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The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us?  economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care.
 
Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers  are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the well-being of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops.
 
Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers.
 
As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.
 
 

In this book, an award-winning journalist tells the story of people devising innovative ways to live as they approach retirement, options that ensure they are surrounded by a circle of friends, family, and neighbors. Based on visits and interviews at many communities around the country, Beth Baker weaves a rich tapestry of grassroots alternatives, some of them surprisingly affordable:

• a mobile home cooperative in small-town Oregon
• a senior artists colony in Los Angeles
• neighbors helping neighbors in "Villages" or "naturally occurring retirement communities"
• intentional cohousing communities
• best friends moving in together
• multigenerational families that balance togetherness and privacy
• niche communities including such diverse groups as retired postal workers, gays and lesbians, and Zen Buddhists

Drawing on new research showing the importance of social support to healthy aging and the risks associated with loneliness and isolation, the author encourages the reader to plan for a future with strong connections. Baker explores whether individuals in declining health can really stay rooted in their communities through the end of life and concludes by examining the challenge of expanding the home-care workforce and the potential of new technologies like webcams and assistive robots.

This book is the recipient of the annual Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.

A damning portrait of the dire realities of retirement in the United States—and how we can fix it.

While the French went on strike in 2023 to protest the increase in the national retirement age, workers in the United States have all but given up on the notion of dignified retirement for all. Instead, Americans—whose elders face the highest risk of poverty compared to workers in peer nations—are fed feel-good stories about Walmart clerks who can finally retire because a customer raised the necessary funds through a GoFundMe campaign.

Many argue that the solution to the financial straits of American retirement is simple: people need to just work longer. Yet this call to work longer is misleading in a multitude of ways, including its endangering of the health of workers and its discrimination against people who work in lower-wage occupations. In Work, Retire, Repeat, Teresa Ghilarducci tells the stories of elders locked into jobs—not because they love to work but because they must.

But this doesn’t need to be the reality. Work, Retire, Repeat shows how relatively low-cost changes to how we finance and manage retirement will allow people to truly choose how they spend their golden years.