By: Van Ton-Quinlivan
In my last blog, I shared an idea we’re exploring at Futuro Health: what if care workers could own a stake in the care economy, not just earn a wage in it? Today I want to step back to the bigger question driving that work.
Who will care for us as we age?
Most of us want to grow old at home. But at some point, whether it’s a fall, a diagnosis, or the slow progression of dementia, we or our parents will need help with the basics of daily life. The people we’ll count on are direct care workers: personal care aides and home health aides. We need more of them than any other kind of caregiver, and they leave their jobs at rates of 60–80% a year. With that much churn, none of us can count on aging with peace of mind.
The numbers make the urgency plain. By 2060, Americans 65 and older are projected to reach nearly 89 million. An estimated 70% of people turning 65 will need long-term services and support. And millions of direct care jobs will need to be filled over the next decade.
Behind those figures are families already making hard choices. Adult children are juggling careers and caregiving. Older adults are working to stay independent. Health systems are realizing that what happens outside the hospital shapes outcomes as much as what happens inside it.
It’s not a training problem
As CEO of Futuro Health, I’m often asked whether the answer is more training. It isn’t. Quality direct care training is widely available. We know. Futuro Health alone trains for more than 20 allied health occupations across nine states and DC. Our Scholars average 31 years old, 90% come from multicultural communities, and 46% are bilingual. They complete at rates above 90%, compared with 40–70% at community colleges with the same open-door enrollment.
It’s not a funding-for-training problem either. Direct care training costs little compared with other in-demand allied health roles. Programs like the California Department of Aging’s CalGrows have already funded training options across many providers, including 60 upskilling modules Futuro Health developed for workers who care for older adults.
It’s an ownership problem
The real issue is the job itself. Direct care work makes aging in place possible, yet it too often comes with low wages, unpredictable hours, and no path to advance. When the job doesn’t sustain the worker, the worker doesn’t stay. Continuity of care suffers, and families and communities absorb the instability.
So the question isn’t only how to fill these jobs. It’s how we rethink the way care is delivered, and who gets to build and own it.
From caregiver to care owner
What if we saw direct care not only as a workforce shortage, but as a pathway to economic mobility, entrepreneurship, and community wealth?
That’s the thinking behind Futuro Health’s emerging Care Enterprise Network™. Through three roundtables with regional, state, and national leaders across sectors, we’re exploring how training, shared infrastructure, and access to capital could help experienced caregivers launch and grow their own care enterprises.
Picture it: caregivers building businesses in the neighborhoods they know. Families finding trusted care close to home. Communities keeping the value of care work local. And people whose work has long been undervalued finally building multigenerational wealth from it.
A wicked problem calls for all of us
This is what planners call a wicked problem: many causes, no single owner, and no simple fix. No one organization can solve it. It will take health systems and health plans, impact investors, policymakers, educators, philanthropy, aging experts, and caregivers themselves, each bringing their own tools and thinking beyond their silos.
If you’re working on any piece of this puzzle, I want to hear from you at partnership@futurohealth.org.
