Who Will Be There to Care?

If certain policies don’t change, you won’t like the answer.

Photo by Getty Images for Unsplash+

I am in pretty good health for a guy who just turned 74, and my ambition is to stay that way for the duration. The odds are not in my favor. Studies indicate that 7 out of 10 people who are 65 or older will need some form of long-term care.

The bigger question is whether anyone will be around to administer that care when 7 out of 10 of us will need it. Based on where things stand today, the outlook is distressing.

In a survey taken by US Aging in 2022, 74% of state and local agencies on aging reported that staffing shortages were a challenge, and 91% said shortages were a challenge for providers they contract with.

A 2022 report by PHI, which conducts health policy research and analysis , found that 4.8 million direct care workers provided care to 9.8 million people at home, 1.2 million in residential care facilities, and 1.2 million in nursing homes. That is not enough to meet current needs. In fact, there has been an acute shortage of healthcare workers for more than two decades.

That’s today. By the end of this decade, that older adult population swells from 56 million to 74 million. An analysis by the National Center for Health Workforce Analysis estimates demand for direct care workers by 2035 will increase by more than 40%. That amounts to 1 million new job openings – if workers can be found to fill them.

What makes these available jobs go begging is no secret. The work is physically hard, emotionally demanding, poorly paid, and undervalued. Turnover rates, consequently, are astronomical. A report before the COV ID-19 pandemic reported that more than half of home health and personal care aides left their jobs within the first year. Institutions are forced to plug staff shortages with contractual workers from agencies, at considerably higher cost – a hidden factor driving up the price of these services.

And COVID-19 didn’t help. Nursing and residential care facilities lost 400,000 employees during the pandemic. In addition, one-third of area agencies for aging reported they lost 50% or more of their volunteers since 2019.

Who Picks Up the Slack?

Bringing all these national statistics down to a personal level, it adds up to a huge impact on families with elderly members who need care. When paid care is not available or not affordable, the burden falls on unpaid family members. More than half of U.S. adults identify themselves as family caregivers. The majority must sacrifice their own financial security to provide care – they reduce their work hours, leave the workforce entirely, take on debt, or draw down their own retirement savings.

Policymakers have ideas for how to address the worker shortage. Better wages. Better benefits. More respect. But first let’s talk about the elephant in the room – immigration policy.

Immigrant-Dependent Care

Foreign-born workers account for more than 40% of home health aides, 28% of personal care workers, 21% of nursing assistants, and 18% of nursing home workers. In short, immigrants are the backbone of the healthcare system.

What would make sense, for burdened families and short-staffed institutions, is a policy that encourages more immigrants to come to the U.S. to ease the gap between healthcare workers and demand for services, a gap which will continue to widen with the aging of the U.S. population.

Needless to say, current immigration policy marches to a different drummer. It threatens legal and undocumented immigrants alike while trying to stop new immigrants from coming. It should come as no surprise that this policy will worsen the worker shortage, further increase the cost of home-based and institutional care, and force more adults to leave their jobs or reduce their hours to care for aging family members, with predictable impacts on economic productivity.

The administration’s immigration policy is not family-friendly, not healthcare friendly, and not economically sound. Without caregivers, the goal of aging in place will be virtually impossible to attain. Who will be there to care? If the current immigration policy continues, the answer will be no one.