Who Will Care for the Women?

Abstract

This article describes the long‐term care system in the United States—what long‐term care is, who needs it, in what settings it is provided, and who pays for it. It shows that a substantial portion of those who need long‐term care rely on unpaid care from family and friends, mainly from women, and that almost half of those that need long‐term care receive it in institutional settings, despite a preference for home‐ and community‐based care. It then argues that, for a number of reasons, states and the federal government will have to respond to the preferences of consumers for home‐ and community‐based care. The problems of ensuring an adequate supply of caregivers, focusing particularly on home‐ and community‐based settings are discussed, and the article argues that problems of recruitment and retention will be solved only when wages and benefits meet workers minimal needs for income and health insurance security. The article concludes by suggesting a set of policies that could be implemented at the federal and state levels to improve recruitment and retention of both paid and unpaid long‐term care workers, and of the long‐term care system in the United States.