America Is Facing a Caregiving Crisis

Maria Diaz, a caregiver, leaves her South Los Angeles home early before sunrise and returns late in the evening. Even on weekends, days off are few. She is the primary breadwinner for her family at 46, having recovered from a series of strokes, and she needs the hours. It is the only way she can make ends meet.

She has three senior clients and four young disabled clients, and she spends an hour here and three or four hours there, traveling between Los Angeles, Huntington Park, and Gardena. She prepares meals and cleans for people, bathes them, monitors their health, and drives them to the grocery store and medical appointments, depending on their needs.

Diaz is a petite woman with uncommon strength, as she assisted in lifting 86-year-old Luis Aguayo from his bed and shouldering him to the kitchen of his modest home in the rear of a house in South L.A. She made him eggs and oatmeal for breakfast and then cleaned his bathroom while he ate.

Diaz often returns a few times a day to check on Aguayo. She relaxes by listening to music and sermons on the radio. Most mornings, Diaz leaves her house before 5:00 AM and returns around 10:30 PM.

Her weekly hours, about the equivalent of two or three full-time jobs, are far from the standard in her field, but she is one of tens of thousands of people in Southern California who multi-task for an aging population. Some of them, like Diaz, make slightly more than minimum wage.

Many others are employed while also being undocumented immigrants. In 2020, almost a quarter-million undocumented immigrants worked in healthcare, according to The Center For American Progress. Of those working in healthcare, approximately 154,000 were employed as nurses, CNAs, PCAs, and home health aides.

Diaz would like to see wages increase. She could work fewer hours if wages were higher. Despite that, she enjoys her work.

“Knowing that I am helping someone to stay in their own home, and still feel somewhat independent, and have the dignity to live their last days in their own surroundings, gives me joy,” she wrote. “I care for these people like they were my own father or mother. They just need love, compassion, and understanding,” she says.

Low wages are a nationwide problem. The average home healthcare worker in the U.S. made just $13.02 per hour in 2021, according to the Bureau of Labor Statistics. Additionally, one in five home healthcare workers lives below the poverty line, according to the New York Times.

California residents who are elderly, blind, or disabled and qualify for Medi-Cal can participate in the state-run In-Home Supportive Services program or IHSS. They are assigned a predetermined number of weekly hours of care based on their needs and are connected with appropriate providers, frequently family members. The program is viewed as a tool to assist consumers in remaining at home and avoiding the higher costs associated with hospitals and other institutions.

According to The Balance, nursing home care costs an average of $7,756 per month for a semi-private room. The average monthly cost for a private room is $8,821. This adds up to $93,072 and $105,852 a year, respectively.

Patricia Santana, 53, looks after her 78-year-old husband, Ismael Anguiano. She and other California employees have marched and organized for raises in pay from levels that vary statewide but have hovered just over minimum wage. The hourly salary in Los Angeles County has been increased to $17.25, falling well short of the Union objective of $20. California is expected to have a caregiver shortage of three million by 2030 across all employment classifications.

I’ve experienced this shortage firsthand due to Cerebral Palsy. In my first three semesters of college, I had three different PCAs. The lack of dependable PCAs added to my stress. I didn’t want to be worried about getting to class on time or using the bathroom.

Sometimes my mother had to miss work to take me to college. I felt guilty. It wasn’t fair for my mom to miss work. Other times, a friend had to miss work. The more this happened, the worse I felt.

The shortage is also impacting children and their families. Chole Mead lives in Queens, New York, with her seven-year-old son Henry, who has SMA, a muscle-wasting disease. Since his birth, Henry has received 24-hour nursing care at home, with Ms. Mead and her husband filling in when a nurse unexpectedly cancels a shift. Unfortunately, a recent shortage of home-care nurses has forced the couple to monitor Henry’s needs for longer periods on their own — up to 36 hours at a time.

The shortage is affecting millions of people across the United States. People from coast to coast are struggling. This crisis is affecting people of all ages. Children aren’t getting in-home nursing care, and seniors aren’t able to remain at home. People’s lives are at risk without proper care. We need to fix this crisis now because care can’t wait.


Alcorn, Ted. “To Keep Their Son Alive, They Sleep in Shifts. and Hope a Nurse Shows up.” The New York Times, The New York Times Company, 4 June 2021,

Donovan, Liz, and Muriel Alarcón. “Long Hours, Low Pay, Loneliness and a Booming Industry.” The New York Times, The New York Times, 25 Sept. 2021,

“Home Health and Personal Care Aides : Occupational Outlook Handbook.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 8 Sept. 2021,

Lopez, Steve. “A Looming Crisis: The Crushing Cost of Elder Care and the Crippling Effects of Low Wages.” The Los Angeles Times, Los Angeles Times Communications LLC, 2 Apr. 2023,

Svajlenka, Nicole Prchal. “Protecting Undocumented Workers on the Pandemic’s Front Lines.” The Center for American Progress , The Center for American Progress , 7 Nov. 2021,

Parker, Tim. “The Median Cost of a Nursing Home.” The Balance, The Balance, 25 Oct. 2021,

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