Americans are confronting a care-giving calamity with the elderly at home, and the alarms are sounding loudly about it. But are experts and politicians grasping the severity of this crushing health care shortfall?
The New York Times, Vox, Washington Post, and Forbes all published detailed and solid news articles about the nation’s quiet nightmare with the workforce needed to deal with the booming population of aging baby boomers.
Just a reminder: This is a huge group that is graying rapidly, with 10,000 boomers each day turning 65 and this startling reality continuing for the next decade or so. Seniors long have said they prefer to age at home, that they dread and may not be able to afford nursing home care, and they are panicked about who will help them in their daily lives as they become debilitated, especially with dementia or Alzheimer’s — conditions predicted to explode in prevalence and cost as the nation’s elderly population increases.
But for now, the economy is doing well, the Trump Administration is cracking down on immigration, and the labor force is in high demand and low supply to care for older and physically and mentally debilitated Americans. This is 24/7, stressful, hard work. And as the New York Times reported:
“Home health care is the fastest growing major job category in the country, one of the most emotionally and personally demanding, and one of the worst paid. Elder boomers living longer and seeking to ‘age in place’ rather than in institutions have created a demographic explosion that even a 150% increase in home care workers in the last decade, to nearly 2.3 million, cannot keep pace with. Nationwide, hundreds of thousands of ailing people entitled to Medicaid-funded home care are on waiting lists.”
It’s easy to see why a booming occupation may not be desirable, as the news and information site Vox reported:
“According to the latest estimates from the Bureau of Labor Statistics, the U.S. economy is expected to create about 1.2 million new positions for home caregivers … by 2026 — a 41% increase from the 2.9 million personal care and home health aides working in 2016. Aging baby boomers and expanded Medicaid coverage have led to the surge in the need for workers to care for the sick and elderly in their own homes. But these positions, which require minimal training and no college degree, are among the lowest paid in the country. Beyond that, home care workers are an easily exploitable workforce. Because of the job’s roots in slave labor, these workers have long been excluded from U.S. labor laws. Live-in caregivers are not entitled to overtime pay or a minimum wage under federal law, or any other labor protections. Neither are caregivers who spend less than 20% of their job helping clients do basic tasks. None are protected from racial discrimination or sexual harassment. They have no right to a safe workplace, and in some cases, they have no collective bargaining rights. One of the fastest-growing jobs in the U.S. is a really lousy one. It’s no wonder the caregiving profession has one of the highest turnover rates in the country. In interviews, several home health aides described their work as emotionally and physically draining, with few rewarding moments.”
The New York Times, Vox, and the Washington Post describe the long hours expected of home care aides who care for seniors 24/7, often working for long stretches like 27 out of 30 days in a month. Many earn the minimum wage or less. They may get room and board. But that also means waking in the middle of the night and early in the morning to provide care. They not only clean the homes of their elderly charges and provide them transportation services and assistance. They also may be feeding them, brushing their teeth, dealing with their incontinence and lack of bowel control, and coping with their anger, depression, and sadness. Seniors with dementia may wander and become abusive.
In Maine, a popular place for retirees and a state that already had its own aging residents, the dearth of affordable home care help has forced younger people — yes, most of them working women — to abandon jobs, so they can take of sick, injured, and aged family and friends. As the Washington Post reported:
“Across Maine, families … are being hammered by two slow-moving demographic forces — the growth of the retirement population and a simultaneous decline in young workers — that have been exacerbated by a national worker shortage pushing up the cost of labor. The unemployment rate in Maine is 3.2%, below the national average of 3.7%. The disconnect between Maine’s aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that’s especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show … Last year, Maine crossed a crucial aging milestone: A fifth of its population is older than 65, which meets the definition of ‘super-aged,’ according to the World Bank. By 2026, Maine will be joined by more than 15 other states, according to Fitch Ratings, including Vermont and New Hampshire, Maine’s neighbors in the Northeast; Montana; Delaware; West Virginia; Wisconsin; and Pennsylvania. More than a dozen more will meet that criterion by 2030. Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the injury that can be inflicted on them when they are sick, injured, and old and subjected to nursing home neglect and abuse. Many more of us than expected may end up in nursing homes. They can be costly, with a private room running on average in excess of $100,000 annually. That’s a major financial problem for many baby boomers, who, on average have saved just $152,000 for their entire retirement.
Most of us, of course, would prefer to be at home as we grow older. So, we’re going to need help — and society needs to not just plan for this but to start acting on ways to support care givers, both those who get paid and family members who provide these necessary services. We need to think hard as to how we can improve the training, respect, and pay for those who care for the aged at home. The nation’s long-term care shortfalls cannot be avoided any longer, and we’ve got a lot of work to do.