, we lived in Nevada. I didn’t get to spend much time with her during the short visits of traveling back and forth and I looked forward to Mom coming to stay with us.

We moved our furniture from the master bedroom into the smaller guest room, to give Mom more room. However, it did take some convincing that all of the furniture from her condo would not fit into the master bedroom. Giving her the larger bedroom made the most sense as she would probably spend a lot of her time there. It was bright and sunny with lots of windows and a slider to the patio over looking the swimming pool.

I set up a card table next to a window for her to work her crossword and jigsaw puzzles on. I also hung a hummingbird feeder just outside the window. Mom always loved hummingbirds. She would talk to them whenever they came to drink from her feeder in California; I think she even named a few.

Our lifestyle changed once Mom moved in. It was more me than her. I think she would have been fine, but I had a tendency to worry about her when we weren’t home. She loved to chase our Springer Spaniel around the swimming pool even though she never learned how to swim. She would say it was great exercise for both of them, never giving a thought about what would happen if she fell in.

One time she tried to toast bread in the microwave oven. Another time she used Dawn liquid detergent in the dishwasher, which was quit a sight. Have you ever had soapy bubbles trail from the kitchen into the hall and onto the carpet in your living room? What Fun! Of course, she would never do this intentionally, she thought she was doing the right thing, bless her heart!

Mom saved everything, including the cardboard paper towels are rolled on. When we returned from grocery shopping she would roll up the plastic bags around the cardboard one bag at a time so when a bag was needed it could be neatly taken off the cardboard roller. My husband teased her about being the “Bag Lady”, which she thoroughly enjoyed. Mom loved to tease and loved being teased. There were many times my sides would hurt from laughing so hard watching the two of them.

Several years later it became necessary to move Mom to an assisted living home. I did a lot of research until I found a home I felt would best fit her needs. Then I checked with the Better Business Bureau and the County Health Department to see if any complaints had been filed. The home was within 5 miles of our house and was family owned and operated. I arranged for Mom to visit for a few hours several times a week so she could become acquainted with the residents and staff, making it a smooth transition when the day came for her to move. We were invited to stay for several meals and I must say; to my surprise the food was very good.

We would visit her on Sundays and take a special treat. She loved chocolate ice cream and hard peppermint candies, the ones with red or green strips were her favorite. Mom was funny…she would unwrap a red peppermint and put it in her mouth and then ask for a green one. I would say, Mom you already have one and when you are finished with it, I will give you another. She would say, but I have two cheeks and I need another one to make them even. I was afraid she might choke. She would put up such a fuss, she reminded me of a two or three year old who didn’t get their way. Of course, I gave in and guess what? Mom never choked, it was more me than her. Mom was in her nineties by this time.

Every holiday we would bring Mom home and she would spend the night. A change of clothes, a bag of Depends and meds accompanied her. We celebrated Birthdays, Easter, Mother’s Day, Thanksgiving, Christmas and the times family or friends came to town for a visit. As the years past, I began to wonder if this would be the last time Mom would be strong enough to come to our house.

On her 95th Birthday I recorded her singing her favorite little song she had made up about how she took all her troubles and just threw them away. She sang that song so often that it became part of her legacy. I told her I was going to have it engraved on her tombstone, which I did; “She took all her troubles and just threw them away”. People who visit the cemetery may not have a clue what it means, but we know and I think she is delighted. I dedicated a webpage to Mom on the day she left this world for a better place. It has her picture and the recording of her singing her song. Visit if you would like to meet Mom and hear her delightful song.

It wasn’t long before Mom starting showing signs of dementia; her biggest fear was forgetting, she said she was so frustrated because she couldn’t remember anything. I would smile and say; at least you can remember that you can’t remember which means you can remember something. She said she never thought of it that way and then she would laugh. I made a memory book for her of her baby pictures, childhood and family pictures, the home she grew up in, wedding pictures of her and dad, their first home together, the homes that followed, the children’s pictures in chronological order, the grandchildren and great grandchildren. I put a label under each picture with dates, the name/names of people and place. She found the memory book to be helpful in remembering the past.

Fortunately, years earlier Mom had signed a Living Will and had a pre-need plan for her funeral arrangements. She had even picked out her coffin and burial plot. So, when the time came for her final resting place and arrangements, everything had been taken care of by her. There was no guess work on our part, which was a huge relief when going through a difficult time. I feel she even orchestrated her funeral. I love the hymn, In the Garden, but after she passed I kept hearing Mom singing How Great Thou Art, I hadn’t heard her sing that hymn in over thirty years. So I said okay Mom, the song played at your funeral will be, How Great Thou Art and it was.

It may not have always been easy having Mom move in with us, but those are years and times I will always treasure and be grateful for. Was she the best Mother, probably not, was she the best Mother she knew how to be, absolutely!

So, if you need to move over because Mom or Dad are moving in remember the time will pass quickly, make the most of it and have no regrets. We do not get the chance to do it over, so give it your best, get the support you need and cherish your memories; you will be glad you did!

California Babysitters Entitled to Workers’ Comp?

Finding a reliable babysitter can be a headache. Parents, above all, want a childcare provider that they can trust to properly care for their children. When you finally find such a person, you do not want to search for another babysitter to cover their breaks. However, if Assemblyman Tom Ammiano’s new “babysitting bill” passes, childcare could quickly become more expensive and more complex.

Assembly Bill No. 889 has already passed in the Assembly and is receiving support in the U.S. Senate. If passed, parents would have to provide workers’ compensation benefits and overtime payment to any domestic workers in their employment. If an employee works for more than five hours, they must receive a meal break, and every two hours they must receive a rest break. A substitute caregiver will have to cover these mandatory rest and meal breaks, which could pose serious inconveniences for busy parents. If they fail to meet all the requirements in the bill, they will be obliged to pay extra fees and could be liable to a lawsuit.

Workers who will be exempt from this bill are babysitters under the age of eighteen and family members. Thankfully, the bill was amended so that parents would not have to provide paid vacation time to domestic workers. However, providing workers’ comp, mandatory breaks, and overtime, could prove to be too much for some families. It could prevent them from hiring any domestic workers, thus putting children and elderly family members into institutionalized care.

With an estimated 200,000 domestic workers in the state of California, it is important that their rights are protected. Some nannies live in unfit conditions and are paid well below the legal minimum wage. In the worst cases, they are exploited, have no job security, work long hours, and are abused and sexually assaulted. They are not protected by law as are other members of the workforce. The government does need to promote their safety and health, but many organizations do not believe this bill is the best way to do so. Complaints regarding its expensive and unrealistic stipulations are arising from care provider organizations and state agencies from across California. Since its first submission in February, the bill has undergone amendments and has been defended by its writers. Supported by the Democrats and opposed by the Republicans, it remains to be seen if the bill will make it out of the Senate and into state law.

How State Benefits Work in California

State benefits refer to any regular long-term payment from a government. This may be in the form of state pension, benefits for low income, children, careers, incapacity or sickness.

Almost all states provide state benefits to its citizen. This is given to provide assistance to disabled and less fortunate.

In California alone, an approximate of a thousand laws was enacted to provide state benefits to its citizen. The following are some of it:

California CalWORKs

This is a welfare program that gives cash aid and services to eligible needy California families. The program serves all 58 counties in the state. This is operated locally by county welfare departments. The family that applies and qualifies under this law receives on going assistance each month to help pay for housing, food and other necessary expenses.

Requirements under this Law

To qualify for this benefit program, you must be:

Resident of the State of California

Pregnant or responsible for a child under 19 years old

US national


Legal alien

Permanent resident

Low or very low income


Unemployed or about to become unemployed

Needy families may apply for this benefit at any office located in any county where they live.

California Food Stamp Program

California Food Stamps is a federally funded program that helps people buys the food they need for good health. Food stamps are only part of their food budget; they must spend some of their own cash to buy food enough for a month.

Requirements to qualify under this Law

In order to qualify under this law you must be a resident of the state of California and must fall into one of these two groups:

With current bank balance under $2,001

With current bank balance under $3,001 who share their household with a person age 60 and over or with a person with disability.

California Head Start

This is a national program administered by the Head Start Bureau within the administration of Children, Youth and Families, Administration for Children and Families, and Department of Health Human Services. This provides developmental comprehensive services to children from birth up to entry in the elementary school. This program is designed to address developmental goals for children, employment and self-sufficiency goals for adults, and support parents in their works and child caring roles.

Requirements for this Law

To qualify for this law, you must be:

Resident citizen of the State of California

A parent or primary caregiver responsible for a child who is too young for public school

Household annual income before taxes must not exceed $10,400 if you have one person in the household

California Healthy Families

This law is a low cost insurance for California children and teens. It provides health, dental and vision coverage to children who do not have insurance and do not qualify free Medi-cal.

Requirements under this Law

In order to qualify under this law, you must be:

Resident of the State of California

Under 19 years old

Not covered by health insurance

US national


Legal alien

Permanent resident

With annual household income before taxes of less than $26,000

CNA Classes in California

If you live in California and are considering a career in the health care field, consider becoming a CNA. CNA jobs are projected to grow 20% until 2020, as reported by the U.S. Department of Labor. Working as a CNA is the first step in the career ladder towards a successful nursing career. CNAs work under supervision of a licensed practical or registered nurse, by providing personal care for patients and assisting nurses with routine procedures.

There are many CNA training options in California to choose from. CNA programs are offered at:

Technical and community colleges in California offer state approved CNA programs which successfully prepare student to work as CNAs in a variety of health care facilities.

The American Red Cross offers a 171 hour Nurse Assistant training program which prepares students to test to be a certified Nurse’s Assistant. Students will then be prepared to work in long-term care facilities, skilled nursing facilities, hospice centers and other health care facilities.

Job Corps -Job corps is a federally funded program which provides free education to young people ages 16 – 24. They offer a CNA program which prepares students to take the nurses assistant’s competency exam and work in the medical field.

Nursing Homes – some nursing homes in California offer free CNA training in exchange for a year of employment. They may even pay an hourly wage while you are training. Inquire at a local nursing home to see if they offer this type of CNA program.

CNA Schools

Bakersfield College Nursing/Allied Health offers a Certified Nurse Assistant program which encompasses the role of the caregiver in the healthcare environment and how to safely care for the adult patient. After successfully completing the program, students are eligible to take the Certified Nursing Assistant Competency Exam issued by the Department of Health and Human Services.

MiraCosta College offers a CNA program which prepares student to test for competency and receive certificate from California Department of Health. Many students from MiraCosta College continue to pursue their education to the next level by becoming a licensed practical or registered nurses.

Online Studies

Online CNA programs are available for students who can’t attend classes because of family or job obligations. Just make sure the classes are acceptable by the Department of Health and Human Services and to find out if additional testing is needed before taking your competency exam.

California Nurses Aide Certification Info

After successfully completing a CNA program, a student will need to take the Nurse Assistant Certification Exam for competency. After passing the competency exam, CNA’s names are listed the California Nurse Aid Registry which ensures potential employers that you’ve met federal and state guidelines for employment.

New California Employment Law Protects Domestic Workers

In March 2011, a movement began in California calling for increased employment rights of domestic employees – housekeepers, nannies and personal attendants. Now, more than two and half years later, Governor Jerry Brown signed AB 241 into law.

The new law, also known as the Domestic Workers’ Bill, was reintroduced by Assemblyman Tom Ammiano (D-San Francisco) after it was defeated in the California state legislature last year. California is only the second state in the Union to pass a law of this kind, following New York that passed their own version of the bill in 2010.

Domestic workers include individuals who are employed by a private household, or by an employer in the healthcare industry, who are hired to work in a private home. They can either be responsible for assisting, feeding or dressing a child, or for supervising and helping the elderly, or individuals with mental or physical handicaps.

Industry Statistics

Proponents of the law state that domestic workers represent one of the most abused classes of employees in the country. The National Domestic Workers Alliance and Center for Urban Economic Development at the University of Illinois at Chicago conducted a survey in 2012 which revealed the following startling statistics:

About 67 percent of live-in workers are paid below minimum wage;
The median hourly wage of these workers is $6.15;
Only 4 percent of workers receive employer-provided insurance;
65 percent have no health insurance coverage;
In California, almost 70 percent of domestic workers are Latina;
93 percent of domestic workers are women.

Provisions of the Bill

The bill works to ensure the following six rights for domestic employees:

Overtime pay;
Meal and rest breaks;
Three paid sick days;
Workers’ compensation coverage;
The right to use kitchen facilities; and
The right to have some hours for sleep (eight hours recommended, with some possible exceptions).

The new law goes into effect on January 1, 2014, and requires that domestic workers and personal attendants be paid time-and-a-half for any hours worked in excess of nine hours in any single work day, or more than 45 hours in a week.

The previous failed bill included additional benefits including covering the cost of living increases, thirty days notice of termination and certain Cal OSHA protections. However all these have been omitted from the current version out of concern that they could become an unreasonable burden on low-income, elderly or disabled individuals who require full-time care.

The Impact to the “Employer”

It is estimated that approximately 62,000 personal attendants in California will be affected by the new law. While this may be a boon for the domestic worker industry, it may have an adverse impact on the very families and individuals who require these services the most. The increased labor costs imposed by AB 241 will undoubtedly force many families and employers to cut back on the caregiver services they currently utilize, or would force those who require around-the-clock care to employ multiple workers in an effort to avoid the overtime and rest-period requirements. In turn, this may negatively impact the domestic worker industry as employers hire fewer workers. So while this new California employment law may be viewed as a significant win for the industry, the long-term impact may not be felt for years to come.

Ari Rosenstein is the Director of Marketing at HR Outsourcing company CPE, a firm specializing in labor law compliance and PEO services. It currently services over 600 clients representing 75,000 employees nationwide.

The Toy Gun That Killed – Be Careful What’s In The Boxes You Donate

Caregivers, when you clear out your loved one’s belongings, be careful what you donate to a charitable organization.

The Toy Gun that Took My Nephew’s Life

Shortly before noon on a September morning, my twenty-year old nephew picked up a toy gun, while working at a major charitable organization, and began playing with it.

Chris was an FUN-loving kid who continually found ways to bring JOY to others. I can just imagine him as a caregiver-he would have made it FUN.

In his assistant manager’s office, he lifted what he thought was a cap gun and looked it over. Then in jest, he placed it to his head and pulled the trigger. What happened next surprised the manager who was sitting at her desk in the office. Chris collapsed. She nudged him. He didn’t move. Thinking he was still joking around, she nudged him again. Her employee (and buddy) remained unresponsive.

The toy gun my nephew held, according to a subsequent police investigation, was a real gun registered in 1920.

The Silver Dollars that were (almost) Given Away

While my nephew lay in a coma, I called a long-time caregiver friend. She lost her mother a few months earlier and was feeling guilty about taking a respite when she got the call that her husband with dementia died unexpectedly.

During our call, I told her about my nephew. She shared her own story. Her daughter was going through her late grandmother’s boxes that had been set aside to be donated when she discovered a quite a few silver dollars at the bottom of the box.

At a book club meeting the following week, a few of us stayed afterward to reminisce about our own childhood memories while pointing out pieces we recognized among the hostess’ collectibles and antiques. I shared with my fellow bibliophiles, what my caregiver friend had shared with me the weekend prior. One of the attendees mentioned that he thought each silver dollar was valued at over $100. I haven’t confirmed this. Still, imagine if her daughter had not looked through the box marked for donation.

If the two examples above don’t yet get the point across about looking through your belongings before donating, the following will.

$100,000 in U.S. Savings Bonds

Overwhelmed by my father’s and mother’s accumulated life belongings in their Wisconsin home of forty-five years, I was faced with clearing out everything after my mother died and we moved my father into our California home.

I recall my brother saying he would simply toss everything. I think the analogy he drew was to open a fire hose at one end of the house until everything was hosed out.

Fortunately, he was not the executor. As I went through every sheet of paper and each page of the piles of newspapers and magazines, I found my father’s notes, U.S. Savings bonds, and cash.

“I never expected to find $100,000 between two old books in the built-in bookshelf in the living room!”

One of the findings was in the living room between two old books in the built-in oak bookshelf. Between these books was an old sheet of paper folded in thirds held tight by three dried out rubber bands. When I scraped off the rubber bands, I saw cards. Turning them over, I read $1,000 in each corner. There were twenty eight–$28,000 in face value. With accumulated interest over twenty to thirty years, their value exceeded $100,000.

If I simply grabbed the old books off the shelf and tossed them in a box to give away…what a loss!

Imagine the unintended results of not looking through your belongings.

The toy gun that took Chris’ life was likely donated along with boxes of other goods that a family was trying to clear out after the death of their loved one. Perhaps the owner or a family member placed the gun at the bottom of the box to keep it safe and away from guests; only to have forgotten about it-maybe for years-before unknowingly donating it with other boxes. Undoubtedly, the family would be horrified to learn a life was lost after a kid played with their family’s gun.

Imagine if my caregiver friend’s daughter wasn’t curious enough to explore her grandmother’s things.

Imagine the $100,000 we would have lost if I tossed everything instead of spending hours going through each sheet of paper.

The police told me that they are called in from time-to-time to pick up a gun that has been donated to a charitable organization. Unfortunately, my fun-loving jokester nephew got to it first.

Please, PLEASE, PLEASE, look though boxes of belongings before donating them. You may save your family’s inheritance-your money and a LIFE!

Brenda Avadian, MA

Caregiver Spokesperson, Advocate, Editor, & Author

Brenda Avadian, MA, an award-winning speaker, serves as a national spokesperson for family and professional caregivers and is an internationally acclaimed author.
Brenda advocates making use of the caregiving continuum, including support groups, geriatric assessment, educational sessions, in-home care, adult day care, elder law services, clinical studies, and residential, assisted living, or nursing care.
More than a dozen years since she became a caregiver, she continues to bring hope and strength to caregivers around the world through knowledge, humor, and tears of joy.

Poetry As a Means to Negotiate Alzheimer’s and Other Dementia Related Diseasesv

Book Review:

Kakugawa, Frances H. Breaking the Silence: A Caregiver’s Voice. Nevada City, California: Willow Valley Press, 2010.

Despite striking achievements of science and technology, the problems of human life and destiny have not ended, nor have the solutions been seriously affected by scientific knowledge. Alzheimer’s disease, which currently affects about 10% of people over 65 years of age and 50% of those over 85 years of age, has no cure. As many as 5.3 million Americans are now living with the devastating disease. According to a study, unless new treatments are developed to decrease the likelihood of Alzheimer’s disease, the number of individuals with Alzheimer’s disease in the USA may rise to 14 million by the end of the year 2050.

Read against this background, Frances Kakugawa’s book, a mix of poetry, story and practical guide, is a recognition of the services rendered by professional and voluntary organizations that seek to minimize the pangs of Alzheimer’s sufferers as well as the sufferings of their near and dear ones. It pays tribute to caregivers who have been untiringly working for creation of a world without dementia, stroke, or cancer just as it seeks to help them endure the innumerable crises of caregiving.

Breaking the Silence: A Caregiver’s Voice merges Frances Kakugawa and her poet-colleagues’ varied experiences with a broad human perspective, engaging both mind and heart. The caregivers seek to share their compassionate spirit with a sense of gratitude to all those who help the victims of Alzheimer’s disease negotiate their mentally vacant existence. They are not only aware of the sufferers’ substantial loss of brain cells or progressive decline in their ability to think, remember, reason, and imagine, or their language problems and unpredictable behavior, confusion, or loss of sensory processing, but they also know well how the Alzheimer’s victims suffer a sort of living death, becoming a mere body stripped of its humanity. They have been witness to caregiving family members of increasingly confused and helpless sufferers themselves often becoming the disease’s exasperated and exhausted victims:

” Is she the mom who nurtured me?
Is it the dementia playing havoc with my mind?
Or is this really my mom? I don’t know.”

(‘More Glimpses of a Daughter and Mother’)


“I am torn between two needy factions.
Mom unaware, daughter pushing all boundaries
Both out of control.”

(‘The Sandwich’)

For Frances Kakugawa, caregiving is a mission even as the memory and image of her Alzheimer’s struck mother persists in her life as a “loud presence”. She gives voice to many caregivers who are ever worried about their loved ones not even able to carry out the simplest tasks and/or are completely dependent on others for their care. She expresses the very haunting fear of death:

“Is she breathing? Is she alive?
Is she finally gone, freeing me once again?
I continue my sentinel watch.”

(‘Unspoken Mornings’)

Frances not only articulates their fear but also learns to negotiate it by boldly facing it as part of life. In fact, she turns the metaphor of death as integral to life, be it in the form of “an ache of emptiness”, “unfulfilled dreams”, or “unlived moments”. In her deeper silences, she explores the very meaning of life:

“A second gust of wind
Lifts another fistful of ashes.
Be still and listen.”

(‘Song of the Wind’)

It is hearing the inner silence, which is something meditative, Biblical, and spiritual. It is awaking to the self, the Holy Spirit, the Divine himself. When the soul peaks into silence, human becomes divine. She sounds earnest and exceptional, seeking harmony with the highest ideals, irrespective of chaotic personal experiences. As Setsuko Yoshida says in ‘Can I?’:

“Poems by Frances this morning
Reveal the feelings of ‘divine’
In caregiving.”

In fact, as women poets, Frances Kakugawa and her caregiver colleagues (Elaine Okazaki, Linda McCall Nagata, Eugene Mitchell, and others) present a feminine and yet very humane perspective to the dementia-related illnesses. Jason Y. Kimura, Rod Masumoto, and Red Silver, though male poets, demonstrate the ‘Prakriti’ or ‘Yin’ aspects in rhythm with other contributing caregivers’ sensibility. They variously turn the Alzheimer’s into a metaphor for the loss of language, the loss of memory, and the loss of voice. Their poetry, often brief and personal, and rich and insightful, becomes a means to communicate the sufferers’ loss of feeling, love, dignity, honor, name, and relationship; in short, their isolation, or threat to living itself:

“All my life I have lived
With crayons in one hand,
Filling in spaces,
Spaces left by departed lovers, family, friends,
Leaving me crayons smashed against walls
Creating more grief than art.”

(‘Empty Spaces’)

They also use the metaphor for challenge to survive, to exist, without fears and anxieties:

“I am woman,

(‘Nissei Woman’)


“I am not merely heaven, man and earth
Rooted by cultural hands.
Sift those sands. Yes!
I am free!
I am tossed into the winds.
I shed my kimonos.
I spread my legs.
I am free.”

(‘Lesson #3′)


“When I am 88
I will still be woman,

(”When I am 88’)


“I am still here
Help me remain a human being
In this shell of a woman I have become.
In my world of silence, I am still here.
Oh, I am still here.”

(‘Emily Dickinson, I am Somebody’)

They convert the Alzheimer’s into a search for reprogramming the mind, the thought, and the attitude to overcome the irreversible suffering and helplessness. As Frances very feelingly asserts: it is the search for

“…the same umbilical cord
That once set me free
Now pulls and tugs me back
To where I had begun.
There must be hidden
Somewhere a gift very divine
In this journey back.”

(‘Mother Into Child, Child Into Mother’)

They are true to themselves as they voice their search for the whole. With an empathetic awareness, they disclose their innate goodness, trust, and compassion to make a “symphony of truth.” At the core of their musing lies a desire to integrate themselves, to live in time as well as in eternity:

“What other path is there
Except the divine
Where love, kindness, compassion,
Help me discover little pieces of myself
That make me smile
Bring me such quiet joy
At the end of each day.”

(‘Bless the Divine’)

They reveal the working of the primal impulses of the human soul which rises above the differences of race and of geographical position. In short, they give vent to the thought of all people in all lands.

As poet-caregivers they cope with their tensions, fears and anxieties through introspection, and accommodate their inner and outer conflicts, sufferings and celebrations through imaginative insight. They mirror the broad social or familial conditions as well as their own personal state with perceptions that are often different from those of the male poets (or male caregivers). Their quest is for real reality vis-à-vis degeneration, privation, insecurity, helplessness, anonymity, and death. They search for life and live with awareness of what lies beneath the skin of things around, the psycho-spiritual strains, the moral dilemmas, the betrayals, and the paradoxes:

“Why do you say I am sacrificing
Good years of my life
For caring for my mother,
When it shouldn’t be a secret
That I am really living
In a way I have never lived before?

No, this is not sacrifice.
It is just reality.
I am really living
In a way I have never lived before.
I am living love.”

(‘What I Know’)

Against the complexities of experiences, they demonstrate a sense of values such as love, faith, truth, tolerance, patience, peace, charity, harmony, humility, and healthy relationships. They tend to think intuitively and/or turn personal, inward, spiritward, or Godward, without indulging in intellectual abstraction. They write with poetic sensibility. Their metaphors and images reflect their inner landscape as much as their responses to what they observe or experience externally. They are often reticent and honest in their verbal expression, and their inner vibrations touch or elevate the readers’ senses. As they create discourse of themselves as caregivers, they also sound committed to their home, family, children, motherhood, and neighborhood, often voicing their own vision and understanding which cuts across cultures and regions.

They seek to transcend their body or femininity and respect the woman in themselves, even if affected by the Alzheimer’s environment. They turn inside out and reveal what is personal yet universal in their different roles as mother, wife, daughter, and feel the agony of the spirit while trying to know “Who I am?”, or “How I should live, who I should be”, or “What am I looking for? Why did I come?”

As they look back or reflect their present, they also voice the need for strong sense of togetherness vis-à-vis their inner conflicts, spiritual hunger, loneliness, or dependence. They sound challenging the Alzheimer’s itself:

“You could not rob us, though we forgot.
You could not erase us, though we could not write.
You could not silence, though we could not speak.
The stories, the laughter, the moments that passed
Into their keep, you could not steal
Into a night of silence.”

Child’s Food Allergies Linked to Anxiety and Other Mental Disorders

Taking care of a child with a food allergy can be a nerve-wracking experience and a cause of worry for parents. It holds true even more in case the family is from a low socioeconomic background. Apart from ensuring that the child does not take foods causing allergy, it is also necessary to keep a stock of epinephrine auto-injectors, which expire annually and are expensive. Epinephrine auto-injectors are life savers in case a child eats something that he or she may be allergic to and develops an anaphylactic reaction.

A recent study conducted by researchers from the Columbia University’s Mailman School of Public Health, Ferkauf Graduate School of Psychology and Albert Einstein College of Medicine has tried to unveil the association between food allergy and childhood anxiety. 80 children aged four to 12 years with low socioeconomic status were selected for the study. The sample consisted of children both with and without a food allergy. The impact of the allergy on their caregivers was studied as well. It was observed that 57 percent children with a food allergy had anxiety issues as opposed to 48 percent who did not report any such condition.

According to lead author Renee Goodwin, Ph.D., of the department of epidemiology at Mailman School of Public Health, “These demands could result in higher levels of anxiety for those with fewer financial resources and further heighten anxiety symptoms in children and their caregivers.”

One of the reasons why children with a food allergy might be more prone to developing an anxiety disorder could be that they feel isolated and bullied both at school and at home where their siblings might be eating all that they are prohibited. The stress of avoidance of favorite foods and having limited choices exacerbates the anxiety. In such situations, it is important for the adults, whether parents, teachers or caregivers, to take measures that could alleviate the child’s anxiety.

Developing coping behaviors in response to allergy-induced anxiety

One of the best ways of addressing anxiety arising due to food allergies is ensuring that the child knows about the dangers. Brushing things under the carpet can only exacerbate the condition and make the child more fearful and nervous.

Given below are some tips to help parents tackle such situations:

Normalizing the home environment: While a child’s allergy could be a cause of worry, it is important that right from the time the diagnosis, things are normalized at home. Stress at home will make the child more worried. Siblings should be informed about the condition and encouraged not to act as bullies.
Being watchful about their own anxiety spilling over: Parents of children with allergies are more anxiety prone. They have a constant urge to be by their child’s side. As a result, their anxiety spills over and the child becomes more nervous about the situation. The child must be encouraged to face the situation bravely and given space to grow and learn.
Diffusing a tense situation: Children with allergy to specific food items know they have to practice restraint. They might end up in situations where they have to refuse food offered by friends and peers, which might be offensive to them. In order to diffuse such a situation, it is necessary that the child learns appropriate responses. A simple refusal, such as “excuse me, but I cannot have cupcakes because I am allergic to eggs or wheat,” helps.
Training the child to read labels and handling auto-injectors: Apart from training the child about the know-how of auto-injectors, it is essential to teach the child how to read the labels of food items as well and identify ingredients that could trigger an allergic reaction. It is also essential to train caregivers in emergency help services.

If the child’s anxiety increases by the day, it is best to seek the help of a therapist.

Road to recovery

Sovereign Health is a leading provider of behavioral health treatment services for both adults and adolescents.

Caregiver Versus Personal Attendant – Wages and Benefits

Are you a caregiver or a personal attendant who works in a private household or home? As a household worker either as a caregiver or personal attendant, are you entitled to minimum wage? Over-time pay? Other benefits?

If hired directly by an individual or family, your benefits are different from one who is hired by a private firm or agency and governed by general employment laws: applicable federal and state statutes.

A live-in employee as opposed to a live-out employee is subject to special work rules discussed below.

A caregiver or “care custodian” is defined by Section 15610.17 of the California Welfare and Institutions Code as:

“… an administrator or an employee of…public or private facilities or agencies, or persons providing care or services for elders or dependent adults, including members of the support staff and maintenance staff.”

A “personal attendant” is not entitled to overtime compensation, unless: (1.) he or she is a live-in employee; or (2.) he or she does general household work (cleaning, cooking, feeding, dressing, or supervising) that exceeds 20% of the total work time; or (3.) he or she does nurse-like duties (checking pulse, taking temperature, giving medication) more than 20% of the total work time.

In these three instances, the household worker is no longer considered a “personal attendant” and is entitled to overtime pay. Otherwise, light house keeping and cooking chores qualify as work exempt from overtime compensation.

Personal Attendant As Defined In CA IWC Wage Order 15:

Section 2(J) of the California Industrial Welfare Commission (IWC) Wage Order No. 15-2001 defines “personal attendant” as follows:

“‘Personal attendant’ includes baby sitters and means any person employed by a private householder or by any third party employer recognized in the health care industry to work in a private household, to supervise, feed or dress a child or person who by reason of advanced age, physical disability, or mental deficiency needs supervision. The status of ‘personal attendant’ shall apply when no significant amount of work other than the foregoing is required.”

Indeed, the California Division of Labor Standards Enforcement (DLSE) has historically adopted the standard used in the federal regulations, 29 C.F.R. 552.6 on “companionship services,” to wit:

“…(T)he term ‘companionship services’ shall mean those services which provide fellowship, care, and protection for a person who, because of advanced age or physical or mental infirmity, cannot care for his or her own needs. Such services may include household work related to the care of the aged or infirm person such as meal preparation, bed making, washing of clothes, and other similar services. They may also include the performance of general household work: Provided, however, that such work is incidental, i.e., does not exceed 20 percent of the total weekly hours worked.”

Federal regulations, 29 C.F.R 552.6, supra, further clarifies that:

“The term ‘companionship services’ does not include services related to the care and protection of the aged or infirm that require and are performed by trained personnel, such as registered or practical nurse.”

Thus, the acceptable duties of a “personal attendant” involve activities of daily living such as getting in or out of bed, showering, bathing, using a toilet. A “personal attendant’s” duties of “supervising” would include assistance in obtaining medical care, preparing meals, shopping for personal items or groceries, using a telephone, even managing money.

As long as any general housekeeping duties performed do not exceed 20% of the weekly working time spent by a “personal attendant,” he or she is exempted from the protections of California Wage Order No. 15-2001 such as overtime compensation, etc., except for minimum wage. But prior to 2001, a classification as “personal attendant” also excluded minimum wage in California.

This overtime compensation exemption also applies to “personal attendants” as well as other household workers such as caregivers, spending 20% or less of their working time doing general household work, who are employed by an agency and sent to private households to work.

Benefits Of Household Workers:

A. Minimum Wage:

The state minimum wage covers all employees, including household workers (live-in employees, caregivers, and “personal attendants”) but excluding legitimate independent contractors. The current California minimum wage is $8.00 per hour since January 1, 2008, a 6.7% increase over the previous $7.50 minimum wage.

There are several factors that determine whether a person is an independent contractor or not. But the primary factor is control by the employer of the means, manner and outcome of the job. An independent contractor runs his or her own household services business, has his or her tools and materials, and controls the manner and outcome of the job.

Independent contractors are not covered by minimum wage and overtime compensation statutes.

B. Overtime Pay:

Household workers who are not live-in employees, as well as “personal attendants” who do general household work that exceeds 20% of their weekly working time, are entitled to overtime compensation, consisting of one and one half times their regular rate of pay for working more than eight (8) hours in a day, or more than (40) hours in a week.

Live-in employees must be paid one and one half times the regular rate for all hours worked over twelve (12) hours (instead of over eight (8) hours) in one work day for five (5) workdays. On the sixth and seventh day, live-in employees must be paid double the regular rate for all hours worked over (9) hours per day. See California IWC Wage Order No. 15-2001 3(A)-(B) (8 Cal Code Regs. 11150(3)(A)-(B)).

Under federal law, 29 U.S.C. 213(a)(15), “any employee employed on a casual basis in domestic service employment to provide babysitting services or any employee employed in domestic service employment to provide companionship services for individuals who (because of age or infirmity) are unable to care for themselves” is granted exemptions from minimum wage and overtime pay.

C. Other Benefits Of Household Workers:

1. Hours And Days Of Work:

A live-in employee is entitled to at least twelve (12) consecutive hours free of duty during each workday of twenty-four (24) hours, and the total span of hours for a day of work should not exceed twelve (12) hours, except that: (a) the employee must have at least three (3) hours free of duty during the 12 hours span of work; and (b) the employee required or permitted to work during scheduled off-duty hours or during the 12 consecutive off-duty hours must be paid one and one-half times the regular rate of pay for all such hours worked. See California IWC Wage Order No. 15-2001 3(A).

Moreover, no live-in employee shall be required to work more than five (5) days in any one workweek without a day off of not less than 24 consecutive hours except in an emergency. See California IWC Wage Order No. 15-2001 3(B).

2. Rest And Meal Periods:

Household workers are entitled to a ten-minute paid rest break for every four (4) hours of work under California IWC Wage Order No. 15-2001 12(A), and a thirty-minute meal period of every five (5) hours worked, just like others kinds of employees, under California IWC Wage Order No. 15-2001 11(A).

Otherwise, the employer shall pay the employee one (1) hour of pay at regular rate for each workday that the rest period, or the meal period is not provided. See California IWC Wage Order No. 15-2001 12(B), 11(D). But “personal attendants” are not granted rest and meal periods.

3. Meal And Housing Deductions From Wages:

The employer may subtract meal and housing credits from the employee’s paycheck if: (a) the employee actually uses the meals and is provided with housing; (b) meals and housing are used as salary to comply with the minimum wage; and (c) the employee executes a voluntary, written agreement, crediting meals and housing towards minimum wage.