As Americans enter old age, elders and their loved ones alike hope they will be able to remain as independent as possible. Nursing facilities are very expensive, and people prefer to grow older at home as long as they can. Currently, four out of five elders in need oflong-term care live at home in the community. Most ofthe personalized care they require comes from family members.
But such unpaid family care may be less available in the future, given smaller family sizes and increased childlessness, rising employment rates for women, and high rates of divorce. These trends translate into a growing need for paid home care workers. The Bureau of Labor Statistics projects this to be the fastest growing occupation overthe next decade.
Job growth is of course very welcome in a slowly expanding economy, but low wages and a lack of employee benefits make home care employment unsustainable for many workers. In 2010, home care aides earned a mean wage of $9.44 and 31% of them had no health insurance. Hours tend to be irregular and part-time, and the work can be both physically and emotionally demanding. Not surprisingly, home care agencies face turnover rates ranging from 45% to 65% each year. Such high turnover is costly to agencies and compromises the care of elderly clients. Often, the cost to replace workers falls on taxpayers who support public programs such as Medicaid, a primary funder of long-term care.
A Close Look at Home Care Workers in Maine
To probe job experiences and explain turnover, my colleagues and I tracked 261 Maine home care aides for eighteen months apiece between 2008 and 2011 in the Home Care Worker Retention Study. During the research period, just over a third of the workers quit their jobs, and we conducted telephone interviews with these 90 individuals soon afterwards. We learned that study participants had very high levels of job satisfaction, but left their work despite loving it. Key predictors of termination were younger age, lack of health insurance, and low compensation.