You’re ready to leave the hospital but don’t feel able to care for yourself at home.

Or, you’ve completed a couple of weeks in rehab. Can you handle your medication regimen, along with shopping and cooking?

Perhaps you fell in the shower, and now your family wants you to arrange help with bathing and getting dressed.

There are facilities that provide such help, of course, but most older people don’t want to go there. They want to stay at home.

When older people struggle with daily activities because they have grown frail, their chronic illnesses have mounted or they have lost a spouse or companion, most don’t want to move. For decades, surveys have shown that they prefer to remain in their homes for as long as possible.

That means they need home care, either from family and friends, paid caregivers or both. But paid home care represents an especially strained sector of the long-term care system, which is experiencing an intensifying labor shortage even as an aging population creates surging demand.

“It’s a crisis,” said Dr. Madeline Sterling, a primary care doctor at Weill Cornell Medicine and the director of Cornell University’s Initiative on Home Care Work. “It’s not really working for the people involved,” whether they are patients (who can also be younger people with disabilities), family members or home care workers.

“This is not about what’s going to happen a decade from now,” added Dr. Steven Landers, CEO of the National Alliance for Care at Home, an industry group. “Do an Indeed.com search in Anytown, USA, for home care aides, and you’ll see so many listings for aides that your eyes will pop out.”

Against this grim backdrop, however, some alternatives show promise in upgrading home care jobs and in improving patient care. And they’re growing.

Researchers and elder care administrators have warned about this approaching calamity for years. Home care is already among the nation’s fastest-growing occupations, with 3.2 million home health aides and personal care aides on the job last year, up from 1.4 million a decade earlier, according to PHI, a research and advocacy group.

But the nation will need about 740,000 more home care workers over the next decade, according to the Bureau of Labor Statistics, and recruiting them won’t be easy. Costs to consumers are high — an average $34 per hour for a home health aide last year, the annual Genworth/CareScout survey shows, with big geographic variations. But the aides take home less than $17 an hour, on average. These remain unstable, low-paying jobs. Of the largely female workforce, about a third immigrants, 40% live in low-income households and most receive some sort of public assistance.

Even if the agencies that employ them offer health insurance and they work enough hours to qualify, many cannot afford their premium payments.

Unsurprisingly, the turnover rate approaches 80% annually, according to a survey by the ICA Group, a nonprofit organization that promotes co-ops.

But not everywhere. One innovation: home care cooperatives that are owned by the workers themselves. The first and largest, Cooperative Home Care Associates in the Bronx, began in 1985 and employs about 1,600 home care aides. The ICA Group counts 26 such businesses nationwide.

“These co-ops are getting exceptional results,” said Dr. Geoffrey Gusoff, a family medicine doctor and health services researcher at UCLA. “They have half the turnover of traditional agencies, they hold onto clients twice as long and they’re paying $2 more an hour” to their owner-employees.

Through an initiative to provide financing, business coaching and technical assistance, the ICA Group intends to boost the national total to 50 co-ops within five years and to 100 by 2040.

Another approach gaining ground: registries that allow home care workers and clients who need care to connect directly, often without involving agencies that provide supervision and background checks but also absorb roughly half the fee consumers pay.

One of the largest registries, Carina, serves workers and clients in Oregon and Washington state. Established through agreements with the Service Employees International Union, the nation’s largest health care union, it serves 40,000 providers and 25,000 clients.

Carina functions as a free “digital hiring hall,” said Nidhi Mirani, its CEO. Except in the Seattle area, it serves only clients who receive care through Medicaid, the largest funder of care at home. State agencies handle the paperwork and oversee background checks.

Hourly rates paid to independent providers found on Carina, which are set by union contracts, are usually lower than what agencies charge, while workers’ wages start at $20 and they receive health insurance, paid time off and, in some cases, retirement benefits. Other registries may be operated by states, as in Massachusetts and Wisconsin, or by platforms like Direct Care Careers, available in four states.

The U.S. has never committed to paying for long-term care for the middle class, and it seems unlikely to do so. Still, savings from innovations like these can reduce costs and might help expand home care through federal or state programs.