WOODLAND, Calif.—A labor shortage is worsening in one of the nation’s fastest-growing occupations—taking care of the elderly and disabled—just as baby boomers head into old age.

Nursing homes and operators of agencies providing home-care services already are straining to find enough so-called direct-care workers, who help the elderly or disabled with such things as eating and bathing. They also face looming retirements in the current workforce, in which one-fifth of workers are 55 years old or older.

The reasons for the shortage: pay is low, typically less than $12 an hour, injury rates are high, and the work can be unpleasant and physically draining.

Nursing aides say they often are being asked to work double shifts at short-staffed nursing homes. Indeed Inc., which runs an employment website, says the number of U.S. nursing-home-aide jobs advertised in December was 10,922, up 120% from a year earlier

Demand will continue to grow. The number of Americans 65 years and older is projected to reach 73 million in 2030, up from 40 million in 2010. Serving that growing population will require five million direct-care workers in 2020, up 48% from the 2010 level, according to U.S. government projections.

Eloise Burns, a 73-year-old nursing aide at the Cottonwood Healthcare Center here in Woodland, says she aims to retire next year. Gordon Hodnett, Cottonwood’s administrator, is looking for aides who can anticipate residents’ needs, not just respond to a call button. Finding them, he says, “can be difficult.”

Nursing aides, mostly women, do some of the toughest work in nursing homes—hoisting residents out of bed and changing their diapers. They are among the residents’ closest companions, spending more time with them than relatives typically do, and are often first to spot a turn for the worse that requires medical attention. Their rate of occupational injury, usually related to back or muscle strains, is higher than construction and factory workers. Aides are sometimes kicked, bitten or spat upon by residents suffering from dementia.

Such demands lead to high labor turnover. Between 43% and 75% of nursing aides turn over each year, various studies have found. That compares with a 28% rate for all health-care and social-assistance jobs in 2012, according to U.S. government data.

“They are absolute saints,” says David Gifford, a senior vice president at the American Health Care Association, which represents nursing-home operators. He says some operators are trying to reduce turnover by seeking employee suggestions and giving aides more consistent schedules and duties.

Becoming a nursing aide is fairly easy. The federal minimum-training requirement is 75 hours, though some states require 150 to 175 hours. No college degree is needed, and even high-school degrees aren’t always required.

Research by Nicholas Castle, a health-policy professor at the University of Pittsburgh, shows nursing homes with higher turnover levels tend to have worse records for quality, as measured by such things as the number of patients with bed sores or urinary-tract infections.

Some industry leaders agree high turnover damages the quality of care. “If you don’t really know the individuals you’re taking care of, you can’t always address their needs in a timely manner,” says Dr. Gifford of the American Health Care Association. It is also costly. Hiring a new aide typically costs about $4,000, including recruitment and administrative expenses, said the group.

Low pay doesn’t help. The median hourly wage for nursing aides is $11.74, according to the U.S. Labor Department, compared with $16.71 per hour for all occupations.

“These people are the actual backbone of nursing-home care,” says Lew Little, chief executive officer of Harden Healthcare LLC, Austin, Texas. Hourly pay for nursing aides at some of Harden’s nursing homes in Texas starts at $8.25, or $1 above the minimum wage.

“We’d love to be in a position” to increase aides’ pay, Mr. Little says. But he sees “no clear path” toward higher wages because of cutbacks in Medicaid and Medicare reimbursements, the main source of operators’ revenue.

Nursing aides have long suffered from a high injury rate. Nonfatal injuries are measured in terms of those serious enough to cause days away from work, transfers to a different job or restrictions on work—a gauge known as the DART rate. Privately owned nursing-care facilities in 2011 had a combined DART rate of 5.3 cases per 100 full-time workers. That was modestly better than the 2010 rate of 5.6, but close to triple the average of 1.9 for all occupations. It is more than double the 2.1 rate for construction and 2.4 rate for manufacturing.

Renee J. Tillman of Copperas Cove, Texas, quit nursing-aide work at age 57 and now is doing home health-care work that doesn’t involve lifting. “After 30 years, my body told me, no more,” Ms. Tillman says. She still has pain in her back, wrists and neck. Many of her colleagues, she says, walk with a stoop.

Last April, the U.S. Occupational Safety and Health Administration, or OSHA, announced a “national emphasis program” to reduce injuries of nursing-home workers. The program involves more inspections of homes with high injury rates.

The American Health Care Association says improving worker safety is a priority. Still, “it is difficult to engineer every hazard out of this industry,” says spokesman Greg Crist.

Many nursing aides say they are asked to look after more residents than they can safely handle. On average, U.S. nursing homes have one aide on duty for every 10 residents, estimates Charlene Harrington, a professor emeritus at the University of California San Francisco. The typical ratio should be about one for every seven on day and evening shifts, she says.

Some nursing aides say they have to care for 15 or more residents at a time. “You can’t possibly do it,” says Dr. Harrington. “That’s when they get into trouble because they try to lift the patients by themselves.”

There is no federal standard for nursing-aide staffing levels and only about two-thirds of the states set minimum levels. Mr. Crist of the industry association says it is “difficult to determine” whether inadequate staffing levels contribute to workplace injuries.

Dorie Seavey, an economist at Paraprofessional Healthcare Institute, a New York-based nonprofit that advocates better staffing for the industry, says better pay and working conditions for aides would reduce turnover and workers’ compensation claims for injuries. She has estimated turnover costs among aides and other “front-line” workers in long-term health care at $6.3 billion a year, including recruiting and training.

A visit to the Cottonwood nursing home in Woodland shows the bonds between aides and residents. At dinner, Ken Musyoki, a 29-year-old native of Kenya, is wearing white sneakers and a maroon uniform. He gently helps a resident into her dining chair. “Slowly! Slowly! There we go,” he says, squatting as he guides her. Another resident is unhappy about whipped cream in her fruit cup. He dashes to the kitchen to fetch plain fruit, presents it and says, “Problem solved!”

Mr. Musyoki, who has been an aide for 3½ years and works out in a gym daily, says injuries can be avoided by using “proper body mechanics.”

Sonia Dhaliwal, 27, another aide at Cottonwood, is a native of India. While she was helping a resident put on socks one day, the resident punched her in the eye. “You have to be ready physically and mentally,” she says. Even so, Ms. Dhaliwal says: “They’re our family. We really do love them.”

Please follow and like us: