The hardest part of Culix Wibonele’s first job in long-term care was not getting injured.

Originally from Kenya, Wibonele worked as a certified nursing assistant in Atlanta in 2014. She went to the homes of mostly older clients, helping them with everything from bathing to cooking. Wibonele worked alone and sometimes had to lift clients much bigger than her.

It was demanding work and paid only $9 per hour with no benefits. If not for Wibonele’s second job as a babysitter and her husband’s income, they would not have made ends meet while supporting their four children.

“My paycheck, you know, was literally just nothing,” Wibonele said. “I was kind of shocked, like, the amount of work we (were) expected to do and the pay you get at the end.”

Wibonele’s experience reflects broader trends in the long-term care workforce. Those who tend to older adults in settings like private homes and assisted living facilities across the U.S. face low wages and risk of injury while the industry struggles with staff shortages, CNHI News and The Associated Press found as part of an examination of the state of America’s long-term care.

Meanwhile, demand for these workers is rising as the population ages. By 2030, roughly 20% of the U.S. population will be 65 or older, and that share will continue to grow, according to the U.S. Census Bureau.