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In November 2022, Beth Pinsker's 76-year-old mother began to get sick. Ann Pinsker, an otherwise healthy woman, had elected to have a spinal surgery to preserve her ability to walk after having back issues. What Ann and Beth had thought would be a straightforward recovery process instead yielded complications and infections, landing Ann in one assisted living facility after another as her daughter navigated her care. Eventually, by July of the following year, Ann died. "We thought she'd be back up to speed a few weeks after hospital stay, rehab, home, but she had complications, and it was all a lot harder than she thought," Beth Pinsker, a certified financial planner and financial planning columnist at MarketWatch who has written a book on caregiving, told CNBC. It wasn't Pinsker's first time navigating senior care. Five years before her mother's death, she took care of her father, and before that, her grandparents. But throughout each of those processes, Pinsker said she noticed a significant shift in the senior caregiving sector. "From the level of care that my grandparents received to the level of care that my mom received, prices skyrocketed and services decreased," she said. It's evocative of a larger trend across the sector as the senior population in the U.S. booms and the labor force struggles to keep up. Recent data from the U.S. Census Bureau found that the population of people ages 65 and older in the country grew from 12.4% in 2004 to 18% in 2024, and the number of older adults outnumbered children in 11 states — up from just three states in 2020. Along with that population change came other shifts, including increased demand for care for older people. According to the U.S. Bureau of Labor Statistics, the prices for senior care services are rising faster than the price of inflation. In September, the Consumer Price Index rose 3% annually, while prices for nursing homes and adult day services rose more than 4% over the same period.
But the labor force hasn't necessarily kept up with the surge. The demand for home care workers is soaring as the gap widens, with a projected 4.6 million unfulfilled jobs by 2032, according to Harvard Public Health. And McKnight's Senior Living, a trade publication that caters to senior care businesses, found that the labor gap for long-term care is more severe than any other sector in health care, down more than 7% since 2020.
'A critical labor shortage'
That shortage is primarily driven by a combination of low wages, poor job quality and difficulty climbing the ranks, according to experts. "This is coming for us, and we are going to have this create an enormous need for long-term care," Massachusetts Institute of Technology economist Jonathan Gruber told CNBC. Gruber said the country is entering a period of "peak demand" for aging baby boomers, creating a situation where rising demand and pay do not sufficiently match up, leading to a "critical labor shortage." On top of that, the jobs at nursing homes are often strenuous and vary in skills depending on the specific needs of each senior, he said, leading nursing assistants to be staffed in difficult jobs that often only pay slightly more than a retail job, despite requiring more training. According to the BLS' most recent wage data from May 2024, the average base salary for home health and personal care aides was $16.82 per hour, compared with $15.07 per hour for fast food and counter workers. "If we can create a better caring system with an entitlement to all care for those who need it, that will free millions of workers to make our economy grow, so this is a drag on economic growth," Gruber said. Pinsker said she saw that shortage play out firsthand. At one of the assisted living facilities she toured for her mother, she noticed nurses wheeling residents into the dining hall for lunch at 10:30 a.m., an hour and a half before lunch would be served, because the home did not have enough caregivers to retrieve them at noon. "They were bringing them in one at a time, whoever was available, seating them in rows at their tables, and just leaving them there to sit and wait," Pinsker said. "This was their morning activity for these people in this nursing home. … They just don't have enough people to push them around. That's what a staffing shortage looks like in real time." Pinsker said her mother was placed in a nursing rehab facility, unable to walk or get out of bed, and that her facility had zero doctors on the premises. Most often, she said the facility was just staffed with business-level caretakers who change bedpans and clothing. "They don't have enough doctors and registered nurses and physical therapists and occupational therapists and people to come and check blood pressure and take blood samples and that sort of stuff," she said. "They're short on all ends of the staffing spectrum."
Filling the gap
Gruber said there are three directions he thinks the country could go in to solve the labor gap: Pay more for these jobs, allow more immigration to fill the jobs or set up better career ladders within the sector. "It's not rocket science — you've either got to pay more, or you've got to let in way more people. … There are wonderful, caring people all over the world who would like to come care for our seniors at the wages we're willing to pay, and we just have to let them in," Gruber said. He's also part of an initiative in Massachusetts focused on making training more affordable for nurses to be able to climb the career ladder and pipelines to fill the shortages, which he said helps staff more people.