Crisis of Care and Larger Crisis in the Workforce

Hook Law News | Sep 5, 2019 | Letha Sgritta McDowell

Much has been written and contemplated about the care that an individual needs to age successfully, and even more has been written on how to pay for the care for chronic illness which is often needed as one ages. However, not much thought has been given about who will provide care. Our country is aging at a rapid rate. 10,000 baby boomers reach the age of 65 each day and, by the year 2035, it is projected that the number of individuals over the age of 65 will outnumber the number of individuals under the age of 18. In the year 2020, there will be 3.5 working adults for every person over the age of 65 but, by the year 2060, that number falls to 2.5 working adults for every person over the age of 65.

The result of this is that it is likely going to be difficult, if not impossible, to find enough elder care workers. Many who are tasked with finding appropriate care for loved ones find it difficult to find, and keep, good care providers. The job of aiding an older adult with their care needs can be both physically challenging as well as mentally exhausting. Care activities include tasks from shopping and meal preparation to medication monitoring to housekeeping to aiding with physical activities such as bathing. Not only can the job of caregiving be taxing, it is often low-paying.

Low-paying difficult jobs result in caregivers who begin the job and then leave to find other work, or caregivers who will leave agencies for small increases in pay or benefits. For individuals who choose to hire caregivers privately, the same issues apply without a backup. This means that, when a caregiver calls in sick, there isn’t an agency who can send a replacement for the day.

The challenges with locating and managing care providers can, in turn, become burdensome on family members and friends who have chosen to accept the responsibility to organize care. Much in the same way parents are often left in a lurch when a child is sick and cannot attend school or daycare, loved ones coordinating care cannot simply leave an aging person with chronic illness at home alone. However, unlike a small child with an illness, an older adult with a chronic illness is not portable and cannot easily be passed from one family or friend’s home to another. 

The challenges with caregiving and coordinating care exist today and result in lost work time, lost vacation time, lost contributions to retirement plans, and in some cases, lost promotions and lower pay. With the trend of reduction in the number of able bodied care providers as well as the increase in the number of individuals needing care, the effect on a working adult coordinating care of a loved one will be significantly greater.

In years (and generations) past, many individuals did not live into old age as we do now. Or, for those lucky enough to reach old age, they did not suffer the same chronic illnesses we live with today. In cases where care for chronic illness was needed, often a family member was not working and was able to be a care provider. Today, life expectancies are greater than ever. In addition, household demographics (and thus cost of living) have changed drastically. In 1960, less than 50% of households had both spouses working, yet in 2010, more than 65% of households had dual incomes. Therefore, the cost of living has increased along with household income. This means that the loss of income which may result from providing care could be disastrous financially.

How exactly the care crisis will play out in terms of finding available paid caregivers remains to be seen. Even more challenging will be determining how the potential inability to find paid caregivers will affect the economy and the workforce. What does seem clear is that finding caregivers for an aging population may be just as challenging as finding a method to pay.

Ask Kit Kat: Donkey on an Island

Hook Law Center: Kit Kat, what can you tell us about a donkey that was stranded on an island in California for 2 years before being rescued?

Kit Kat: Well, this is an interesting tale. The donkey’s name is Hillary, and she has a lovely grey coat. She is considered wild, and she got stuck on some high ground in Mariposa County, CA about 2 years ago. At that time, there was severe drought, and the lake bed was completely dry. Near the middle of the lake was some high ground. When heavy rains filled up the lake bed, Hillary was left stranded in the area which now appeared to be an island. Somehow others in her herd got to higher ground before this happened. She stayed there for 2 entire years! People in the area brought her hay and other food on a regular basis, but they were stumped on how to rescue her. Being wild, she was not exactly cooperative.

Finally, the Department of Fish and Wildlife decided to intervene. At first, they tried using a large cage with watermelon as an enticement. Hillary didn’t even go near the cage, and geese finished off the watermelon. They finally decided that she’d have to be tranquilized by darts in order to transport her. This was successful. She was not reunited with her herd, because they discovered that she had a leg injury. Because they feared her herd would reject her after such a long absence, she has been sent to a wildlife sanctuary. She is quarantined for now, as they begin to evaluate and treat her. Eventually, she will be introduced to a herd at the sanctuary who have special needs. It likely that she will stay there for the rest of her life.

Hillary is one lucky lady, and we wish her the best! (Hilary Hanson, “Hillary The Donkey Finally Rescued After 2 Years Stranded Alone On Island,” The Huffington Post, August 26, 2019)

Letha Sgritta McDowell

Attorney, Shareholder, CELA
757-399-7506 | 252-722-2890
[email protected]

Letha Sgritta McDowell is a Shareholder of Hook Law practicing in the areas of estate planning, elder law, special needs planning, estate and trust administration, asset protection planning, long-term care planning, personal injury settlement consulting, guardianships & conservatorships, and tax law. Ms. McDowell’s clients range from high-net-worth individuals with over $75 million in net worth to families with limited assets.

Ms. McDowell is a past President of the National Academy of Elder Law Attorneys and was named as a Fellow of the prestigious American College of Trusts and Estates Council (“ACTEC”) in 2020. She is certified as an elder law attorney by the National Elder Law Foundation (“CELA”) and Board Certified as a specialist in Elder Law by the North Carolina State Bar Board of Legal Specialization. Furthermore, McDowell is accredited to prepare and prosecute claims with the Department of Veterans Affairs.

Ms. McDowell is currently the chair of NAELA’s strategic planning committee, a member of the Board of Directors for the North Carolina Chapter of NAELA, and a member of the Board of Directors for the Purdue Center for Cancer Research. She is the former Chair of the North Carolina State Bar’s Elder Law Specialization Committee and is the former Editor-in-Chief of “Gray Matters”, the newsletter for the Elder Law Section of the North Carolina Bar Association. She is a consultant for InterActive Legal and has worked on several law and technology initiatives including IBM’s Watson project. Along with her experience practicing as an attorney, she has dedicated much of her time writing for national publications including, but not limited to: Wolters Kluwer,, the NAELA Journal, Trust & Estates Magazine and many more.

Practice Areas

  • Elder Law
  • Estate & Trust Administration
  • Estate Planning
  • Asset Protection Planning
  • Long-Term Care Planning
  • Special Needs Planning
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