https://www.nytimes.com/2025/12/02/health/seniors-aging-home-care.html?smid=nytcore-ios-share
summary:
The U.S. home care system is in crisis. The aging population is surging while facing severe labor shortages. Home care aides—who earn less than $17 per hour on average despite consumers paying $34 per hour—face unstable, low-paying jobs with an 80% annual turnover rate. Three promising innovations are emerging: worker-owned cooperatives that pay $2 more per hour and have half the turnover of traditional agencies; registries that connect workers directly with clients, allowing better matches and higher wages by cutting out agencies; and enhanced training programs that equip aides to spot early warning signs in patients with complex conditions like heart failure. These approaches show potential to improve both job quality and patient care, though they don’t solve the fundamental affordability problem—middle-class families often must spend down their assets to qualify for Medicaid or go without care entirely. The nation will need 740,000 additional home care workers over the next decade.
We better pray that they come up with some very useful robots to care for seniors because there won't be enough younger people to do it (not will they want to). We'll need robotics to do just about any manual labor task, like hand-picking crops, collecting garbage, etc.
I am certainly trying to brace myself and not waste oxygen griping about the wrong things. I am 60 and my mother is 80.
For the long term health of planet earth, I think the contracting birth rate is a good thing, but for the current and next several generations of old and infirm or disabled, plus daycares for kids, it’s going to be very tough going to get help. Including my generation for sure.
If elders hire privately and then pay aids in cash, they prevent the aids from contributing to their own SS and Medicare. A person has to have 40 quarters of recorded employment history in order to receive these benefits. That's 10 years.
I'm currently hiring agency aids for my 96-yr old Mom. She's paying $46 p/hr here in metro Minneapolis area. But this agency has been stellar in getting aids when I need them as well as subs. But: many I've been sent so far are women my age or older (66) and many have bad knees or other health issues. Younger aids are very rare and don't stay long (at least in my experience).
The US is below the replacement birthrate (which is 2.1 children p/woman and the US is 1.6), so we have a much smaller young population while the Boomers are an exceptionally large demographic that is living longer. This is a permanent labor shortage because it is mathematical. You can't force people to have more children. BTW, this is a global problem of all industrialized nations and none have been able to solve it to this date.
Maybe you've heard that South Korea's birthrate is .7 -- currently the lowest in the world. This means with each generation (25 years) their population is being cut in half. China, Germany and Italy are also in deep population crisis right now. The US has been buffered due to the immigration of young people -- and we should be welcoming legal immigrants with open arms. They will be coming from countries that also have low birth rates and can't afford to lose their young people. This includes all of Mexico (1.7), and Central and South America. Countries have closed off their adoptions, so this has stopped being a viable option for Americans, as well.
Africa's birthrate is still about 4 but that's actually decreased from 10. So, even Africa is following the global trend for decline.
We seniors need to understand what is going on so we don't waste oxygen griping about the wrong things for the wrong reasons. We need to brace ourselves for the care challenge right now and in the foreseeable future.
I strongly recommend watching the award-winning documentary, "Birthgap" (on YouTube) that was written by a professional demographer who worked for a company that provided demographic information to car companies and he started to see a trend and decided to look deeper into it. It is full of facts, statistics, personal interviews with community leaders from all over the world.
But the nation will need about 740,000 additional home care workers over the next decade, according to the Bureau of Labor Statistics, and recruiting them won’t be easy.
These remain unstable, low-paying jobs. Of the largely female work force, about a third of whom are immigrants, 40 percent live in low-income households and most receive some sort of public assistance.