The holiday season brings families together. Unfortunately, these times are the exception rather than the rule. Most older people live miles from loved ones, which means they often need to find other kinds of assistance if they want to age at home.
That can be a real challenge, and unsurprisingly it’s one that’s getting increased attention from policy leaders. In fact, during the 2024 presidential election, both presidential candidates offered proposals to help more seniors access in-home care. Now that a new administration is preparing to take office, it’s time to think big and find outside-the-box ways to create more and better options for these people.
But thinking big shouldn’t mean government expansion. In fact, heavy-handed government programs can often crowd out innovative solutions and sink us deeper into debt. Rather, we need innovative, budget-neutral solutions focused on meeting seniors’ specific needs.
While the vast majority of seniors prefer to age in their own homes rather than move to a senior residential facility, about one-third of seniors require regular in-home caregiving support — for example, help with light housework, meal preparation, driving to appointments — to stay at home. The average annual cost of in-home support is about $60,000 per year. This might be an affordable option for a portion of the senior population with higher incomes, but for most, it would be “crushingly expensive.” Unfortunately, the gap between the cost of this type of care and what most seniors, many of whom rely on fixed incomes, can afford to pay has been exacerbated by years of high inflation.
This matter affects not only seniors themselves but also middle-aged people trying to care for ailing parents. An increasing number of adults are “sandwiched” between raising their children and taking care of their elderly parents and, as a result, are trying to juggle multiple obligations and expenses.
The good news is that there is already a working model in place that can be expanded to help meet these needs. Expanding the existing au pair program to include elderly care is one relatively simple way to enable more senior citizens to receive the support they need to age in place. The program, housed under the State Department, already facilitates caregiving arrangements for host families to bring 18- to 26-year-olds coming from outside of the country to live with them in their homes. Currently, however, only host families with young children are eligible to bring in an au pair.
Under the au pair program, prospective au pairs undergo vetting procedures to ensure they are suitable and can safely live with families. Host families or individuals are expected to provide room, board, access to cars and other incidentals, and financial support. They are required to follow rules set by oversight entities to ensure au pairs are treated fairly. The current cost of hosting an au pair, in addition to providing room and board, is about $1,800 per month. Given that full-time at-home support for seniors costs about $60,000 per year, or $5,000 per month, this option is comparatively affordable, especially for a senior who has a spare bedroom.
In addition to expanding the au pair program to include senior care, policymakers should consider modifying the age requirement. There is no reason to limit caregiving opportunities solely to people aged 26 and under, and this change would also increase the supply of qualified au pairs and encourage greater participation in the program.
Moreover, there’s no reason to stop with the au pair program. To increase the supply of caregivers even more, Congress can create an American Caregiver Program replicating the au pair program infrastructure to provide U.S. citizens and residents with similar work opportunities. Current regulations on live-in work arrangements for domestic workers are often unworkably complex, which is why few households employ in-home workers.
Importantly, a new American Caregiver Program and expanding the current au pair program would cost the government and taxpayers close to nothing.
In addition to making it easier to meet seniors’ care needs, engaging in-home caregivers might help alleviate feelings of isolation and loneliness. Right now, many older people are yearning for more companionship. In 2023, 57% of U.S. adults aged 65 years and older reported feeling lonely. Loneliness and social isolation can be detrimental to a person’s health and well-being and are linked to various physical and mental health problems, including dementia, stroke, heart disease, anxiety, and depression.
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Because strong social connections are associated with increased longevity and better health, live-in caregiving will enable people to grow old in their homes while also preventing social disconnection. According to a 2021 study published in the American Association for Geriatric Psychiatry, companionship intervention is a successful strategy for alleviating loneliness and improving the mental health of older people.
For too long, the caregiving needs of elderly people have been overlooked. Many seniors have devoted their lives to service to others — as parents, grandparents, mentors, and friends. They deserve our support. By expanding the au pair program to include senior care and creating an American Caregiver Program, we can help ensure that they have the opportunity to live in the comfort of their own homes as they age and that they can do so with dignity and companionship.
Heather Madden is the policy staff director at Independent Women’s Forum.