Why is There a Caregiver Shortage?

While it has become noticeably more difficult to find qualified caregivers during the COVID-19 pandemic, this current shortage pales in comparison to the looming caregiver crisis facing America over the next decade.

Any crisis usually has multiple and complex causes and explanations, but in this case, the number one reason behind the increasing lack of good caregivers to meet the needs of the elderly is the rapid aging of the U.S. baby boomer population. Approximately 10,000 baby boomers turn 65 every day. Our senior population is expected to double in the next 20 years and swell to 88 million by 2050. Within the aging population, about 70% of individuals have severe needs for long-term care and support, often for multiple chronic health conditions ranging from diabetes to dementia.

Additionally, an overwhelming number of seniors are opting to receive care in their home setting rather than in an institution. According to the AARP, almost 80% of adults ages 50 and older prefer to stay in their homes as they age. This dovetails with efforts by the nation’s strained healthcare system to keep sick seniors out of hospitals, assisted-living facilities, and nursing homes and instead have them cared for in their homes.

The combination of these demographic realities and care delivery preferences has led to the current spike in demand for caregivers. At the same time, however, the home-based care industry is experiencing a workforce shortage. A recent report by the Global Coalition on Aging (GCOA) and Home Instead Senior Care examined the current state of the caregiving workforce, predicting that a national shortage of 151,000 caregivers will exist by 2030 and a 355,000-caregiver shortfall by 2040.

Part of the problem is that there are few incentives to attract and retain home-care workers. Low wages and benefits, hard-working conditions, heavy workloads, and a job that has been stigmatized by society makes worker recruitment and retention very difficult. Recently compiled industry data indicates that median national industry pay hovers around $11 an hour. 60% caregivers work full-time, while turnover rates are around 50%. About 46% of the workforce are ages 45 to 64, and 87% are female. Sixty percent are people of color, and 29% are immigrants.

Home care providers also struggle to recruit and retain workers who don’t want the stress of caring for those with physical disabilities and/or mental health issues, such as dementia and depression. Workers in the lower-income bracket can, in most cases, get paid more to do other jobs that are less challenging and more appealing. These other jobs usually don’t require a background check, specialized training, or driving to people’s homes in bad weather. As a result, there are many seniors going without the care they need, or being placed on long waiting lists, or experiencing declining health conditions due to the caregiver shortage.

Due to the lack of qualified home care aides, many family members have had to take on the burden of caregiving, often while juggling full-time jobs and caring for their own children. This often drains family budgets and leads to excessive stress in the lives of family members. Some states have begun proposing state income tax credits for families that need help with home caregiving, but the reform has to go deeper.

Rebuilding the caregiver workforce will require applying a number of strategies that address the variety of challenges these healthcare workers face. To begin with, wages need to be raised above the minimum wage. An at-home caregiver should make more than a worker at McDonald’s. (Note: Currently Cahoon Care pays well over the national median, at $18-20 an hour. This is 7% higher than local competitors.)

Benefits should also be addressed. Even part-time caregivers should be entitled to some kind of benefits package. At Cahoon Care, we offer 401(k)s and paid sick time, unlike many other home care agencies. Both wages and benefits should increase as a worker’s years in the industry increase. Employees who have been with a caregiving agency for a while should have increased flexibility to set their own schedules (as is the case at Cahoon Care), and should be offered paid training.

Clients must realize – and accept – that in order to attract caregivers, home care agencies across the board are currently having to raise rates. The alternative is that clients will not have access to any caregivers, and will have to care for their loved one on their own as a result. Most caregivers are getting numerous recruiting calls each week from other agencies, and if they are unhappy with their current agency or pay rate, they can usually get a new job within a few days. All of these factors add to the ongoing challenges of making sure care is available for clients who need it.

Other reform efforts include recommendations to change what are known as scope-of-practice laws, which would allow personal-care aides to receive additional training that would permit them to take on certain medical duties (such as managing diabetes, Alzheimer’s care, and physical therapy) that are currently performed by nurses and other skilled practitioners. Right now, personal-care aides (also referred to as certified nurse assistants, personal-care assistants, or home health aides) typically cook, shop, clean, bathe, dress, and generally offer companionship for their clients, while nurses and other skilled practitioners manage in-home medical needs, such as administering medications and wound care. This fundamental change in scope of practice would raise the stature of the caregiver profession, increase compensation, and address shortage issues by attracting new hires.

While older people and their families typically recognize the value professional caregivers provide, caregiving is still all too often considered low-status work. The industry must begin to receive the respect and acknowledgement it deserves, or the current supply and demand issue will quickly turn into a national crisis.