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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 with several vital tasks: 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 2012 more than 759,970 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 15,400 certified nursing homes in the United States as of 2011, a number that has stayed quite stable for most of the past decade. About 1.4 million Americans live in these facilities, and the primary payer is Medicaid for 63 percent of the residents, Medicare for 14 percent, and private or other sources for 22 percent.
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 2007 national survey by the National Center for Health Statistics found 14,500 home health care and hospice care agencies, of which 75 percent provided health care only, 15 percent provided hospice care only, and 10 percent provided a mix of services. Medicare is the main payer for these kinds of home care, especially for hospice care. On any given day in 2007, almost 1.5 million Americans were receiving these kinds of home care. The kinds of care most frequently received in this setting were skilled nursing services, reported by 84 percent of the patients, physical therapy (40 percent), and assistance with daily living activities (37 percent).
So much elder care is taking place at home partly because this is where seniors want to be. A 2012 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.