Home care crisis drives innovation for aging in place

"Home care is one of the nation's fastest-growing occupations. In 2024, 3.2 million home health and personal care aides were on the job up from 1.4 million in 2014, according to PHI, a research and advocacy group. The U.S. Bureau of Labor Statistics projects a need for 740,000 additional aides over the next decade, the KFF report shows. Consumers pay a median of $34 per hour for home health aides, while median wages for aides remain under $17, with limited access to benefits."

"Many workers largely women and one-third immigrants live in low-income households and rely on public assistance. Turnover approaches 80% annually, according to the ICA Group. Some innovations are improving conditions for workers and patients alike Home care cooperatives businesses owned by the aides themselves have demonstrated lower turnover and higher pay. Cooperative Home Care Associates in the Bronx, New York, launched in 1985 and now employs 1,600 aides."

"These co-ops are getting exceptional results, said Geoffrey Gusoff, a UCLA health services researcher. They have half the turnover of traditional agencies, they hold onto clients twice as long and they're paying $2 more an hour. He described responses from co-op members as overwhelmingly positive when asked about their working conditions. But the biggest single response was, I have more say' over working conditions, patient care, and the administration of the co-op itself, Gusoff said. Workers say they feel more respected."

Home care employment rose from 1.4 million in 2014 to 3.2 million in 2024, with the Bureau of Labor Statistics projecting a need for 740,000 additional aides over the next decade. Consumers pay a median of $34 per hour while median aide wages remain under $17 and benefits access is limited. Many aides are women and about one-third are immigrants; many live in low-income households and rely on public assistance. Annual turnover approaches 80 percent. Cooperative ownership models and registry platforms are improving pay, retention, worker choice, and respect. Training programs further improve outcomes.

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