Manny and his wife, Tina, live in a small Tudor-style house, a 10-minute walk from Yonkers Raceway.  Manny bought the house in the mid-1980s, soon after retiring as a cop. For most of his years on the force, Manny worked a beat on 138th Street in the Bronx, an area, at that time, nicknamed “Fort Apache.” As soon as he made it to 20 years, Manny left the force and entered Manhattan College to become a teacher.

Manny fulfilled his undergraduate requirements in three years. To get state certified in special education, Manny then took several additional courses and completed an internship at a residential treatment center for children with special needs.

A large man with huge hands and a world of patience, kids enjoyed being around him. After graduating Manhattan, Manny landed his first teaching job at a NYC Board of Education school that served boys with serious behavioral and emotional problems. Twenty-one years later—greatly loved and admired—Manny retired again, with two successful careers under his belt. 

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Manny and Tina are now in their late 70s. Neither is doing well, health-wise. Manny’s back and hands are arthritic, and Tina had a stroke about two years ago, disabling her left side and impairing her vision.

Doing household chores—going up and down stairs to clean and do the laundry, shopping and preparing meals—was wearing Manny out. Having to help Tina shower, dress, go to the toilet, and take her pills each day left Manny feeling overwhelmed and mentally exhausted. With a son in California and a daughter in Maryland, Manny felt isolated and helpless.

Last year, a neighbor recognized Manny’s distress and helped him to connect to a homecare agency that screens and hires caregivers. Manny thought his savings and pensions would be enough, but a year later, $20 an hour, eight hours a day, seven days a week, was breaking his bank. He just couldn’t keep up with the $1,000-a-week price tag. 

Manny advertised in the Penny Saver for a home healthcare aide, thinking it would be easy to hire someone privately—maybe someone who might also live-in some of the time—and he could pay her off the books. It took almost a month of ads, but he finally found an appropriate and affordable caregiver—a warm and friendly Guatemalan woman who lived with her sister’s family in West Yonkers, just off Getty Square. Six months later, she got a better offer closer to home, which Manny couldn’t match.  He continues to look for someone to take her place.

There are several reasons it is becoming more and more difficult to find and keep good elder care providers. Our country is aging at a rapid rate, and there is ballooning demand. Older people are living longer, and most will eventually develop chronic diseases and disabilities. The fast-growing numbers of aging baby boomers further increases the demand. Ten thousand baby boomers reach the age of 65 each day, and, according to Paul Osterman, a professor of human resources and management at MIT’s Sloan School of Management, by the year 2030, it is estimated that there will be a national shortage of over 151,000 paid direct-care workers. By the year 2040, Osterman estimates there will be a shortage of 355,000 paid workers. That does not include the 11 million unpaid family caregivers Osterman projects the country will need, as well.

“We’re headed toward a perfect storm of crisis,” says Osterman.

The job of caring for older adults, especially those with chronic illnesses, is challenging, physically demanding and mentally exhausting. Homecare providers earn low wages—the median wage for home care workers is about $12 an hour—receive poor benefits, often work long and unpredictable work hours, and have no chance for advancement.

Many Americans are reluctant to work as caregivers. One in four of the direct-care workers in our nation’s nursing homes, assisted living facilities and home care agencies are foreign-born, according to an analysis by the Paraprofessional Healthcare Institute. And, in New York, California, New Jersey and Florida, upwards of 40 percent of direct-care workers are immigrants.

In the grey market of elder care, where homecare workers are hired directly by the consumer and paid off the books, the percentage of immigrants working as home healthcare workers is much, much higher and a very large percentage are likely undocumented. 

So, along comes Donald Trump, who makes restricting immigration a centerpiece of his presidency, complaining that unschooled immigrants and undocumented workers are threatening the country’s safety and taking good jobs away from Americans.

Don’t get old and sick in this country, unless, of course, you’re extremely well-off. There may not be anyone left to take care of you.