Pauline Beck is the mother of six children and she cares for nieces, nephews and foster children. Ms Beck is also a Home Health Aide– a profession that is undervalued, underpaid, but absolutely critical to the sustainability of our health care system, our work system, and our families.

Pauline Beck is the woman President-elect Obama shadowed for a full day in August 2008 as part of the "Walk a Day in My Shoes" programme. At the end of that day Mr. Obama said: "Walking just one day in Pauline's shoes was probably the best experience I've had on this campaign so far."

Ms Beck is American but she could be from Bermuda, the Philippines or just about anywhere. She works full-time for minimum wage ($10.50 an hour in a California state-sponsored home-care programme) but she does not have sick pay, vacation pay, or overtime pay. Many work days are longer than the regular 40 hours because the 85 year-old gentleman she cares for depends on her and one other care worker for total home care support.

Is it any wonder that the health-care profession is facing a global shortage of monumental proportions? Anyone who has tried to hire a health care worker in Bermuda knows just how bad the shortage is when it comes to good, qualified, reliable workers in the hospital, the home, or a long-term care facility.

PHI, the Paraprofessional Healthcare Institute of America, has a pretty alarming graph on its website, www.phi-qcqj.org. It shows a yawning gap between the exponential growth of those aged 65 and above through to 2030, and the almost flat-line in growth of women in the age bracket 25-44. This graph shows that women, who have historically been the majority of persons in nursing and other direct-care work, can no longer meet the demand.

The HRSA (Human Resources and Services Administration of the US) has also issued some alarming statistics. They have identified nursing as America's largest health care profession with almost three million registered nurses in 2007. At the same time, they advise that there is a nursing shortage that could reach a deficit of one million nurses by 2020.

In addition, the PHI estimates that between 2006 and 2016, the jobs described as Personal & Home Care Aides and Home Health Aides are the second and third fastest growing occupations, increasing by 51 percent and 49 percent respectively over that time period, followed by Nursing Aides, Orderlies, and Attendants at 18 percent.

The overall winner as the number one, fastest-growing occupation in the US from 2006-2016 is that of Registered Nurse.

And herein lies the rub. The average age of nurses is rising. By 2010 it is anticipated that 40 percent of nurses will be over the age of 50. Alarmingly, there are not enough nursing professors, training facilities or adequate budgets to meet the training demand. In the US alone, in the academic year 2007-2008, more than 40,000 qualified applicants were rejected due to insufficient capacity in training programmes.

Furthermore, the average age of nursing professors is already above 50 and the average age at which they retire is 62. This means we can expect an ongoing collision of rapidly growing demand with diminishing capacity to train registered nurses to the high academic standards of a four-year Bachelor in Science of Nursing (BSN) degree.

This does not bode well for quality of care unless radical steps are taken to reverse the current trend. Researchers reporting in various American medical journals point to a direct relationship between registered nurse staffing levels and outcomes for hospitalised patients that are framed in terms of "survival advantage" or "survival disadvantage". In simple terms, a 2003 study found a direct connection between higher numbers of BSN nurses in hospitals with a lower rate of death in hospitals.

Knowing that failure to plan is planning to fail, we absolutely must address this crisis as a top priority. We must fully resource the training of BSN nurses. We must also raise the bar for para-professional direct-care workers by valuing their work, by providing ongoing training and employment benefits that are routinely denied the hourly-paid, and by paying them a decent living wage. Failure to do so puts each and every one of us at risk, including Pauline Beck.

Marian Sherratt is Executive Director, Bermuda Council on Ageing. She writes on issues concerning our ageing population each month in The Royal Gazette. Send email responses to info@bdaca.org