Making home care jobs quality jobs is not only the right thing to do for workers; it is imperative if we are to meet the demands of an aging America.
Meeting the Demands of an Aging America
Nearly 90 percent of older adults want to stay in their home as they age.1 In addition to being the consumer preference, remaining at home is most often less costly than alternatives such as institutional care. But with 10,000 Americans turning 65 every day,2 there is only one paid workforce that will allow for aging in place to become a reality: home care workers. We must ensure that home care workers, who provide an estimated 70 to 80 percent of paid, hands-on care,3 are supported in their critical role.
Family caregivers and home care workers (often referred to as personal care attendants and home health aides) are the backbone of in-home long-term services and supports. Like home care workers, family caregivers provide critical assistance with activities such as bathing, dressing, and shopping, and almost half perform medical or nursing tasks.4 The economic value of family caregiver contributions was approximately $450 billion in 2009. The ratio of family caregivers to older adults, however, is on a sharp decline. In 2010, the ratio was more than seven potential caregivers to every one person in the high-risk years of 80-plus. In 15 years, that ratio will be four to one, and by 2050, it is expected to be only three to one.5 To fill this tremendous gap, we must significantly strengthen the home care workforce.
Need to Improve Job Quality
Within seven years, we will need one million new home care workers—a growth rate nearly five times higher than the rate of overall job growth, and a seemingly impossible charge given the industry’s low pay and strenuous working conditions. 6 While the home care workforce faces fast-growing demand, multiple factors make these jobs some of the least desirable positions:
- Home care wages are poverty wages, with average annual earnings of just $18,598, and most often without benefits, paid time off, or paid sick time.7
- Wages are falling, just when demand should result in rising wages and improving conditions. In the past 10 years, when adjusted for inflation, home care worker wages have fallen nearly six percent, with average hourly wages of just $10.30 per hour. 8
- Schedules and hours are unpredictable, and nearly half of home care workers are not offered full-time or consistent work.9
- It is the most dangerous job in America. The on-the-job injury rate for home health aides is higher than that for coal miners.10
- Workers have been denied the most basic federal labor protections—federal minimum wage and overtime protections—afforded to almost every other worker in America, further drawing down their wages.11
Because of these conditions, a 50 to 60 percent turnover rate12 plagues the industry, causing unpredictability for older adults and their family caregivers and affecting continuity and quality of care.
Conclusion and Recommendations
We have made fantastic advancements that allow us to live longer. But ensuring that those are quality years requires a shift in our values and investments in the things that truly matter, such as remaining at home, receiving quality care, and providing decent wages and working conditions for the workers who make that possible. Meeting the needs and wishes of older adults and supporting their family caregivers demands meaningful and quantifiable investments in the home care workforce.
- AARP Public Policy Institute and National Conference of State Legislatures, In Brief, Aging in Place: A State Survey of Livability Policies and Practices. 2011 December. At: http://assets.aarp.org/rgcenter/ppi/liv-com/ib190.pdf
- Pew Research Center, Baby Boomers Retire. 2010 December. At: http://www.pewresearch.org/daily-number/baby-boomers-retire/
- PHI, Facts 3: America’s Direct-Care Workforce. 2013 November. At: http://phinational.org/sites/phinational.org/files/phi-facts-3.pdf
- AARP Public Policy Institute. Home Alone: Family Caregivers Providing Complex Chronic Care. 2012 October. At: http://www.aarp.org/home-family/caregiving/info-10-2012/home-alone-family-caregivers-providing-complex-chronic-care.html
- AARP Public Policy Institute, The Aging of the Baby Boom and the Growing Care Gap. 2013 August. At: http://www.aarp.org/home-family/caregiving/info-08-2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html
- PHI, Paying the Price: How Poverty Wages Undermine Home Care in America. 2015 February. At: http://phinational.org/research-reports/paying-price-how-poverty-wages-undermine-home-care-america
- NELP, Giving Caregivers a Raise: The Impact of a $15 Wage Floor in the Home Care Industry. 2015 February. At: https://www.nelp.org/wp-content/uploads/2015/03/Giving-Caregivers-A-Raise.pdf
- PHI, The Direct-Care Worker at a Glance (2011). 2013 November. At: http://phinational.org/sites/phinational.org/files/dcw-infographic.pdf
- Hudson, Robert B. Boomer Bust?: Economic and Political Issues of the Graying Society, p 243. Greenwood Publishing Group, Westport, CT.
- NELP, Implementing Home Care Reforms webpage at: https://www.nelp.org/campaign/implementing-home-care-reforms/
- PHI, SURVEY: Home Care Worker Turnover Topped 60 Percent in 2014. 2015 April. At: http://phinational.org/blogs/survey-home-care-worker-turnover-topped-60-percent-2014