The Wahkiakum County Eagle - Established as The Skamokawa Eagle in 1891

The one and only adult family home (AFH) in the county has been owned and operated by Puget Island resident Beth Lorenzo for nearly 17 years.

An AFH can house as many as six clients, but Lorenzo prefers to keep her number at four to maintain her vision of “family home” in the AFH industry.

Reliant on state income and embattled by the rising costs in sustaining a facility, one thing remains the same--Lorenzo’s concerns about being able to continue doing what she does best.

“Every year I wonder if I’m (still) going to be around,” she said this week.

Lorenzo graduated from Wahkiakum High School in 1982. Her best friend invited her to Alaska to work for her dad, cleaning fish. She quickly tired of the work and when there was an opening in the kitchen, Lorenzo jumped on it. She started dishwashing but it wasn’t long before she was promoted to cook. Upon her return to Cathlamet in the fall, she struggled to find employment. There was more cooking, some bookwork and a quick turn on the dining room floor, waitressing. It didn’t take.

The local nursing home was hiring, as it often was. Friends and family encouraged her to apply but she was hesitant, certain that it was not a good fit. Responsible for a young child, she set her reservations aside and went in to apply for a position in laundry, housekeeping or the kitchen. At the interview, she was informed that the nursing home needed caregivers. Would she give it a try?

She did, and she hasn’t looked back.

"It’s 30 years ago I started doing this," said Lorenzo. “How many people taught me how to be the caregiver that I am today? I look back at the nursing profession, nurses…who were trained in the military and then went to work in hospitals or nursing homes. They were…very stern, very strict.The rooms looked like ship-shape. That’s the way I learned.

"The beds were made like nobody had been in there. The military corners, the wheelchairs were folded and put against the wall. The slippers or shoes were tucked under the foot of the bed so that nobody tripped on them. The nightstands were cleaned. When you put [the residents] into bed, it looked like they were tucked inside the covers. [The nurses] went through after we put people to bed and checked on those people and checked on our rooms and made sure there was no trash and no dirty clothes and things were clean and tidy. We got in the habit of just doing it.

"I look back at those nurses and how much respect and admiration I had for them.”

Those years spent on the floor, working with the infirm has done much to solidify most of her opinions about how things should be done in the Adult Family Home (AFH). For instance, she is allowed to have six beds, but is adamant about taking in only four clients at a time, not wanting to take on too much and see a diminishing level of care.

“I don’t have a glorified home like you see in the magazines; I don’t have one of those because I take state patients. Most of the time, 100 percent of my income is from state clients. The ratio of 70 percent private pay, 30 percent state pay is ideal, that’s what they say is what you have to have to make it.

"I have 100 percent state patients. In almost 17 years of doing this, I have had, at different times, four private pay clients. They didn’t get any different care. I don’t charge them any more than what I would get, if they were a state client. I feel like, you give them the same quality of care.

“It used to be when I started this, it was $50 for your license for the year. Now it’s per bed. Now I think it just went up to $300 per bed per year. What for? I get shocked by how much I have to pay.

"There used to be only one company in the whole state of Washington that covered AFH for liability insurance, which is something you have to have, people like to sue people for things. I believe when I first started it was $700 for the year for liability insurance. Then I was paying $2700 for a year.

"Now there are more companies because Obama put that new act in...So now my rates are…just over $1700 for the year. So that’s gotten better.

"It’s gotten that high, strictly because of abuse and neglect in homes. It used to be that we didn’t have to belong to the association. In order for me to provide care for a state client in my home, I have to be a member of the association who will fight in litigation for me at the state capitol. They aren’t speaking for me, because my beliefs and feelings are quite a bit different from a lot of providers. I take it very seriously. In an AFH, it’s a family. When I started this I had my kids at home. It gave me the opportunity to stay home, be here for my kids and earn a living at the same time.”

The fee to be a member of the Washington State Residential Care Council (WRSCC) is 300 dollars a year. But there are other licenses one needs, and certificates of training.

“You have to have specialty licenses. If you take any mental health clients, you have to have a mental health specialty license. It doesn’t mean you know what you’re doing, it just means you sat through the class and passed the test. Same with dementia. Just a few hours and you have a certificate saying you passed the test, so you paid attention. Same with developmental disabilities. I have all three. You just pay for the classes, they become a part of your license. “

She doesn’t think much of the system. It isn’t enough.

“Phooey. I don’t care if you can sit through a class and pass a test. People are getting AFH licenses because they can pass a test. It doesn’t mean they know what they’re doing, it doesn’t mean they understand what they’re doing. I really think that they need to require that someone work in a long term care facility a minimum of two years full time in order to qualify to get a license."

When you’re making 12 cents an hour, as Lorenzo says she is, it’s hard to justify hiring staff. But still, they are a necessity, and they add to her care and the care of the clients in her home.

“My caregivers are with me, usually for years. When I need to hire, I cringe,” she said.

Lorenzo pays for their training, something that is required before they spend a moment caring for anyone. It’s a chancy game, fees paid without guarantees that the employee won’t bolt or fail to meet Lorenzo’s standards.

She can’t pay the wages she’d like, so she makes up it for by feeding caregivers or allowing them to bring their children to work.

“The kids interact with the residents, so it’s like any other home,” she said.

She’s making it work for now. As for any advice she might give in caring for someone, “Every body changes, so what you do today might not work tomorrow.”

You have to go with the flow.

That’s what she’s doing.