Care Gap Report

Care Crisis: The Senior Care Gap in America

America is in the midst of a senior care crisis. 10,000 Baby Boomers turn 65 every day and 90 percent of these older Americans want to stay in their homes. The demand for home care is exploding, but our long term care system is not equipped to meet families’ needs. There is a significant shortage in the paid workforce that is – and will be – available to care for America’s seniors as we age.

19 million seniors need long term care supports and services and that number is set to nearly double by 2050. [i],[ii] We need a national strategy to address the senior care gap. Failing to do so will result in higher rates of injury and medical complications, higher per capita healthcare costs, and more stress on seniors and their families.

The Senior Care Gap

Nearly half of all seniors need assistance with tasks of daily living, including both self-care or mobility tasks (e.g. eating, bathing, dressing) and household tasks (e.g. meal preparation, shopping, housekeeping).[iii] 19 million seniors – living in their own homes as well as assisted living facilities and similar settings where people may get some amount of support but are still largely on their own – need daily care. However, only about 2 million people make up the workforce available to care for these seniors.[iv]


Consequences of the Care Gap

The senior care gap has two main consequences.

First, most seniors end up relying on informal assistance from friends and family, including their own spouses. One estimate is that more than 85 percent of the hours of care provided to people with daily living needs are provided by family and friends.[v] This puts a tremendous strain on the families and social networks of seniors. Adults aged 51 and over who are caring for a parent are less likely to work, more likely to work part-time, and more likely to live in poverty than non-caregivers.[vi] These informal caregivers have little training or support.

Second, the shortage of caregivers leads to unmet needs. Nearly one-third of seniors who need assistance report adverse consequences due to unmet care needs. These adverse consequences notably include (but are not limited to) wet or soiled clothes due to incontinence, taking of incorrect medication, and missed meals.[vii]

Seniors and their families are doing the best they can to get by, but better public policy is needed to support them.

A Growing Problem

The number of people who likely will need home care services is growing much faster than the population that provides care. As shown below, aging trends will only heighten the care gap, with the number of adults over 65 fast outpacing adults aged 18 to 64.



Measuring the Care Gap, State by State

To quantify the senior care gap, we estimated the number of seniors in need of home care for every home care worker, or “Consumers per Worker” (CPW).

Nationwide, there are approximately 9 consumers for each worker. There is considerable geographic variation in the care gap – some states are much worse than others. A higher CPW indicates a larger senior care gap, meaning that each caregiver has to provide for many consumers, or those seniors’ needs will go unmet.

The map below shows the size of the care gap (measured as CPW) in each state (not including Alaska and Hawaii).

Note that (as reported above) many of these seniors are not currently receiving assistance. Note also that these numbers do not reflect the millions of non-seniors who need assistance with tasks of daily living. For a detailed description of the methodology, please see Appendix A.




Our long term care system must be restructured to ensure affordability, availability, and quality for all consumers.

Older Americans and their families should be able to afford the care they need in the setting they choose. Those who need care should be able to find a qualified home care worker. Finding reliable, quality care should be a consistent, easy process throughout every city and state. And, in order to ensure home care services are of the highest quality, we need to build a robust support system for caregivers and consumers, including higher wages, better training opportunities, and clearer career pathways.

It’s common sense to invest in home care.


Home care services save states hundreds of millions of dollars each year. Investing our public dollars in expanding and strengthening a system that allows seniors to live at home with dignity and independence — rather than in nursing homes — is not only what people want, it makes the most financial sense. In addition, public dollars that finance care services should go to workers’ wages, not agency profits or CEO bonuses.

SEIU, the country’s largest union of healthcare and home care workers, is committed to joining with government and industry partners to raise home care worker wages and improve quality and access to care services for seniors and people with disabilities.


Appendix A. Methodology 

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Interpreting the CPW

A higher CPW means that there are more consumers relative to home care workers and so this would indicate a larger home care gap.  Said another way, a larger CPW means that there are less people to care for the population in need of services.

Estimating Home Care Workers

The primary source for home care worker estimates is the May 2013 release of the Bureau of Labor Statistics (BLS) Occupations Employment Statistics (OES) data.  BLS conducts a semiannual mail survey designed to produce estimates of employment and wages for specific occupations.[viii] Home care workers are found in two occupations:   Home Health Aides (SOC Code 31-1011) and Personal Care Aides (SOC Code39-9021). This data is released annually. For some circumstances, such as missing data points, it was necessary to use additional sources including previous OES releases and industry data.

Estimating Home Care Consumers

We rely on the research presented in “Disability and Care Needs Among Older Americans” by Freedman and Spillman which reports that nearly half of all elderly Medicare beneficiaries have difficultly performing daily activities without assistance.[ix]   45.3% of seniors living in the community (non-nursing home residents) need some help with activities of daily living.  We apply that ratio to the count of senior Medicare beneficiaries to arrive at our estimates of potential consumers.  Counts of senior Medicare beneficiaries are from the Medicare Denominator Limited Data Set File. We count seniors (age of 65 or higher) living in the 50 states and the District of Columbia for the year 2013, the latest year available for this data.

Note that many of these seniors are not currently receiving assistance.  Note also that these numbers do not reflect the millions of non-seniors who need assistance with tasks of daily living. 

[i] Freedman, V., & Spillman, B. (2014). Disability and Care Needs Among Older Americans. Milbank Quarterly, 92(3), 509-541 and SEIU analysis of Medicare data. See Appendix A for details.

[ii] U.S. Census Bureau, “65+ in the US: 2010.”

[iii] Freedman, V., & Spillman, and SEIU analysis of Medicare data.

[iv] U.S. Bureau of Labor Statistics, Occupational Employment Statistics, 2013, and internal SEIU estimates for the home care workforce. This paid workforce consists of Personal Care Aides and Home Health Aides. See Appendix A for a description of the methodology.

[v] Laplante, Kaye, Kang, and Harrington, “Unmet Need for Personal Assistance Services: Estimating the Shortfall in Hours of Help and Adverse Consequences,” Journal of Gerontology 59B:2 (2004), S98-S108.

[vi] Barbara Butrica and Nadia Karamcheva, “The Impact of Informal Caregiving on Older Adults’ Labor Supply and Economic Resources,” Urban Institute, October 2014.

[vii] Freedman and Spillman, Table 7.


[ix] Freedman, V., & Spillman, B. (2014). Disability and Care Needs Among Older Americans. Milbank Quarterly, 92(3), 509-541.