With members of the baby boom generation aging into their retirement years, the elder care industry has long been anticipating a shortage of caregivers as demand increases.
But with the covid-19 pandemic driving some health care workers away from the field, this trend has accelerated, and facilities throughout the country are struggling to hire workers.
The American Health Care Association and National Center for Assisted Living reported a steady decrease in workforce levels at nursing homes nationwide, with a net loss of 220,000 jobs between March 2020 and October 2021. In the assisted living sector, there was a net loss of 38,000 jobs during that time frame.
The scarcity of professional caregivers is being seen in skilled nursing and at assisted living facilities, as companies compete against one another to hire workers.
"There's always been a looming caregiver shortage on the horizon and the pandemic accelerated it, and so we have a lot more openings than we did prior to the pandemic," said Cory Fish, director of human resources at St. Paul's Senior Services in San Diego County, Calif.
St. Paul's runs several elder care facilities that serve in areas such as independent living, adult day care, memory care, assisted living and skilled nursing.
As more caregiving jobs remain open in the region, the price is continuing to increase for those who need the help.
County resident Mike has, at times, struggled to find in-home caregivers to help support his 71-year-old wife, who was diagnosed with dementia six years ago. (Mike asked that his last name not be included to protect their privacy, and out of worry that hiring new caregivers could become more difficult.)
Over the course of the pandemic, Mike said, he has seen the cost of caregivers increase by about 35%, up to about $34 an hour. To employ four caregivers in his home for 120 hours per week, he now pays more than $16,000 a month for his wife's care.
Only some of that is covered by long-term care insurance, but eventually that money will run out. Then all the costs will be out-of-pocket.
A lot of that money goes to the agency, not the caregivers doing the work, but further increases are expected to be unsustainable for most families.
"I won't say [caregivers are paid] minimum wage, but they're probably not as appreciated financially as maybe they should be," Mike said. "But it's a double-edged sword because people that need the help can't afford exorbitant costs either."
Regardless of the current instability of the elder care industry, the nation faces future struggles when it comes to addressing the needs of older adults.
About a half-million people age 65 or older live in San Diego County, and that number is expected to double by 2030, according to county estimates.
"We are just so far behind the eight ball in terms of being able to meet that need," said Terra Lawson-Remer, a member of the San Diego Board of Supervisors who has made increasing the "care economy" one of her goals.
Lawson-Remer introduced an agenda item in a board meeting last month to assess the idea of increasing local investment in the care industry and improving caregiving through programs like In-Home Supportive Services, a county initiative.
"Part of the issue is, we haven't really done the investment in making this into a career and a job that actually is a job people can live on," Lawson-Remer said.
"There's a lot of structural reasons that those jobs haven't paid well enough, they haven't provided good job security -- they provide social benefits that in general nobody has been willing to pay for," Lawson-Remer said. "It's not just caregivers. It's a broad challenge of fundamentally undervaluing work that historically was often women's labor."