The Crisis in Our Midst: Ensuring Quality Home Care in an Aging America

November is National Family Caregivers Month, a time to offer gratitude to those who step in to care for their loved ones when they need it most. It is work that requires a great deal of self-sacrifice, and it often goes unnoticed. In November we take time to recognize family caregivers for the role they play in protecting the independence and dignity of so many Americans.

But this month is also a time to honor those who have chosen to make caregiving for both family and non-family members their full-time profession -- this country's two million home care providers. These workers are on the front lines, helping seniors and people with disabilities live safely and independently at home and in their communities.

They perform a wide array of tasks to care for their clients, ranging from household upkeep to paramedical care. For older Americans, home care means staying out of institutions and aging at home where they are most comfortable.

But with an annual turnover rate of 50 percent nationwide, the at-home care industry is plagued with home care provider shortages that are on the verge of reaching crisis-level proportions. As it stands, there is only one active home care worker for every nine home care recipients, and that troubling ratio is expected to worsen if we don't take immediate action.

By 2030, 72 million Americans will be eligible for retirement, and will make up about one in five people in the country. It is estimated that 70 percent of this aging population will need some form of long-term care during their lifetime. And as our nation's baby boomers age, we're going to need an additional 2.5 million home care providers within the next 15 years.

A study by the Paraprofessional Healthcare Institute (PHI) indicated that the staggeringly low wages home care workers make are a huge contributor to the high rate of turnover. On average, home care providers earn about $9.61 per hour, and when you factor in fluctuating hours as a result of budget cuts and those who work only part-time, their median annual salary is only $13,000. In fact, when adjusted for inflation, home care provider wages actually decreased by five percent in the ten-year period from 2003 to 2013.

To put it frankly, many people simply cannot afford to care for themselves or their own families on a home care worker's wages. And this means the United States is woefully unprepared to meet the challenges facing our nation now and in the coming decades as more and more Americans transition into retirement -- we simply do not have enough workers to care for our seniors.

In addition to low wages, roughly half of home care providers rely on public assistance to get by. Employment benefits are rare -- here in California the home care workers who provide care through the state-run In-Home Supportive Services program (IHSS) do not get paid sick leave, vacation days, or retirement benefits--so home care workers who make anything over the maximum income thresholds for programs like Medicaid or nutritional assistance look at other career options when they struggle to make ends meet.

And there are very little opportunities for training and upward mobility in this profession. Many home care agencies refuse to invest in their employees, making it difficult for providers to improve their quality of service and workforce marketability.

But we can still prevent this looming crisis and its disastrous consequences. If we pull together as a country, we can fix long-term care for millions of older Americans and children and adults with disabilities.

The U.S. Department of Labor set an example when they recognized the legitimacy of the home care profession by finally extending minimum wage and overtime protections to workers. We can build upon this, and invest in long-term care for seniors by investing in long-term caregivers. We must fight for a living wage for home care providers, demand that workers receive paid sick leave, and advocate for training and growth opportunities. If we do these things, we can begin to build a robust home care workforce that is equipped to meet the needs of our aging loved ones.

So let's use this month to thank caregivers for their service in a tangible way. Let's work on improving the working conditions that lead to high turnover and give the home care profession the respect and dignity it deserves. Very few crises offer such a window of time to prevent calamity. The time to act is now.