Who Provides Care?

Currently, there are not enough direct care workers (home health aides, personal care attendants, and nurses aides) to meet the demand. Long-term services workers are typically not well paid, and they often lack benefits such as health insurance or paid sick leave. For example, approximately 19 percent of health care aides and 16 percent of nursing home aides are not even paid at a level sufficient for them to rise above the federal poverty level. Low compensation and lack of respect for the profession, combined with the physically demanding nature of the work and often inadequate training, have made worker recruiting and retention difficult. The demand for services is projected to far outpace the supply of workers in the coming decades.

Worker shortages, the high cost of care, inadequate coverage, and patient preferences have lead most people who need long-term services to rely on informal caregivers for at least some of their care. Informal caregivers, such as family members, provide more than $375 billion in uncompensated care every year to those needing long-term services. About 52 million informal caregivers provide long-term services to family or friends at some point during a year. However, providing such care can be a substantial drain on caregiver finances and can result in reduced formal employment and lower wages. The typical working family caregiver loses approximately $110 per day in wages and health benefits due to care giving responsibilities.