Friday, Feb. 18, was National Caregivers Day, so it seems a propitious time to discuss caregiving. About 5 to 6 million in the U.S. have dementia, and the numbers are growing. Many are cared for at home, but hundreds of thousands are in varied memory-care facilities that range from serving a few residents to well over a hundred.

As someone who has had two family members with dementia, I have spent significant time visiting more than a dozen memory-care facilities in New York, Washington and Silicon Valley. Over the past five years, I have interviewed/spoken with some physicians, three dozen personal caregivers and memory-unit staff, and the visitors of those living in facilities, as well as members of a support group dealing with their close relatives' memory problems. Locally, I have spent more than 400 hours and 120 meals at five separate facilities in Silicon Valley.

Based on my personal observations and conversations, reform is needed in our nation's caregiving facilities.

Before the pandemic and the monitoring for COVID-19, distressing medical problems sometimes occurred at the facilities I visited. At one particular local facility, rank-and-file caregivers with severe (and contagious) respiratory illnesses were often allowed to work with the memory-care unit's residents, many of whom were immune compromised.

There also were times when a few of the memory unit's residents occasionally hit one another, but the unit's caregivers typically didn't respond unless the hitting was prolonged and noisy. Very occasionally, because of understaffing, residents fell and went unnoticed. At least twice, I witnessed a resident lying on the floor in the corridor, or elsewhere, for some time.

At one memory-care unit, some residents who were very slow eaters were not given enough time to finish their meals. These residents required extra time — maybe 30 more minutes or so — to finish their meal. But the memory unit's inflexible meal schedule led the paid caregivers to have to remove these residents' half-finished food plates. The result: Some residents were left hungry and ultimately lost a lot of weight. Their weight loss, in turn, reportedly puzzled the facility's supervisors — and, thus, went unexplained to the troubled families of those unit residents.

There also is substantial turnover at some of these facilities. At one facility, there was about 40% turnover in the 12 months preceding the pandemic. In 2020, there was reportedly even a higher turnover in the facility's memory-care unit, which has approximately 15 staff members who rotate shifts. The facility greatly understated its turnover rate of paid caregivers in its memory-care unit, claiming only about 15% annual turnover. That means that families planning to place a loved one with dementia in that unit were remarkably misinformed. (There is no other ready source for correct information.)

The high turnover is not surprising. Demands on paid caregivers are substantial, their work is difficult and their wages low — generally about $16 to $18 an hour. In our high-income, very expensive area, this makes it very difficult to retain workers, especially where considerably higher-paying jobs are often available.

To note all these problems seems painfully appropriate, but such a list of defects must be placed, in fairness, alongside the considerable evidence that many of the memory-unit's working staff of caregivers are well-intentioned and compassionate in dealing with the unit's residents. These are important virtues and indicate great humanity by much of the staff.

That does not eliminate, however, the need for substantial improvements such as adequate communication, better training, more supervision and organized scrutiny by various outside sources.

I believe that many of my observations raise important issues about the needed role of the government in carefully regulating matters, inspecting conditions, making informed recommendations, and yes, committing to help with growing funding issues.

Perhaps President Biden's new loosely formulated initiative for expanded safety-net provisions, if it passes, will help. That might be a useful form of assistance in helping to address massive problems.

Caregiving activities and the needs in memory units constitute cultural, political and economic issues of great magnitude. In many ways, this is a national problem that reaches quietly, but powerfully, across generations.

Caregiving issues are far more than a personal matter. They are a significant national challenge. Unfortunately, the issues are little acknowledged, and generally receive limited attention.