Our country is getting older and each year, more of us need help with everyday tasks as we age. Supporting older adults is big business – in this business cycle alone, employment in services that assist older Americans has grown rapidly. But if dignity in old age is a national priority, the quality of these jobs does not reflect it. These jobs are much less stable and pay much lower wages than jobs in general and other health care jobs in particular. No wonder then that we are heading towards massive shortages in home health care and skilled nursing care. Making sure that paid care work offers people real careers with meaningful pay and benefits will have to be a key step towards dignified aging for all.
As the country is aging, the need for a wide range of services to support older Americans is growing. These include home health aides, who help with things ranging from cooking and personal care to medication reminders. Such services also include things like adult day care centers with physical and occupational therapies to keep older Americans mentally and physically ready for the future. Nursing home care is often also necessary when older Americans are no longer able or willing to stay in their own homes. And many older Americans already live in community based settings outside of nursing homes, where they can get help with daily activities and enjoy the company of others, overcoming the dangers of isolation in old age.
No wonder then that employment in these services has rapidly grown. From January 2008, when the current business cycle started, to May 2019, the month for which the most recent complete data are available, employment has grown from 3.0% to 3.9% of all jobs in the U.S. economy. Importantly, even in the midst of the past recession, when the labor market lost more than 700,000 jobs per month, employment in these services kept growing.
But despite the importance of these jobs, helping older Americans poses serious economic challenges for those who choose this work . For one, jobs are less stable than others. The typical month-to-month job fluctuation in paid care services for older people amounted to more than 10% of all positions, compared to less than 5% for all jobs in general and to less than 4% for jobs in hospitals, for instance (see figure below). Job instability is very high in all services for older people, except in nursing homes (see figure below). Jobs are growing in these services but at a very uneven rate, often because people leave to find more stable, less mentally and physically demanding, and less isolating jobs. Many care providers even leave their jobs for retail and fast food jobs, which should tell us something about the poor quality of jobs in providing care to older adults.
In a similar vein, people helping older Americans not only work fewer hours each week, often because they cannot find more work, but those hours are also more volatile and unpredictable. Weekly hours in services helping the elderly and disabled fluctuated by 3.3% each month from January 2008 to May 2019, compared to only 0.9% in hospitals and only 0.6% in all private sector jobs (see figure below). Hours in home health care are especially unpredictable, reflecting the competing influences on care providers such as unpredictable length of a care situation.
Low pay for workers in care services compounds the unpredictability of jobs and hours . The average hourly pay for typical workers in services for the elderly and disability such as day centers was just 61.6% of the average pay for all private-private sector workers. Even at the high end, people working in home health settings only earned 80% of the average for private sector workers (see figure below). Yet these workers have both tremendous responsibilities for their care recipients and incredibly mentally and physically stressful jobs. After all, they often take care of people with challenging and changing needs for long hours each day without having assistance from peers or family caregivers.
Care providers likely also have fewer employment-based benefits than other private sector workers. They often work in unstable job settings, which makes it both hard to qualify for benefits if they exist at all and difficult to make a financial plan to take advantage of such benefits. They also have low earnings, which means that they enjoy fewer tax incentives to save for their future, for instance, than is the case for higher-income earners.
There is no doubt that the availability of quality, well-compensated care is a critical and growing aspect of offering older Americans dignity towards the end of their lives. Yet, we have not built up the societal institutions to make sure that care work is properly valued. Part of this will mean more public and private long-term care insurance, so that the resources exist for better pay for care providers. Valuing care will require better pay, real career options, and more predictable hours to begin with. But it will also require additional benefits for the care workforce such as health insurance and retirement plans, so that their own future is secure.