The Untapped Potential of Older Adults in Direct Care Work

Older Americans Month, which takes place every May, is an opportunity to reflect on the profound needs and contributions of older people in this country. In this context, we're drawing attention to a critical yet less visible segment of this older adult population: older adults who work as direct care workers.

According to PHI, more than one in four (28%) direct care workers in this country is ages 55 or older. Direct care workers support older adults and people with disabilities in a wide range of long-term care settings, from private homes to congregate care settings such as assisted-living and nursing home environments. Many individuals supported by the 4.7 million direct care workers in the United States are also older people (and people with disabilities of all ages) who need help with daily tasks, such as dressing, bathing, eating, and often, much more. Also, today's long-term care clientele has become increasingly complex regarding its care needs, for instance, as dementia rates increase. This highly diverse and complex population necessitates a stable and trained direct care workforce.

Unfortunately, this critical workforce is far from stable. The typical direct care worker faces numerous challenges that make it difficult for them to survive financially. Wages in this job sector are poverty-level, and many of these workers rely upon public assistance to survive. Alarmingly, industries like fast food and retail can offer low-wage workers higher pay and better hours than can long-term care employers, which lures many current and potential direct care workers to those sectors, and away from the people who need them.

'Industries like fast food and retail can offer low-wage workers higher pay and better hours.’

As a result, a worsening workforce shortage—or a shortage of high-quality jobs, to be more precise—threatens services and supports for many older adults and people with disabilities. This problem will magnify in the future; between 2020 and 2023, nearly 7.9 million direct care jobs will need to be filled, including new jobs and job vacancies caused when workers leave this field or exit the labor force, typically for the industries cited above.

Older Adults and the Labor Market

Because older adults are a fast-growing proportion of our population and labor force, they present an important opportunity to long-term care leaders as they wrestle with recruiting and retaining workers. Older adults also often bring considerable experience as family caregivers and the wisdom accrued across their professional careers to the direct care job, which requires emotional demands and problem solving, among other skills. According to the U.S. Administration on Aging, nearly 56 million Americans are older than age 65, with projections that by 2060 that number will be nearly 95 million. Also, the average 65-year-old can expect to live another 20 years and as many as 80% of older adult–led households are financially struggling. Further, poverty is increasing among older adults, meaning that many older adults will need to remain in or reengage with the labor market. With the increasing need for direct care workers in this country, older adults are primed to fulfill this role in even greater numbers in the future.

While the need for longer employment is the reality for many older adults, they also often face ageism in accessing the labor market. Tapping this older population to fill direct-care jobs will require addressing the many ageist employment-related barriers.

Older adults bring different perspectives and insights that might foster innovation and problem-solving.

Despite the benefits of hiring older workers and the legal protections in place for this population, age discrimination in the workplace is common and widespread. Many employers are working to address overt ageism, but age bias remains quite prevalent, with as many as two in three older workers reporting age discrimination at work. Much of this comes from personal biases and misconceptions of what elders might be capable of, rather than an actual assessment of individuals to discern whether their skills align with the work needed.

For employers, ageism can lead to a loss of talent, experience, diversity and productivity. Older workers often have valuable skills, knowledge, networks and loyalty that can benefit their employers and coworkers. Also, they can bring different perspectives and insights that might foster innovation and problem-solving. With the growing need for long-term care and the growing worker shortage, employers who overlook this key population of employees do so at their own peril.


How can policymakers and industry leaders improve jobs for direct care workers so that older adults choose to stay in direct care, along with everyone else in this field? For starters, they could provide a living and competitive wage for direct care workers, coupled with adequate funding for home care agencies, residential care settings and nursing homes.

Policy and practice leaders also could enhance the training landscape for direct care workers. In this context, federal leaders could boost training requirements and programs for this workforce (which are currently scattered and under-developed) and establish a national standard for direct-care competencies applicable to all direct care workers. Direct care workers also need advanced roles, both because they could turn this job into a career and because they can improve care and reduce unnecessary costs in a grossly expensive healthcare system.

The Direct Care Workforce Capacity Building Center—funded by the Administration for Community Living and led by the National Council on Aging, in partnership with PHI and several other leading organizations—also could be helpful. Over the next five years, this Center and its core partners will provide technical assistance to states and service providers to improve the direct care workforce's recruitment, retention, training and professional development.

Older adults look at direct care work as a viable employment opportunity in their communities. One in which they can earn income, stay active and healthy, and find meaning and purpose in helping others. If reentering the workforce, the National Council on Aging has a new online tool that gives older adults tips on how to begin a job search. To understand how your state fares with regard to direct care workers, and which could benefit from more advocates, visit PHI's Direct Care Workforce State Index.

This month let's remember older adults who are helping to sustain the paid frontline of long-term care: direct care workers. They bring considerable experience and strengths to these roles, and we owe it to them—and the people they support—to make sure they can thrive every single day.

Robert Espinoza, MPA, is the executive vice president of policy at PHI, a national organization focused on strengthening the direct care workforce through research, advocacy, and workforce innovation, and he’s chair elect for ASA’s Board of Directors. Josh Hodges is the chief customer officer at the National Council on Aging, a national nonprofit focused on ensuring everyone has the right to age well.

Photo credit: Shutterstock/Chay_Tee