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Modern medical science and public health will allow most of us to live to an age at which we can no longer live fully independently. Our physical and mental capabilities may erode slowly or may decline suddenly, as with a stroke or serious accident. When that happens, we will need help in several areas: to accomplish the tasks of daily life that we now are able to do by ourselves; to maintain our health to the extent possible, for as long as possible; and finally to ease our transition to death. Family members may not have the time, the skills, or even the physical strength to provide all these kinds of care. This is why there is a demand for the elder-care industry.
The Bureau of Labor Statistics estimates that in 2015 more than 1 million people were employed at establishments providing services for the elderly and persons with disabilities in the United States. Some of these establishments are nursing homes or assisted-living communities where elderly people reside, but others provide health-care services for seniors who are living at home or are being dropped off during daytime hours only.
The type of facility with the longest tradition of specializing in elder care is the nursing home. The Kaiser Commission on Medicaid and the Uninsured estimates that there were around 15,401 certified nursing homes in the United States as of 2014, a number that has stayed quite stable for most of the past decade. About 1.4 million Americans live in these facilities.
AARP estimates that there are around 50,000 assisted-living facilities, with a total capacity of 1.2 million beds. This figure includes facilities that some states license as adult foster care, meaning that the seniors are cared for in the care-provider's residence. Because Medicare does not pay for assisted-living care, nor does Medicaid in many states, private payments from residents and families account for most of the revenue.
A 2013–2014 national survey by the National Center for Health Statistics found that long-term care service was provided by 4,800 adult day services centers, 12,400 home health agencies, 4,000 hospices, 15,600 nursing homes, and 30,200 assisted-living and similar residential care communities. Medicare is the main payer for these kinds of home care, especially for hospice care. On any given day, more than 1.5 million Americans receive these kinds of home care services. The majority of patients receive skilled nursing services on a daily basis, followed by physical therapy, and then assistance with daily living activities.
So much elder care is taking place at home partly because this is where seniors want to be, "aging in place," as the term has come to be known in the elder care industry. A survey by AARP found that 90 percent of adults 65 and older planned to stay in their current homes for the next five to ten years. Home care also can reduce costs, especially when the level of care that is needed does not require highly skilled workers.
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