Who will care for the baby boomers?

updated 6:02 p.m. ET June 14, 2007

NEW YORK - As the huge baby boomer generation surges toward retirement age, an unsettling issue grows ever more pressing: finding the work force to tend to the millions of boomers who will someday need ongoing care because of physical and mental frailties.

Alarm is spreading across the health care sector in the face of stark demographics.

There will be an enormous increase in America’s elderly population in the next few decades, while the traditional labor pool for caregivers — women from their mid-20s to mid-50s — will scarcely grow at all, compounding problems for a work force already beset by low wages and high turnover.

Federal statistics suggest that roughly 3 million people work in direct-care jobs, mainly with the elderly, as nursing assistants, home health aides and personal care aides. Experts project there will be demand for nearly 1 million more of these workers in the next decade, and perhaps a total of 3 million more by 2030 — when all surviving members of the 78-million-strong boomer generation are older than 65.

Direct-care workers “are the hands, voice and face of long-term care for millions of elders,” said Steven Dawson, president of the New York-based Paraprofessional Healthcare Institute.

“And yet, the long-term care system has simply presumed that an endless supply of workers ... will always be available to transfer our mothers from bed to wheelchair, or to feed our fathers, no matter how little we pay these workers, or how poorly we supervise them, or whether we even have the decency to offer them health insurance.”

Wages for these jobs, as of 2005, averaged less than $10 per hour, and a quarter of the work force had no health insurance. Groups advocating for better compensation were stunned this week when the Supreme Court ruled unanimously that the nation’s 1 million home-care workers are not entitled to overtime pay under federal law.

The ruling “underscores how unprepared we are to care for the millions of seniors who will want to live at home instead of institutions,” said Gerry Hudson, a vice president of the Service Employees International Union. “If we are to avert a home-care crisis, we must invest in living wages and health care coverage.”

SEIU already represents about 400,000 caregivers; it hopes to expand those ranks by touting its success in states such as California, where extensive unionization has been followed by higher pay and lower turnover.

But Hudson acknowledges that caregiving differs from most industries — strikes would be a desperate last resort because of the potential harm to elderly clients, and there is some common cause with employers on the need for broad changes in how America finances long-term care.

That kind of overhaul may be far away; in the meantime, many proposals and projects have emerged.

Some states are providing health coverage for uninsured caregivers. Community colleges, with funds from state agencies and the Labor Department, are beefing up training programs for home-care workers. Vermont is experimenting with a Choices for Care program in which it pays any caregiver — including a friend or relative — $10 an hour to tend to an elderly person who might otherwise be forced to a nursing home.

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