This article first appeared in Quartz on December 12, 2018. Read the original there.
A lot of caregiving policy feels like it was written in the 1950s—because it was.
Our system of caregiving was built for a time when the economy functioned on women’s unpaid labor. In the 1960s, when Medicare was created, just over one third of women participated in the workforce. As most women were full-time homemakers who stayed home to cook, clean, and care for the children and grandparents, the social safety net didn’t need to provide support because women were picking up the slack.
The statistics have changed radically in the 21st century—but unfortunately for women, the stereotypes have not.
Both parents now work in 60% of American two-parent households with children under age 18, and women account for at least 40% of the workforce in many countries, yet caregiving is still usually expected to fall on family members, especially women. Many of these families are also part of the “sandwich generation,” which describes people who are taking care of a parent (or older family member) while taking care of their own children—and holding down a job. That’s double the labor with half the help.
In addition to policies that have not kept up with the times, there are an unprecedented number of people reaching retirement age. By 2030, there will be at least 300 million more people aged 65 years and older than there were in 2014. In the US alone,10,000 baby boomers turn 65 each day.
As a result, both those needing care and our care workforce are vulnerable. In the US, the median annual pay for home-care jobs hovers around $13,000 annually with few benefits, and more than half of all care workers rely on some form of public assistance. Turnover is therefore high, and care workers have to do multiple jobs to provide for themselves and their families. Add cuts in funding for social-welfare programs, the soaring costs of health care, and the fact that the majority of people aged 65 and older want to continue to live at home, and it’s clear that something has to give.
But instead of viewing the aging population as a series of problems to be solved, we can view these gaps in our care infrastructure as opportunities to be filled. Over the next decade, care jobs, such as personal-care aide and home-health aide positions, are projected to grow five times as fast as overall job growth. “Globally, health care and related jobs from aging could grow by 50 million to 85 million by 2030,” according to McKinsey.
This presents a remarkable and untapped opportunity. By refocusing our resources on turning these jobs into better jobs—both benefitting caregivers and those they care for—we will reshape our economy while lowering health-care costs.
A (baby) booming business
The future of aging brings a huge employment opportunity to offset other jobs lost due to economic shifts. While the physically demanding part of care work may become automated—like cooking, cleaning, lifting, and transportation—the emotional and intellectually skilled aspects of care work will remain automation proof.
Research shows that isolated adults die at significantly higher rates than well-connected ones, and a well-trained, empathic caregiver can make all the difference for an otherwise isolated older adult. It is worth noting that the emotional connection, which caregivers are called upon to provide, cannot be easily replicated by a robot nurse, making care jobs harder to automate.
This is a key reason for growth we will see in the care industry: These jobs will continue to grow even as AI and automation take over the repetitive aspects of many other skilled jobs. The fact that seniors increasingly want to stay in their homes as they age, living longer and independently, means they will rely even more on caregivers for providing much-needed skilled support. Rather than moving to expensive nursing facilities, much of elder care will be provided at home, customized to fit individual needs, at half the price or less.
In addition to the boom in home-care workers, it also means a boom in demand for a whole host of senior-friendly products and services. These will range from multigenerational apartments and affordable housing cooperatives to personal-care products for improving cognitive function, financial products that enhance savings, and transportation options that are designed to fit an older population’s needs, including self-driving cars (which, in the future, might be synced to your wheelchair).
However, we currently face a severe shortage of care workers. In the US alone, by 2030 the shortfall will be 151,000 paid direct-care workers and 3.8 million unpaid family caregivers. In order to incentivize a new wave of care workers, including men and millennials, to join the care industry and take advantage of the boom in care jobs, we need better compensation and more support for caregivers. We also need a cultural shift in how we think about care jobs.
Because a majority of care work happens behind closed doors, in our homes, it is invisible to us. This is a big part of the stigma associated with home-care jobs. There is also a deep historical association of women of marginalized social status performing care work worldwide. Here in the US, care work was once performed by black women, and then migrant women from poorer countries joined their ranks. We will need to break these cultural stereotypes that undervalue the work of women and women of color by strengthening and diversifying the care workforce.
As care workers become more financially stable, our economy will see the positive effects of a strong and engaged workforce. So how can we ensure that home-care workers are paid well enough to sustain themselves and their families?
In the US, home-care workers are often paid through Medicare and Medicaid, so their salaries are often capped as low as states can afford to pay them, (i.e. at the minimum wage). This obviously needs to change so that a higher percentage of the state payout is allocated towards care workers’ salaries.
While the care workforce is undervalued and underpaid in many countries, Sweden has gone directly to the source by investing nearly $135 million in increasing wages and training for workers since 2011. In Japan, where a public long-term care insurance program was mandated in 2000, the shortage of workers to provide care was still dire. As a result, the country has recently begun to relax its notoriously tough immigration policies to allow immigrant workers in to provide care.
Technology will also make their jobs easier. Lifting technologies can take much of the physical burden off workers, while new medical technologies, like robots and telemedicine, can help caregivers monitor their care recipient’s health in real-time. By training care workers to take advantage of the latest health-care technologies, they will become a real bridge between those they care for and health-care specialists, especially nurses. They will thereby ease the burden on nurses, as economist Paul Osterman points out.
Working family caregivers
For those who can’t afford to or choose not to hire professional care workers, technology and the evolution of workplaces can provide many opportunities for improving care and connection between family caregivers and their loved ones.
Most people are confronted with caregiving issues just as they reach the peak earning years in their careers, and many people pass up or are passed up for promotions in their work because of their caregiving responsibilities, or even quit altogether.
If the cost of care was affordable and accessible, companies could avoid the huge loss of talented workers to caregiving. However, with the median cost of full-time home care hovering around $50,000 per year, people have to choose between staying in the labor force and caring for their loved ones. But there are innovative ways in which employers and new technologies can help make home care affordable.
Private-sector companies need to acknowledge the caregiving needs and responsibilities of their employees. This means developing flexible schedules, benefits, and practices that accommodate employees’ caregiving needs. For example, Starbucks recently announced that it would offer heavily subsidized backup care to both full-time and part-time employees.
Technological innovations will also make a huge difference for working family caregivers. The same virtual technologies that home-care workers use to connect to doctors can be used by working family caregivers to connect to their loved ones and monitor how they are doing. For example, you will be able to video conference to your mother’s appointment in her physician’s office. As we strengthen the care workforce and continue to develop technologies to keep us connected, working family caregivers will be better able to stay in their jobs while still being there for their families, strengthening their own financial security.
Finally, we need public policies that more comprehensively address families’ caregiving needs. Universal Family Care is our policy vision for federal legislation that would create a family-care insurance fund that individuals could use to pay for child care, elder care, or paid time off from work to attend to caregiving needs. It would allow individuals and families to access caregiving supports throughout their lifetime, from the arrival of a child to long-term care for a family member or oneself.
The future of aging has opened up a unique opportunity to radically redesign our care infrastructure along with care jobs to better serve the needs of an older population. When we view the care workforce as unskilled labor, we limit their potential and the impact they can achieve. However, when we view them as skilled care providers, working in partnership with families, nurses and doctors, we begin to see their full potential.