Where Will Our Home Care Aides Come From?

As we age, become frail, and need personal assistance, we will increasingly require paid aides to help us with routine daily activities, such as bathing, dressing, or cooking. Demand for those aides will increase by 50% over just the next decade, to 3 million. But where will they come from?

Aides are poorly paid, have little opportunity for advancement, and often get no benefits. Their on-the-job injury rates are among the highest in the U.S.—higher, for instance, than coal miners.

At least one-quarter are from other countries, a source of workers that may dry up under the Trump Administration’s immigration policies. And as labor markets tighten, many aides will find easier—and better paying—work in other fields.

The painful paradox

Yet, despite the low pay and paltry benefits that plague aides, many families cannot afford to hire them. To save money, they hire on the “gray market,” where they pay cash for care assistants who are unlicensed and unbonded, may be unskilled (not necessarily the same thing), or may face legal issues. Or family caregivers make do on their own, with no paid assistance.

It is a painful paradox. Aides are not paid enough. Yet they are too costly for many families.

And as demand for personal care services rises, it is going to get worse. Today, more than 12 million people need long-term supports and services in the U.S. That number will double in just a few decades.

Increasingly, less care will be delivered by family members, in part because the Baby Boomers had so few children and in part because society is so mobile. A significant number of adult children live in cities other than their parents, and daughters work or care for their own children.

Low pay, few benefits

That leaves paid aides.

But who will do the work? In 2016, according the Bureau of Labor Statistics, home health aides were paid an average of $10.87 an hour–a wage that has barely changed in a decade after accounting for inflation. Personal care assistants (who have less training) were paid about $10.50. If you hire an aide through an agency, you’ll pay about $22-an-hour. The firm will get half (out of which it must pay its share of Social Security taxes, benefits, and other overhead) and the aide will get half.

While consumers pay some of these costs out-of-pocket, two-thirds of home care revenue comes from either Medicare or Medicaid. As a result, the normal laws of  economics—where a limited supply and growing demand should result in higher compensation—does not apply.

For context, $10.50-an-hour is about what we pay short-order cooks and just two-thirds of what we pay vet techs. In other words, we pay people $5-an-hour more to care for our cats than to care for our mothers. Read more…

Where Will Our Home Care Aides Come From?