A Modest Foreign Policy Proposal for the Middle Class (and The State Department’s Easiest Win): Au Pair for Senior Care

My mother needs an au pair. Most of her friends do as well. In fact, most of my friends’ parents do, too. I suspect a myriad of American seniors are in same situation as my mother—healthy enough to manage with help but unable to live alone, no cognitive issues, fairly independent but not safely so, and desperately wanting to stay in their home. She is hopefully years away from needing round-the-clock nursing home care, yet all options are staggeringly unaffordable.

The United States’ middle class needs an affordable stopgap to ease the burden for aging seniors and their families, who fast run through their hard-earned nest eggs to have care in old age. The State Department can partially ease this burden by expanding its Au Pair Program—a cultural exchange work-study program providing care for babies, toddlers, and kids—to include caring for seniors. The Au Pair Program itself comes at zero cost to taxpayers, as it is administered by private sector agencies who charge a fee, and is then paid for by host families. The State Department would need to work with Congress to amend Title 22 CFR Section 62.31 - Au Pairs to expand the remit of this program beyond children, although bipartisan support for middle-class seniors and their families seems likely.

This is an unapologetically tactical proposal in an age grasping for sweeping strategic solutions to help the middle class. A small change to the Au Pair Program could be one of the most simple, tangible, and appreciated examples of how an agency promoting “foreign policy for the middle class” can do just that.

Au pairs for seniors is a stopgap solution: it plugs a hole for a stage of aging, but is far from a wholesale solution to our national crisis in affordable eldercare. That said, there is no time to wait for politicians to agree on a longer-term solution to make getting old in the United States affordable. What does my mother need? Companionship; a watchful eye for her safety; an extra pair of hands around the house; some light housework, laundry, and to make sure she eats a healthy meal; and someone to drive her for errands, a trip to the library, or to see her friends. Her needs are essentially the same job description for a current au pair. The cultural exchange and interaction could be as big a benefit to elders as toddlers. Moreover, au pairs want to improve their English language and learn about American culture, arguably easier to do with an adult than a small child. Many seniors live alone and are desperate for conversation, happy to teach and explain things, and can always use someone young to help them with basic tech questions.

This care crisis is urgent. The cost of senior care in the United States is crushingly expensive and disproportionally hits the middle class, as they have hard-earned savings, just not enough. Many states try to ease the burden and keep seniors in their home through community programs, but alternatives for this transition stage—between full independent functionality and moving to a care facility—are few, expensive, and vary widely from state to state. The cost for live-in care ranges from $300 to $700 a day in Massachusetts. According to the National Investment Center for Seniors Housing & Care (NIC), the most basic assisted living starts at $60,000 a year on national average, but can cost far more depending on services, location, and accommodation. This 2019 NIC study further assessed that more than half (54 percent) of middle-income seniors would not have enough assets to cover projected costs by 2029, even if they generated equity by selling their homes and committing all of their annual financial resources. Costs have skyrocketed since this 2019 study due to COVID-19, and labor shortages are hitting the senior care services sector particularly hard.

Compared to this, au pairs are a bargain and a potential godsend. According to Cultural Care Au Pair, one of the oldest and largest agencies, the estimated monthly cost for an au pair is $1,775, approximately $21,299 annually for forty-five hours a week live-in, with two weeks of paid vacation, in addition to room and board. EduCare Au Pair, a related State Department–administered program, offers thirty hours a week at 75 percent of the cost of traditional au pairs, allowing more time for study. The au pair annual educational stipend paid by the host is $500 toward six college credits, about the cost of one day of full-time live-in healthcare in many states.

The nationwide infrastructure to support an expanded au pair program already exists. Fourteen agencies are currently approved by the State Department to administer the U.S. Au Pair Program. The agencies screen and select au pairs between the ages of 18 and 26, using offices and networks of professionals around world. They do criminal background checks, interviews, review references, and verify education level and English-language qualifications. Before COVID-19, approximately seventeen thousand au pairs came to the United States each year through these agencies to care for children. Once the au pairs arrive, the agencies provide orientation and training, monitor au pair participation throughout the program—including monitoring the welfare of the au pair and liaising with the host—and usually provide platforms for au pairs to socialize with each other. The period of stay is twelve months, with the option to extend up to another twelve months.

Importantly, there is no statutory cap on J-1 visas for these cultural work-study exchanges. It is not a challenge to the immigration system, as it is a long-standing exchange program where students go home at the end.  Host families choose the country of origin and the individual au pair, with most candidates from Asia, Australia, Europe, and Latin America. The expansion of the Au Pair Program could make a huge difference in the lives of middle-class Americans. While it can be done without taxpayer support, a credit or benefit system for lower-middle-class seniors, which includes a substantial amount of women who left the workforce to raise families, could make the program more widely accessible.

It is time for creative solutions. The senior care challenge is set to get exponentially worse, as retired populations are growing fast and life expectancy is getting longer. According to the Georgetown Center for Retirement Initiatives, “in 2000, there were 35 million Americans age 65 and older. This number grew to 49.2 million in 2016 … By 2030, this number will grow to 74 million, and 98 million by 2060,” citing analysis by the Urban Institute. For seniors lucky enough to have family, the burden can be shared, but often at the expense of the so-called “sandwich generation” caught between covering soaring senior care costs and soaring child care costs, while families struggle to remain in the labor force to be able to save for their own retirement.

The worst kept secret is that many middle-class seniors across the United States, who worked hard their entire lives, decide to sell down all their assets, forcing their own bankruptcy, to qualify for state support and Medicaid, putting more strain on an already-overburdened system. These are normal middle-class seniors, not con artists trying to game the system. They do so to not burden their adult children, or because they do not have a choice. They are proud middle-class Americans and it is demoralizing, unacceptable, and fiscally irresponsible in one of the richest countries in the world.

In the United States, the middle class cannot afford to grow old. The country needs a systemic overhaul and political will to care for its aging population and to support middle class families trying to make ends meet. Perhaps someday that will happen. In the meantime, au pairs for senior care could be an immediate plug in the system. And my mother, my friends’ parents, and all the other families struggling to keep mom at home could thank the State Department.

This post was written for the Council on Foreign Relations’ Renewing America initiative—an effort established on the premise that for the United States to succeed, it must fortify the political, economic, and societal foundations fundamental to its national security and international influence. Renewing America evaluates nine critical domestic issues that shape the ability of the United States to navigate a demanding, competitive, and dangerous world. For more Renewing America resources, visit https://www.cfr.org/programs/renewing-america and follow the initiative on Twitter @RenewingAmerica.