I think the main problem with the personal care assistant isn’t so much the pay is so low but rather it’s hard for people to actually pay someone full time (or even part time) to care for someone.

A full-time care taker is also often living in the house. So, even if they are are only getting paid $22k, that money isn't really going to any expenses.

They are likely getting paid more than that anyways.

I'm not sure how "often" but some do.

There might be people with special arrangements but if you are like the people I interact with then you probably engage with an assisted living agency for anywhere from $18-$30/hr. Let's take the low number as an example. $18 * 24 * 365 = $157.7K per year. How many people can afford $150k just for care? Not very many.

And $18/hr is on the very low end of the spectrum. If you're at $30+/hr that's $250K+ on up not including medical, insurance, etc. IME, caretakers are normally paid out-of-pocket, too. It's expensive business, especially if you have to do it for any period of time.

Assuming the actual work to care for an elderly with non-full-time need is up to 8 hours a day, paid at $12 per hour, the cost would be 8 * 365 * $12 = $35,040 per year. Other family members can hopefully cover the rest of hours if needed.

My question: What are the benefits of going through an agency when the cost could be over 100% higher than hiring someone directly? Hiring direct allows you to screen in person and makes sure there is a good fit of personality and other factors too.

My gut response is, this could be ripe for Uber-like disruption. I had relatives who used home-care assistants and another who worked as one, and the discrepancy between cost and compensation seemed quite stark indeed.

It has been tried.

That was the whole point of HomeHero[0] which tried to do that model but was thwarted by legislation.

Again, I'm no expert but I've been spending a lot of time in this area lately and ultimately while it's nice to think about it's also tough:

1. Scheduling. Finding someone to come by once or twice a week to do some chores and housework is easy. But if someone needs 24x5, 24x7, or some weird incantation of it then only a single person scheduled just won't work.

2. Turnover. I'm not sure how it is in other places but turnover here is high. Sometimes you might not even get notice when someone quits. That's why a lot of people go with agencies—they take care of all of that hassle as well reporting. Also, when you have people with memory problems, there are special people needed to take care of them. People who don't mind being cursed at or belittled. Some people just can't handle it.

3. Legal issues. IIRC, California does stuff where if you work more than 8 hours in a day you can make overtime—even if that's the only day you work. Some of the laws and handling as well as reporting on this stuff make (especially if you do have some sort of insurance or coverage for long-term care)... well let's just say I'm glad I don't have to do any of that.

[0]: https://medium.com/@kaleazy/theres-no-magic-in-venture-backe...

because you're already tired and taxed from dealing with a senior with dementia or a child with severe mental retardation, and there aren't enough hours in the day as it is.

if 22000 is the mean they are equally like to be getting paid less.

(well actually if it's the median it's equally likely but for practical purposes...)

Those numbers make sense at a glance. A truck driver, despite the popular image, more closely resembles specialized work than un-specialized. There are specific skill and documentation requirements to become a Truck driver. The healthcare work you linked to just requires a high-school diploma and no certs, if it's a job like caring for the elderly then the main factor driving up the wage is a shortage of people willing to deal with the challenges of working with an elderly person which can include rude or mentally ill families/customers, excrement, and being comfortable cleaning and/or bathing another human being.

Trucking is absolutely skilled work. It's crazy that people think it isn't.

You start by saying how a personal care assistant is rather unspecialized work and then go on to ruminate on the peculiarities of the job that most people wouldn't want to deal with.

Why isn't trucking an unskilled job just with negative features (long hours alone, danger to health given the erratic hours) too?

>You start by saying how a personal care assistant is rather unspecialized work and then go on to ruminate on the peculiarities of the job that most people wouldn't want to deal with.

Correct. Being willing to endure undesirable work isn't usually included in the definition of skilled labor unless that tenacity is accompanied by another requisite skill or certification. I'm not trying to argue that it isn't a socially valuable skill, just that given the bar for entry it isn't surprising the wage is that low.

>Why isn't trucking an unskilled job just with negative features (long hours alone, danger to health given the erratic hours) too?

Because you've skipped over the training and licensing required to legally operate as a truck driver. You need a Commercial Drivers License if nothing else and many states require the completion of specialized courses before awarding an applicant their CDL. That CDL represents a specialized skill-set without which a person simply won't be permitted to operate as a trucker. Physical endurance and mental tenacity are critical traits in this instance too but they're far from being enough to get you hired.

Edit: Something else I glossed over, but which seems relevant because this is predominantly a tech oriented forum is that the average Cost of Living in America is in line with the wage being paid to the Home Health Aide. It might not be enough for San Francisco or a coastal area, but it's enough in general to pay rent and save some money on the side for additional schooling or whatever purpose appeals.