A second workforce, from scratch

Andrew Olenski and David Grabowski put the number in the New England Journal of Medicine and it deserves to be read slowly. The United States needs about 3.4 million additional long-term care workers by 2040. Fewer than 100,000 people are expected to enter the field in that time. The gap is roughly 3.3 million, and under the optimistic version, with employment back to pre-pandemic levels and immigration above current projections, it is still about 2.9 million.

Now hold that against the size of the workforce we already have, which is about 3 million people. The shortfall is bigger than the entire existing workforce. To close it the country would have to build a second long-term care workforce from nothing, larger than the first, inside fourteen years, while under a hundred thousand people sign up.

That is not going to happen, and saying so out loud changes the question. The reframe that got us here came from a financial advisor, which is fitting, because most families are still preparing for the wrong problem. You can save toward a cost. There is no amount of money that conjures an aide who does not exist. A family with money and no available caregiver ends up in the same room as a family with neither, holding the same clipboard.

So the gap closes some other way, and there are only two candidates. Families absorb more of it, which they are already doing without being asked. And the tools get better at making one caregiver go further, which is a smaller promise than a robot in the hallway and a much likelier one.

Olenski and Grabowski add the part that should worry people most. In every area where policy could help, it is moving the wrong way. Which leaves the arithmetic sitting exactly where it has always sat, on a daughter with a full-time job and a phone full of numbers.