The concept of the "care" or "caring" economy seems finally to be having its day. The care economy involves both paid providers of care -- home care workers, day care providers, nursing home employees -- and unpaid caregivers -- parents and grandparents of young children or older children with disabilities and children of aging parents.
The pandemic has shed a light on how important caregivers are to our society and our economy, and how unappreciated they have been. Caregivers continued to go to work to care for elderly individuals at home, in assisted living and in nursing homes despite the dangers of leaving the home during the height of the pandemic. Millions of women left their jobs and have not returned because their children were not going to school.
Paid caregivers are usually underpaid. Unpaid caregivers are usually stretched thin and undervalued, at least by society if not by their families. Both groups are mostly women of color and many fall into both categories -- underpaid caring for other people's children or parents and unpaid caring for their own.
According to the U.S. Bureau of Labor Statistics, 86% of the 4 million paid caregivers in the United States are women earning a median wage of $13 an hour. PHI, formerly the “Paraprofessional Healthcare Institute,” reports that 18% live in poverty. Massachusetts employs the fifth highest number of home health and personal care aides in the country after the much larger states of California, New York, Texas and Pennsylvania, and the third highest average wage at $16.29 an hour, trailing just Alaska and North Dakota.
Now that there's a labor shortage and salaries for other relatively unskilled work are rising, it's increasingly difficult for home care agencies and nursing homes to find employees. Low pay also leads to turnover. One study reports a 99% median annual turnover of nursing assistants at nursing homes even before the pandemic. This adversely affects quality of care.
Recognition of Greater Need
Fortunately, policymakers are beginning to recognize the need to invest more in caregiving, both for children and older adults. The Biden budget bill would expand daycare for children nationwide. The federal government predicts that we will need an additional 1.3 million direct-care workers for the elderly by 2029, and that's before the bulk of the Baby Boomers will need care.
In fact, we're in a bit of a lull in the need for caregiving since it's the so-called Silent Generation born during the Depression and World War II that are in their 80s today, of whom there are 21 million in the United States. The average age of the 70 million Baby Boomers is 65. In 20 years, it will be 85 and the need for caregivers will be tremendous. We may need to change our immigration policies. Currently, a quarter of direct-care workers are immigrants.
The public recognition that we need to better train and better pay our caregivers is partly the result of advocacy by such organizations as the National Alliance for Caregiving, the Eldercare Workforce Alliance, and the National Domestic Workers Alliance started by Ai-jen Poo, winner of the MacArthur Award. Poo points out that working conditions for many caregivers can be terrible since many work for private families, some of whom are trying to make ends meet themselves or don't satisfy basic requirements of employment, including workers compensation insurance, paid time off, unemployment insurance, or payment into Social Security. No one sees their working conditions because they occur behind the closed doors of private homes. These caregivers did, however, benefit from expanded unemployment insurance during the pandemic which was enhanced to include self-employed workers and those whose employers had not paid into the system.
I've argued before for paying caregivers more. It's not just for them. It's also for all of those receiving care or who might need to in the future. Better pay means higher quality care and more availability of caregivers. We also need to make it easier for private employers to follow the rules and pay into the Social Security, unemployment and workers compensation system.
(For more information on this topic, read "The Invisible Caregiving Workforce" on Next Avenue.)