In 1985, adults over 65 made up just 11 percent of the U.S. population. Today that number is 16 percent and rising rapidly. In 10 years, they’ll be almost one-quarter of the population, according to an estimate by the Population Reference Bureau. More than three-fourths of Americans over 65 face chronic health challenges, from immobility to diabetes.
Already, the number of available professional caregivers and elder care facilities to care for these aging adults has been stretched beyond capacity. Just as they do with child care, Americans face a growing elder care crisis of too few options and too few resources, and have been forced to rely on ad hoc, informal, and half-measure solutions.
None of these facts is breaking news, but breaking news is now headed straight for them. Older adults face the greatest level of risk posed by the growing COVID-19 outbreak. The preliminary data from the World Health Organization shows that for patients under age 50, coronavirus has less than a 1 percent fatality rate. The number climbs exponentially as the ages go up. More than one-fifth of deaths from coronavirus thus far have been adults over age 80. Sick, aging adults need even greater care and attention than healthy, aging adults. The CDC urges older adults to stay in their homes, where they will be even more reliant on having healthy caregivers who can take care of their day-to-day needs. More than ever, we need healthy frontline care workers who can bring aging adults groceries, feed them, bathe them, and assist them in following their treatment plans, from taking medications to doing physical therapy exercises, as well as comforting them and providing them the only social interaction they might get for weeks, a critical factor in their well-being. All this and more for an average $11 an hour.
For years we’ve been warned about the limitations of our tattered, largely informal, and resource-scarce care economy. Now, we’re asking these caregivers—largely low paid, if they’re paid at all—to protect the elderly from a virus that even experts don’t yet fully understand.
Director of the National Domestic Workers Alliance and Caring Across Generations Ai-Jen Poo took to the pages of the New York Times on Monday to make an impassioned plea on behalf of care workers:
The Centers for Disease Control and Prevention should direct more of their resources toward the front-line care professionals who work in the home and the community. These workers should be provided with masks and other safety equipment, rather than having to worry about where they will get them. They should be offered free testing and treatment for coronavirus. State and federal governments should distribute prevention materials in the many languages that domestic workers speak. The same workers who have been in the shadows could be key to stemming the spread of the virus.
But important as detailed instructions in care workers’ own languages and face masks are, they are also the bare minimum we need to do here.
The vast majority of these caregivers are not the professional class of nurses and doctors running our nation’s hospitals (though of course they’re critical and deserve infinitely more support than they currently have). Nurses, at least, tend to have access to the resources of the hospitals they work in, as well as greater union representation to demand what they need to do their jobs safely and well.
But the bulk of our frontline caregivers don’t have the backing of large medical institutions or associations to advocate for them in the midst of this pandemic. There are more than 3 million home health and personal care aides dispersed in private homes across America. While some aides work for agencies or institutions that require training and certification, many others learn to do what they do on the job, drawing only on what they know from past personal experience caring for an elderly or sick adult and what their elderly charge and their family ask them to do. According to the Bureau of Labor Statistics, the number of the aides is expected to grow by 36 percent in the next 10 years as demand for their services grows. An as yet, un-automatable, un-outsourceable job that represents as well as anything what the jobs of our future look like.
Add to that the growing number of elder caregivers who are members of the family. Twenty-nine percent of American adults currently provide care to an aging, ill, or disabled family member. According to Pew Research Center, 40.4 million Americans currently act as unpaid caregivers to adults over 65.
Fifty-five-year-old John Buttell moved home to Silver Spring, Maryland, a few years ago to share the job of full-time certified caregiver for his parents with his sister and a hired aide who assists them three days a week. Buttell’s 93-year-old father has Parkinson-like syndromes that seriously limit his mobility, and his 88-year-old mother suffers from memory loss and the mobility effects of three joint replacements and chronic arthritis.
So far for Buttell’s family, the COVID-19 threat has meant doing the same things they already did to look after his parents’ health—just more intensely and more frequently: hand-washing for everyone who comes in the house, weighing the risks of trips out of the house and the necessity of home visits from speech therapists or other providers. “It’s sort of like my parents are in a fortress, and my job is to maintain and strengthen those defenses as much as I can,” Buttell said. He says the coronavirus scare is also a reminder of why his family is grateful to be in a position to care for his parents in their own home, rather than in an assisted living center, where the virus has been the most deadly to this point. This is only the latest benefit of “aging in place”—that is, keeping aging adults in their own homes with family and community support as long as possible.
When family can’t manage care themselves, a growing workforce of home and personal aides may be called upon, usually through an agency earning the bulk of its revenue through public programs like Medicare and Medicaid. But $11 an hour is not the kind of investment it takes to develop a workforce that can protect the nation from a public health crisis. With low pay, demanding hours, and usually, no benefits, it’s easy to see why turnover for home health aides even outside a public health crisis is around 50 percent.
Pairing that turnover rate with the demographic indicators that suggest the demand for these aides will only continue to skyrocket was worrisome years ago. Now there’s an outbreak of an illness that appears to be most harmful to their ever-growing pool of clients. And what support are we offering these caregivers?
Many Americans are receiving guidance from their employers and industries on what to do and what not to do to contain the spread of the virus and lessen its impact on them and their clients or customers. Low-wage caregivers may be getting advice from agencies telling them to stay home if they’re sick and reminding them to practice good hygiene around the patients. That advice may not even be actionable for many workers, given the widespread lack of access to paid sick days among low-wage workers, and the difficulty of enforcing workers’ rights to them even in the states and locales that require businesses to offer them.
Largely, caregivers are doing what they did before the outbreak—going it virtually alone, on the basis of their best instincts, their baseline training, and their communications, patchy as they may be, with the doctors and other health care professionals they might interact with in the course of their jobs, taking their charges to appointments or calling them for advice.
For years we’ve opted not to make a massive public investment in elder care, or to systematize and formalize the ad hoc system it has created. Instead we’ve opted for a patchwork, mostly informal, and extremely private approach to elder care. We need these caregivers more today than we did yesterday. We’ll only need them more urgently tomorrow—and not just because of the coronavirus.
Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.