What it's About

Most people aren't close to feeling elderly -- and they report feeling younger than they are -- yet baby boomers are helping the elder care industry expand rapidly. As a group they increasingly need companionship, professional homemaking, personal care support and healthcare support.

Senior care work is often tiring both emotionally and physically. But for those who have callings for caregiving, jobs in senior care can be wonderfully rewarding. Here are profiles of various direct service roles in the industry.

In This Article:
Home Care Aides (Companions and Homemakers) ↓
Health Aides, Nurse Assistants and Orderlies ↓
Licensed Practical Nurses ↓
Registered Nurses ↓
Social Workers ↓
Activities Directors ↓
Psychiatrists ↓

Home Care Aides (Companions and Homemakers)

Home care aides for seniors are also called elder companions and professional homemakers. All formal training for this role can be on-the-job; a specific education isn't required. Essential character traits include being compassionate, pleasant and reliable. Home care workers must also enjoy independence and do well without supervision.

Responsibilities of elder companions and homemakers include making house calls to:

  • Provide companionship
  • Help with chores
  • Help clients take medications
  • Provide transportation to appointments

Ideally an elder companion has great conversational skills and plans activities that help keep their clients mentally stimulated. Working with a homecare agency, employees go through orientation programs to learn policies and best practices. The best homecare agencies also provide continuing education to help workers excel in their positions.

Senior caregiving job opportunities are widespread across the US. Finding a job may be relatively easy, and some of the best home care agencies provide health care, paid vacation days and other benefits to full-time workers.

A downside is that the hourly pay for these positions tends to be low despite the importance of the work. Often hourly wages are between $10 and $11 per hour, and the median yearly income for people in this job role was about $22,000 in 2016 according to the US Bureau of Labor Services.

Possibly the increasing demand for home care workers will put upward pressure on wages. The federal government estimates the need for home care aides to expand by 26% between 2014 and 2024, which is very significant expansion compared with US job growth overall.

Health Aides, Nurse Assistants and Orderlies

Health aides and certified nurse assistants (CNAs) work in seniors' own homes and in care facilities. They provide basic healthcare such as blood pressure monitoring, and they help with activities of daily living. Good physical strength is required because workers may need to lift or otherwise move their patients.

Compared with registered nurses and other facility staff, health aides and certified assistants have the most contact with patients. They tend to develop the closest relationships.

Orderlies work in senior care centers. They primarily keep the facilities clean and stocked, and some help move the residents (e.g., push wheelchairs).

Health Aides and Certified Nurse Assistants

Health aides and certified nurse assistants primarily help people with activities of daily living (also called ADLs). They provide basic healthcare too, although specifics vary with state law.

Typical responsibilities include the following:

  • Taking notes about seniors' health concerns
  • Measuring vital signs
  • Helping with medication management
  • Serving meals and helping seniors eat
  • Helping with bathing and dressing
  • Helping patients use the toilet
  • Repositioning and transferring patients

Health aides may work without formal training beyond what the employer provides.

Depending on state law, a person might require certification to work with patients' medications. Certified nurse assistants complete state-approved programs (generally one year of study) and then pass state CNA competency exams. In California the Red Cross is among the providers of state-approved CNA programs programs.

Orderlies

Orderlies work in senior care facilities to maintain cleanliness of the buildings and help transport patients (e.g, move people out of bed and into wheelchairs). A high school diploma is generally the minimum requirement in formal education.

Typical responsibilities for aides and assistants include the following:

  • Assisting patients with transportation about the facility
  • Cleaning equipment and the premises in general
  • Changing bed linens
  • Stocking supplies

Wages for these senior care jobs are relatively low. The US Bureau of Labor Statistics reports that the median yearly wage for an orderly or nursing assistant was just under $27,000 in 2016. Hourly pay is often from $12.50 to $13.

Most people in these jobs work full-time although part-time is an option. Shifts need to be covered for days, nights, weekends and holidays.

Licensed Practical Nurses & Vocational Nurses

Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) provide basic nursing care under the supervision of registered nurses and doctors. Their work environments range from private homes to nursing homes, general hospitals and correctional institutions.

The two jobs in senior care are identical; in most of the USA the workers are called LPNs, but in California and Texas they're called LVNs.

Common duties of LPNs and LVNs include:

  • Taking note of patients' health concerns
  • Measuring vital signs
  • Giving basic health care such as wound dressing
  • Giving medication and IV treatments*
  • Taking samples for lab tests*
  • Helping with bathing and dressing
  • Feeding patients when help is needed
  • Supervising newer LPNs/LVNs and orderlies*

* Depends on state law

To become an LPN or LVN, a person completes a year-long course and then passes the National Council Licensure Examination (NCLEX-PN). Training is usually completed at community colleges but is also provided in some high schools and hospitals. It includes subjects such as caregiving, biology and pharmacology. Students also get supervised clinical experience as job preparation. Accredited programs can be found through the National Council of State Boards of Nursing.

Add-on certifications are available, such as certificates in CPR and gerontology.

LPNs and LVNs earn considerably more than home care aides and orderlies. In 2016 their median annual wage was about $44,000 according to the Bureau of Labor Services. About 80 percent worked full-time.

People with these job titles may also advance through LPN-to-RN degree programs, which are shorter than traditional RN training programs.

Registered Nurses

Registered nurses (RNs) coordinate and directly provide patient care; supervise licensed practical nurses and other caregivers; and educate patients, families and the public about health issues and provide healthcare advice. Some move into teaching-only, consulting or administrative positions. Workplaces range from private homes to nursing homes, hospitals and universities.

To become an RN, typically a person earns one of the following:

  • Associate's degree in nursing
  • Bachelor's degree in nursing
  • Diploma from a nursing program

Another educational option for LVNs and LPNs is completing a bridge program. An LPN-to-RN bridge program lets a person earn a bachelor's degree in under four years by applying credits from LPN/LVN training.

In addition to becoming licensed, RNs may also earn certifications in specific areas of healthcare. Some that especially relate to jobs in senior care include:

  • Geriatrics
  • Physical rehabilitation
  • Nephrology (kidney care)
  • Critical care

Typical RN duties are the following:

  • Recording patients' medical histories and reports of current symptoms
  • Observing patients and recording the observations
  • Performing diagnostic tests and analyzing results
  • Collaborating with doctors and other medical care professionals
  • Setting up or modifying care plans
  • Administering medicines and other treatments
  • Teaching patients and their families how to manage conditions  
  • Supervising home health aides, nurse assistants and LPNs/LVNs

In 2016 the median annual pay for RNs was about $65,000 according to the Bureau of Labor Services. This worked out to approximately $33/hour.

Social Workers

Social workers help people manage and overcome life changes and challenges such as serious illness, marital separation or divorce, and transition from military life to mainstream society. They provide direct counseling and also refer clients/patients to community resources. Some social workers with advanced degrees -- clinical social workers -- may also diagnose and treat mental health conditions.

Common areas of social work include:

  • Assessing clients' situations, needs and strengths
  • Helping clients adjust to changes and other life challenges
  • Responding to crises situations such as a patient with a panic attack or a community struck by natural disaster
  • Providing psychotherapy
  • Referring clients to community resources to help improve well-being
  • Following up with clients after referrals to ensure that needs are met
  • Advocating for the people they serve

Employment settings range from private practice to community development centers, clinics and hospitals. Social workers may also teach or serve as consultants and policymakers in government.

One specialty area is healthcare social work. Those who are focused on older populations may be called geriatric healthcare social workers. Geriatric social workers help people understand and adjust to changes in health. Some common challenges that social workers address are:

For example, a geriatric social worker could help a senior transition to home after surgery by connecting them with services such as Meals on Wheels and home health care, and by counseling the patient and their family about how to handle emotional and mental strains of a long recovery. They may also share information about other senior living arrangements such as moving to an assisted living center or nursing home.

Hospice and palliative care social workers might also especially work with seniors. Hospice and palliative care supports patients who have serious and/or terminal illnesses. Workers also help the patients' families cope with grief. Some directly offer one-on-one and group counseling.

Many direct social work jobs are open to graduates with bachelor's degrees in social work (the BSW). To become a clinical social worker the steps are:

  1. Earn a bachelor's degree in virtually any field.
  2. Earn a master's degree in social work. Programs can be completed in one year.
  3. Complete two years of supervised clinical work.
  4. Pass the state licensing examination.

Doctoral programs are available too, leading to the DSW (Doctorate of Social Work) or a Ph.D. Doctoral programs are generally chosen by people interested in postsecondary teaching and research.

The Council on Social Work Education has accredited more than 500 bachelor's degree programs and more than 200 graduate programs in social work. Information about state licensing requirements is available via the Association of Social Work Boards.

Self-employed social workers may set their own hours, but social work could be needed at any time; crises don't check the clock or calendar! Generally social workers work full time and are able to work evenings, weekends and holidays. The Bureau of Labor Services reports that the median annual salary was about $54,000  in 2016.

Activities Director

Certified activities directors for seniors plan recreational programs that support health and general well-being. They work in senior living settings, community centers and adult day care centers.

The ideal person for the job is empathetic, patient and well-organized. Besides being experts in activity planning, activities directors need to effectively work with budgets and manage volunteers and other workers. They are "high energy" and able to work on their feet, but also stay focused for long stretches of desk work.

For the best job opportunities a person earns a bachelor's degree and then becomes certified by NCCAP, the National Certification Council for Activity Professionals. Typically the college major is therapeutic recreation or leisure studies. Some relevant college courses are in psychology, sociology, recreation programming, art and management. It's also possible to become NCCAP-certified with an associate's degree.

NCCAP certification is rigorous:

  • Applicants with bachelor's degrees need to complete 4000 hours of activity directing work as part of the program. Those with fewer college credits need to complete at least 6000 hours.
  • Requirements also include 30 hours of continuing education over the past five years and a satisfactory score on a certification exam.

To maintain certification a person needs to complete 30 hours of continuing education per two-year period.

Another certification option for those with bachelor's degrees is the National Council for Therapeutic Recreation Certification (NCTRC). Certification from NCTRC requires experience in the field and passing a set of written exams. To maintain certification a person needs to have 480 hours of work over five years. Additionally he or she needs to retake the certification exam or finish 50 hours of continuing education over five years.

In 2017 the median salary for certified activities directors was about $38,000 according to employee reports at Payscale.com.

Psychiatrists

Psychiatrists are essentially psychologists with medical degrees. Besides specializing in different psychological therapies, they may prescribe medication to support mental well-being.

Psychiatrists for seniors may work in private practice, for the government, or for senior care facilities.

Helping people manage and overcome anxiety and depression is a large area of work with seniors, as these challenges become more common with age. In this section about senior care jobs though, we focus on work done with Alzheimer's patients.

Evaluating a person for Alzheimer's disease or other dementia, psychiatrists need to rule out other causes of various symptoms. This requires collaboration with neurologists, physicians, social workers and other care providers. Typically the work of the psychiatrist includes:

  • Compiling the patient's physical and mental health histories
  • Collecting a social history such as family composition, education and employment
  • Giving mental health questionnaires and rating scale tests
  • Ordering lab tests such as blood tests and brain scans
  • Counseling patients and their families to support mental well-being

To become a psychiatrist:

  1. Earn a four-year degree in any area. Taking chemistry, biology and other pre-med courses is advised.
  2. Take the MCAT, which is a multiple-choice test. The MCAT may be taken multiple times until the desired score is achieved. The MCAT score is then included on applications to medical school.
  3. Complete medical school. Those who will become psychiatrists study human behavior, biology, pharmacology and other aspects of social science and medicine.
  4. Complete a residency (supervised work).
  5. Pass the US Medical Licensing Examination (USMLE) in order to work independently.

Continuing education is required throughout a psychiatrist's career to maintain medical certification.

In 2016 psychiatrists' average hourly income was nearly $100. Their average yearly income was about $200,000 according to the US Bureau of Labor Services, making psychiatry one of the best-compensated jobs in senior care.