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Dignifying Care

It's a blessing that people are living longer. But handling the elder boom with justice means changing how we treat care work.

An elderly woman at her home in Madison, North Carolina. Carol Highsmith / Library of Congress

America is about to experience an “elder boom,” a direct result of the baby boom of 1946 to 1964. We have more senior citizens in America today than we’ve had at any time in our history. Every eight seconds an American turns sixty-five; that’s more than 10,000 people per day, almost 4 million per year. A century ago, just about 3 percent of the population was sixty-five or older.

Today more than 13 percent of Americans are over sixty-five, and by 2030, the number will be 20 percent. The 5 million Americans older than eighty-five, our country’s fastest-growing demographic, will number 11.5 million by 2035. Because of advances in healthcare and technology, people are living longer than ever, often into their nineties or breaking one hundred.

Let’s remember: people getting older is not a crisis; it’s a blessing. We’re living longer; the question is how we should live. As a country, we have to figure out how to embrace this demographic shift with grace. Just as the baby boom brought with it incredible power and opportunity, so does the coming elder boom.

One thing we know is that the longer people live, the more likely they are to need assistance. Seventy percent of people aged sixty-five or older need some form of support. By 2050, the total number of individuals needing long-term care and personal assistance is projected to grow from 12 million to 27 million.

It is often assumed that women will absorb these tasks, as they have for much of our country’s history, but that is not going to happen in twenty-first-century America. Most households today are dual income, which means there is no one at home full-time; at the same time, more and more American households have both children and aging parents who need support and care every day.

The need for professional caregivers is skyrocketing. Aging at home necessitates home care workers. Yet the 3 million people currently in the home care workforce cannot meet even the current need, let alone the demand for care that will accompany the elder boom. We will need at least 1.8 million additional home care workers in the next decade. As a result, caregiving, specifically home care, is the fastest growing of all occupations in the nation. By 2018, demand for home care workers will increase by more than 90 percent.

Many of the existing eldercare workers are low-income African-American and immigrant women who are faced with innumerable challenges, among them low wages, long hours, and inadequate training. Of the one-quarter of today’s home care workers who were born outside the United States, about half are undocumented, which means that fear of deportation puts these workers under further stress. These conditions have led to high turnover in the industry, which hurts everyone: elders, their families, and the workers themselves.

Many of these issues also have profound implications for people of all ages with disabilities. With the birth of the disability rights movement in the 1960s and 1970s, independent living replaced institutionalization as the clear preference of people with disabilities.

Alongside assistive technologies, it is home care workers, predominantly known in the community of people with disabilities as “personal attendants,” who enable many people with disabilities to manage their personal care, maintain a home, have a job, go to school, and participate in other aspects of independent living. According to the US Census, in 2000, an estimated 13 million Americans with disabilities were living independently in their communities.

Many Americans currently struggle to afford the care they need. On average, a home health aide hired through an agency costs approximately $21 per hour, the cost of an assisted living facility averages $3,300 per month, and a semiprivate room in a nursing home costs $6,200 per month. Yet the average Social Security check amounts to just $1,230 per month, and Medicare provides little if any support for home-based care.

How can elders or people with disabilities remain at home and live independently without sufficient support or funding? Our country has not adequately accounted for the caregiving we need. Yet home care is the future.

By 2010, we at the National Domestic Workers Alliance, an organization I helped found in 2007 to support the nearly invisible workforce employed inside homes across America, began hearing more and more workers asking for training in eldercare. Although these workers had been hired as nannies and housekeepers, they were now being called upon to provide home care for their employers’ aging parents, too.

In response, in 2011, together with our sister organization Jobs with Justice, we launched Caring Across Generations, an initiative that addresses two of the major social issues of our time: widespread unemployment and the coming need for care for the nation’s expanding aging population.

At the same time that millions of people in the United States are struggling to survive long-term unemployment, there are far too few workers who are positioned and prepared to provide care for the growing number of elders and people with disabilities. The demographic shift creates a moment when we can set in place a system to affirm the dignity of people at every stage of life and in every walk of life, and create millions of good jobs in the process.

Caring Across Generations, led jointly by twenty organizations representing caregivers, care consumers, and their families, is a national movement to embrace our changing demographics, particularly the aging of America, and an opportunity to strengthen our intergenerational and caregiving relationships. We’re calling for an innovative approach to care, rooted in our homes and communities, that brings us all together and offers support to everyone involved.

As a young person, I saw women as key to everything working well, yet our systems were not working for women. So I joined my first women’s organization in high school and have not looked back since.

No question: my dedication to women was inspired by my mother and my mother’s mother — the brilliant, strong, beautiful women who cared for me. They were innovators and trailblazers, yet so much of their work seemed to go unnoticed and unappreciated. They sacrificed so much, even their own health at times, to work and to care for us, the way so many women and family caregivers do.

Today I witness the domestic workers in my organization caring for the families they work for and, after a long day, returning home to care for their own families, surviving with less support and fewer resources than my mother had.

Almost all our major laws and systems for care are based on standards and demographics from another era. However, today, from what I see all over the country and in many places across the globe, we’re finally moving from impossible, false choices to real choices.

People are already adapting. In their experiences and stories, we can see the future we need to create. We can see the way we need to adapt the system. With some course corrections in our culture and in our institutions, we can have the care infrastructure that will enable us to live to our full potential. We’ve adapted many systems before, changing our country for the next era, and while it’s never going to be easy to be the mom, partner, or daughter that you want to be, at least the very material and practical elements of that complexity can be relieved by a solid, reliable care infrastructure.

Care is something we do; it’s something we want; it’s something we can improve. But more than anything, it’s the solution to the personal and economic challenges we face in this country. It doesn’t just heal or comfort people individually; it really is going to save us all. The moral of this story is that a caring America is entirely within reach.