Dying and paid care work in the 21s century

by Karla A. Erickson

For those of us who are already adults in 2015, we are most likely to die due to multiple chronic conditions in old age. Our lives will be longer and our deaths will be slower than our distant ancestors, our parents, even those who were born just a decade earlier than us. From a labor perspective, our longer lives and slower deaths require many more days, months and years of assistance. Enter the ever-growing labor force of workers I call end-of-life laborers.

The “grey tsuanami,” as some scholars call it, is coming, whether or not we are ready. The United States, like many similar nations, is on the brink of a care crisis. We’ve faced teacher shortages in the past, but our focus in the coming decades will necessarily shift all the way to the other end of life. As scholars of labor, we need to prepare to inform the coming re-direct of attention, labor, policy and practice that will accompany the grey tsunami.

Average life expectancy has risen by 30 years in the last 100 years. The benefits of what I call the longevity dividend are not equal. White females born in 2010 are expected to live almost 4 years longer than their black male counterparts. More than half of the babies born in this decade in advanced industrial nations are expected to live to be 100.

At the same time, average birth rates have dropped precipitously around the world since the 1970s, with some countries now dipping below population replacement rate. In advanced, industrialized nations, new immigrants are the primary source of population maintenance or growth. Without new immigrants, the greying of American would be much more apparent. Other nations, including Spain and Japan, are already much further along into the greying of their nation. One can witness the changes even by simply taking a walk in a public park where wheelchairs are more common than strollers.

Up until recently, human energies were primarily focused on helping our young reach adulthood. With the remarkable changes in child mortality, improvements in preventative health, and all the medical technologies that assist in extending our later years, the demographic balance of our nation and most parts of the planet are shifting. Demographers predict that by 2050, there will be more old people than young for the first time in human history. Collectively this will mean more final baths than first baths, more wrinkled hands than new wiggly toes, more assistance and dependence in our elders than our children. Who will care for us and how? These are the questions that must be asked now.

Scholars and experts of many bents: ethicists, medical researchers, family social workers, biologists, philosophers, and psychologists will all be brought into the changing needs of an aging planet. Scholars of labor need to study existing resources and help inform the pipelines of future workers to help address the emerging care crisis.

There’s much to celebrate about our extra thirty years on average, what scholars call the true wealth of nations. Longer lives provide more time to pursue new interests, to see the world, to cherish generations of family, to know old friends and make new ones. Yet longer lives also increase the likelihood we will encounter the specter of our time: Alzheimer’s disease. A specter is something that haunts or perturbs the mind and Alzheimer’s fits that description by being almost perfectly correlated with longer lives. The disease path of Alzheimer’s often outpaces the capacity of family members to care for their aging relatives and is likely to put additional pressure on the elder care industry. So add to the longer lives the frequency of Alzheimer’s in later life, and we can see that the minor pangs of shortage we are experiencing right now are a quiet prelude to the full impact of demographic change coupled with the prevalence of Alzheimer’s.

Workers Wanting: Growing Quickly, Paid Poorly

Aging and dying in 2015 makes use of a mix of help from family, friends, and care providers. But those care providers are often poorly paid and minimally prepared for the work they undertake.

In 2015,nursing aides and home health aides are some of the fastest growing job categories in the U.S. with an average salary of just about $20,000. To learn more about the labor of these workers, I trained to become a nurse’s aid on my sabbatical in 2008. At the time, in Iowa, an aide was trained for 70 hours. The first thing that struck me about this training was that nurse’s aides receive little to no training about the spiritual, psychological, even social dimensions of aging. Organizationally, the necessary focus of nurse’s aides work is to help elders get through the day safely. Nursing aides’ training is structured like a pseudo-medical position – with a focus on not doing harm to the residents. Nurses’ aides learn how to assist with moves in and out of bed, and with clothing, bathing, or toileting. On an organizational level, this is much like the driving purpose of a day care center in which babies and toddlers are kept safe, dry, warm, and occupied. However, elders are complex people with long histories, complicated psychological relationships to their own aging and the changes in their dependency, and many grapple with existential questions in ways that younger groups do not yet wrestle. In short, in addition to the care crisis, there is also a skills gap.

Policy, political activism, and organizational practice will have to turn increasingly to how to serve a broader swath of the American public, how to humanize the work of those who do care for elders, and, finally, how to de-center whiteness and Christianity in many of the organizations that have historically cared for feeble elders.

My interest here is two-fold: scholars need to step foot with ever greater frequency into the spaces for aging in this culture and we also need to prepare the young students we are teaching today to take up professions connected to the greying of the planet. The question of who will care for us is meaty in it complexity. Global dying will proceed better when informed by sociological insights. And perhaps even more importantly, the coming of demographic change is an opportunity for agile thinkers, flexible workers and young people seeking meaningful work. As teachers and scholars, we have a powerful position to influence how we and future generations age and die. Much as the sciences have been preparing students to be future leaders in solving the dilemmas wrought by global warming, social scientists and ethicists will need to provide insight and good counsel as we move into a greyer future.

Karla A. Erickson is Professor of Sociology and Associate Dean at Grinnell College.