Do you know who is going to care for you when you are old and frail? By current standards, it’s likely to be a middle-aged immigrant woman, with maybe a high school education and little if any training, making $20,000 a year.



And that’s if you are lucky. If you live in rural America, you may already have a hard time finding somebody to look after you. Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management calculates that if nothing is done to draw more workers into the field, there will be a shortage of at least 350,000 paid care providers by 2040.

This, I’m sure you’ll agree, makes little sense.

How to provide long-term care for a fast-aging population poses one of the more convoluted challenges of the American labor market. Care providers — home health aides, personal care attendants and certified nursing assistants, in the government’s classification — are expected to be among the nation’s fastest-growing occupations. The Department of Labor’s economists expect about a million more will be added from 2014 to 2024.

And yet despite their critical importance to the well-being of tens of millions of aging Americans, one-fourth of these aides live in poverty. The jobs are so unappealing that it is hard to keep workers in them: four in 10 leave the occupation entirely within a year. Many prefer the fast-food business.