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Secretary of Labor Thomas E. Perez
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Secretary of Labor Hilda L. Solis

Remarks for Secretary Hilda L. Solis
Rosalynn Carter Institute Family Caregivers Summit
Atlanta, Georgia
Thursday, October 6, 2011

Good morning. Buenos dias. Thank you, Dr. Easom, for that kind introduction and for your incredible work directing the Carter Institute. And thank you to the amazing staff at the Institute and to all your partners assembled here today. It's my honor to be with you.

For nearly a quarter-century, you've been the voice, the mind and the collective conscience of the care-giving community. And you're truly a community: working together, studying, collaborating and finding solutions to meet the great challenge of our long-term care system.

I believe your scholarship, your thought leadership, and your 12 evidence-based recommendations for confronting America's care-giving crisis should be required reading for every policy maker in the health care field. I look forward to talking in greater detail about two of your recommendations later in my remarks.

But, first, to my dear friend Rosalynn Carter... where do I begin? Rosalynn has been an inspiration to me for my entire adult life. She redefined what it means to be the First Lady of the United States, and she showed an entire generation of women that we can have it all. We can nurture a family, a career and even a country. We don't have to choose.

Rosalynn always knew how to connect with real people. These days in Washington, you hear a lot of politicians every day giving long speeches about our debt and deficits. You wouldn't believe all the talking points that fly around staffers' email boxes about how to talk to the American people about fiscal responsibility.

Rosalynn didn't have to talk. In her very first act as First Lady, she walked the walk. She showed up to her husband's inauguration in the same elegant dress she wore to his inauguration as governor of Georgia. Times were tough. Families were making sacrifices. And so Rosalynn Carter set an example. She looked beautiful on her first day on the job in Atlanta — and equally beautiful in her first moments as First Lady in Washington.

I was honored to work in the Carter administration. It's a big reason I'm standing before you today. I worked in the White House Office of Hispanic Affairs as a master's student at USC in 1980 and 1981.I applied for the position on a whim, and then the call came. I couldn't believe it. It was my big break, as we say in politics.

I became the editor-in-chief of the White House Hispanic newsletter. It was an internship, but it was a very important job. I was brought on to help shape how the President of the United States spoke to the country's growing Latino community. They gave me an all-access pass to the White House grounds. I could come and go as I pleased, even to the West Wing.

I could talk with top administration officials about Latino issues. It was an incredible learning experience. I befriended the security guards and even got to impress a friend or two with really cool White House tours. For a year, I saw the inner-workings of the Carter White House. The passion, talent and dedication I saw there led to my future career in public service.

The Carter White House was such an inclusive and diverse place. I remember meeting the First Lady and being so impressed that she spoke perfect, fluent Spanish. And then I was blown away on Cinco de Mayo in 1981, when I saw my role model wearing a sarape and dancing to a mariachi band!

I was fascinated and proud to see our First Lady go on state trips as an emissary and a translator for the President of the United States. That was unheard of. And it was inspirational.

Rosalynn Carter would go to cabinet meetings and speak her mind. For her to take up the issue of mental health all the way back in the 1970s — it was courageous in a way that's hard to appreciate, if you weren't there.

She saw the problems in our mental health care system before just about anyone. She was fighting the stigma and giving a voice to the voiceless way back then. She was helping to start a movement.

We learn by watching people, and I learned so much from watching Rosalynn Carter.

I could go on all day, but I just want to say to Rosalynn today: Thank you for being such an amazing role model... to me, back then, and to millions of young women today.

You always had a unique ability to look around the corner. You did it with mental health treatment, and you saw this caregiver crisis coming before it was on anyone else's radar.

Medical science is advancing faster. People are living longer. Treatments are getting better. While these advances are wonderful for our longevity, they place new strains on our families.

Our system is buckling. I know the caregiver crisis is very real. Six million seniors need daily assistance to live outside of a nursing home — and that number will double by the year 2030. According to the Bureau of Labor Statistics, we have less than a million home health care aides in our workforce.

They make about $21,000 a year, and these caregivers often have no health care themselves. That's wrong. It's just wrong. This shortage of qualified, well-paid professionals is one reason why four in five seniors who need daily care get it from loving members of their family.

I'm going to be honest with you. This speaking engagement comes at a very emotional time for me. I'm not just thinking about these issues right now, as a public official. I'm living them, as a daughter.

On Tuesday, my Dad went to the emergency room. He has been in and out of the hospital for sometime with a number of medical issues, and our family has been with him every step of the way to care for him.

These issues are so hard. They're hard on a cabinet secretary, and they're hard on an office secretary. We're all trying to do the right thing. That's what families do for each another.

It's staggering to think that the cost of the unpaid care provided by family members each year exceeds the annual costs of Medicare and the costs of nursing home care.

My family is lucky. There are a lot of us. I grew up as one of seven siblings in the San Gabriel Valley outside of Los Angeles. My father is of Mexican descent and my mother is from Nicaragua. My Mom worked at a toy factory and raised the seven of us. One of her first jobs after coming to this country was as a domestic home care worker. It was before I was born. But from what she has told me, the issues she faced back then are the same problems that millions of women face today.

The fact is, our caregivers do some of the hardest work out there, and it does matter. It matters to the elderly father who needs help opening a medicine bottle, taking a bath, changing his clothes or something simple like getting off the sofa. For our loved ones, caregivers are the first face they see in the morning and the last one they see before they go to sleep. Our caregivers are a source of hope, someone who will listen, and someone who cares.

Now, my Dad will proudly tell you he was a laborer, a farm worker and a railroad worker. My parents taught me the value of a hard day's work. They made many sacrifices so my siblings and I could fulfill our God-given potential. Dad worked for a time in a battery recycling plant. It was dangerous, toxic work. He was a Teamsters shop steward and worked to improve conditions at the factory. My Dad's a survivor of lead poisoning from the hard work he did at that plant. Many of his former co-workers weren't so lucky and have succumbed to cancer and other illnesses.

But Dad is tough. He's 87 years old. He has survived a stroke. And he just went through knee replacement surgery that had complications.

My mother is his primary caregiver, but she has her own health care challenges. She has thyroid problems and her memory isn't as good as it used to be. My siblings and I will do whatever it takes to keep them healthy and happy for as long as humanly possible.

One of my brothers works in construction and is retrofitting their house to make it handicap-accessible so Dad can get around in his wheelchair. My sister, Bea, is the most amazing caregiver and professional I know. She looks after Mom while taking care of her own two kids. My sister is also a successful engineer. Two of my sisters are. But none of us are medical professionals.

The issues we face as caregivers can be difficult. For instance, we know infection is the No. 1 post-surgical complication, but we've had to learn the proper protocols of maintaining a sterile environment.

We know wound care is so important. It's important to know the right way to change a bandage. But what if there's an allergic reaction? Or swelling? Should we use anti-bacterial soap? Does this kill the good germs as well as the bad ones?

When should we let our loved ones get rest, and when should we encourage them to stretch their legs?

I know the doctors in the audience today want us to get these answers right. They don't want to see recovering patients back in the emergency room. And the questions only get tougher as the ailments get tougher.

A dear friend of mine cared for her father in his final years with Alzheimer's disease. She was a senior adviser to the late Senator Kennedy, but she says being a responsible caregiver was the most difficult job of her life. If it's night time, but your father thinks it's day, do you correct him and start an argument? Or do you have a pleasant conversation about what a beautiful, sunny day it is outside?

How many caregivers with parents on Lipitor know that drinking grapefruit juice cancels out the medicine's cholesterol-lowering effects?

These are complicated questions for any lay person to answer, no matter how educated they are. There's so much to learn and do. It's a privilege to be able to give back to our parents. But family caregivers need more assistance, so can they lead full lives of their own. We're all human beings. We need time off. We need some relief.

For me, seeing my family come together to care for Dad has reaffirmed one of my strongest beliefs as the United States Secretary of Labor. All work has dignity. Even the stuff you don't get paid for... especially the stuff you don't get paid for.

For better or worse, we tend to define ourselves by our occupations in this country. I believe there's great honor in saying, "I'm a caregiver."

At the Department of Labor, our major focus is on the so-called "wage-earner." But family caregivers — they don't earn a wage. Their paycheck is waiting for them in heaven. They don't get overtime; they get overworked. They don't get Social Security, or even a social life. We know it can be lonely. Not many people think about that — about just how hard and isolating the job can be. Caregivers work around the clock, often alone, for days or weeks at a time without a break. It's the only job I know where you can spend a whole day with another person but feel totally alone.

My message to the caregivers here today is: Your Labor Secretary believes you matter. Even though you aren't covered under most of the laws I enforce, I value you. And I know this country needs to do more for you. We all need to do more for each other, so we can help our loved ones in the twilight of their lives.

As Labor Secretary, I know that caregivers are sometimes forced to leave the workforce to take care of a family member full-time. That means that they aren't accruing Social Security benefits, they aren't saving for their retirements and they could lose their eligibility for health insurance through their employer. This has a far-reaching impact.

I've committed my department to fighting for good jobs for everyone, jobs that give workers access to affordable health insurance, jobs that allow workers to save for their retirement and maintain a decent standard of living once their working days are over.

So this is an issue of great concern to me and this administration. That's why we passed the Affordable Care Act, so no one goes broke just because they get sick. It's crucial that we defeat the misguided attempts to repeal this historic legislation.

Starting in 2014, through state-based exchanges, individuals and small businesses will be able to pool their purchasing power and get high-quality insurance at a lower cost. They'll be able to compare different options to choose the insurance product that's right for them. There will be subsidies available to make coverage affordable for lower-income caregivers. It's so important they are covered to deal with their own health care struggles.

Maintaining caregiver health is too often overlooked by the medical profession, but it's not overlooked by the Rosalynn Carter Institute. You've taken a rigorous scientific approach to document the serious strains that being a caregiver can place on sons, daughters, siblings and other family members. Whether it's higher rates of anxiety, depression, physical ailments or substance abuse, we've seen the heavy strains placed on our family caregivers.

I'm grateful that Rosalynn Carter has continued her life's work and come to the Department of Labor to talk with me about mental health parity issues. My department, along with HHS and Treasury, has been working hard to implement the Mental Health Parity and Addiction Equity Act. We have a responsibility to make sure mental health treatment is as widely available and affordable as all other forms of care.

And today, I want to make you a promise: As we issue our final guidelines implementing the mental health parity regulations, I will honor that responsibility.

I'm also taking a hard look at the "companionship" exemption that has prevented some home health care aids from earning minimum wage and overtime pay under the Fair Labor Standards Act. We know the duties these professionals perform have grown more demanding over time, requiring greater autonomy, responsibility and skill. And many are being employed not just by families but also by staffing agencies in the business of providing these services. Domestic care workers are now providing these services in both home and community-based settings. Often, they're serving people with physical and developmental challenges, as well as people with chronic and terminal conditions. It's demanding work. So we'll have more to say about this rule once it goes through the regulatory process

I also want you to know about a change my department made that affects family caregivers themselves. Last year, my Wage and Hour Division clarified that the Family Medical Leave Act applies to caregivers who were raised by people other than their parents. We call it our in loco parentis rule. So if an aunt or a grandparent raised you, for example, you get 12 weeks of legally protected leave from your job to take care of them. My department is fully committed to enforce this law to give more family caregivers the support they need.

So let me finish by talking about an exciting pilot program in my department to train up an emerging class of professional that can be an asset and an advocate for our caregivers. They're called community health care advocates, or promotoras, in Spanish.

I know two of your 12 recommendations speak to the need to provide professional support to caregivers. Recommendation No. 4 makes clear that this support needs to be culturally competent and conducted by someone with specialized skills and knowledge of local support systems available for caregivers. And Recommendation No. 6 highlights our need for community partnerships, training and education.

When our Dad was having trouble with his knee, the physician said the pain was the product of his age. There were language barriers, sure. But there were generational issues that are too common in geriatric care. My Dad is a product of the Great Depression era. He can fight through pain. He doesn't want medicine. He doesn't like the way it makes him feels. He's a strong male. But as it turns out, his doctors didn't really hear what he was his saying. And we later learned his knee replacement was actually failing.

At one point, they told him to consider an amputation. The physician actually thought that would be preferable to ongoing treatment. It was a cost-savings approach instead of a humanitarian approach. We pushed back as a family. But I thought about what would happen to other families who didn't have an advocate.

At the Labor Department, we're concerned with building bridges and training more professionals who can help family caregivers, because most of us want to keep our loved ones at home for as long as possible. Seniors who need daily assistance — and their family caregivers — need an ombudsman.

We have a grantee in California that is creating a curriculum to train a new generation of community health advocates. We believe the Affordable Care Act's focus on preventive care will create new economic incentives for hospitals, clinics and employers to create more of these positions.

The promotoras training program is being developed by a grantee in Tulare County, 45 minutes south of Fresno. It's the top-dairy producing county in the United States. Seventy percent of the local population is Latino. We brought together diverse stakeholders representing educators and employers. The Fresno State Department of Public Health and the local community college — the College of the Sequoias — are at the table. So are local family health care networks, the community regional hospital, and CBOs that serve migrant farm workers.

In this particular area the most common issues are asthma, substance abuse, women's health, prenatal care, nutrition and mental health. The community health advocates will help families access and apply for Medicare and Medicaid. They'll make sure families can provide transportation to appointments and the pharmacy. If not, they will tell them how to apply for a free bus pass. They will give guidance on good nutrition and preventing diabetes. But they'll do it in a culturally competent way. For instance, you can make a tortilla with apple sauce instead of lard. And it tastes really good! They'll offer counseling on local assisted living facilities and respite care, when the time is right.

They are filling the first class now. It will begin in November and last 18 weeks — for a total of 118 hours of classroom time. We're excited to read the final report from Fresno State on this pilot. We hope to replicate it for use across the country.

So with that, I'll wrap up. I want to use the rest of my time to listen. I'd like to hear your comments and your stories. I know we're not your agency of jurisdiction. I'm not the Health and Human Services Secretary, but I do sit with her in the cabinet room. So I want to hear your ideas and insights, so I can take them back to Washington and make sure your voice is heard.

We need to create a caring system to complement our curing system. Working together, I know we can improve the quality of life for our elders and their caregivers who give so much. Thank you and God bless.