Caregivers have taken on some of the worst burdens of the pandemic. Home care workers like Joyce Barnes in Virginia described to the Washington Post
last April how she was given paper towels and rubber bands to wear as masks and was expected to buy her own hand sanitizer to use at work. Child care workers like Rosa Carreño in California witnessed a system on the verge of collapse with thousands of fellow providers closing their doors
as the costs of care during the pandemic, including the additional staff needed to support distance learning, piled up.
The vast majority of direct care workers — a group that includes personal care aides, home health aides and nursing assistants who work in private homes, nursing homes and other settings — are women (86%) and people of color (59%)
. The under-valuing of caregiving work is directly linked to racism and sexism
, so it’s not surprising that caregiving is consistently — and wrongly — devalued as “unskilled” and “women’s work.”
Caregiving jobs should be recognized for what they are: essential. This means paying a living wage of at least $15 an hour, improving working conditions, ensuring basic benefits like health care and paid sick time, and guaranteeing the right to a union so caregivers have a voice on the job.
In a bold step forward, Biden campaigned on a plan
to address the full care spectrum. It’s time for Congress and the President to make good on these promises and go even further with principled legislation and executive action to address caregiver needs.
Caregiving legislation must recognize that health care, including care and services provided to people in their homes and communities, is a human right. Everyone who needs care deserves to live with dignity in the setting of their choice, supported by a workforce that is respected, protected and paid for the essential care they provide. By 2050, the population of Americans ages 65 and older will be nearly double what it was in 2012
, adding to the demand for care. However, low wages, lack of benefits, insufficient training and inadequate funding for these jobs result in turnover rates as high as 60%
and a shortage of dedicated workers.
The American Rescue Plan
(ARP) helped take a step forward with more than $12 billion for Medicaid home-and-community based services (HCBS)
in the short term, but we need policies that create more durable long-term solutions. That starts with a robust investment in Medicaid that is directed to both improve the quality of home and community care and ensure workers can provide for their own families while caring for others. And we should expand Medicare coverage of long-term care, including home and community care, and require private insurers, many of which are raking in billions in profits
during the pandemic, to cover additional homecare benefits.
Basic infrastructure, like roads and bridges, allows people to get to work. Child care, like home and community care, is also critical infrastructure for working parents and families. That’s why any caregiving agenda must finally implement a universal system that provides affordable, high-quality child care, directs support to providers to expand availability and ensures a living wage for child care providers. Expanding tax credits will not fix a desperately inadequate system. The ARP delivered $39 billion
to help child care providers stay afloat. Moving forward, we must deliver long-term funding and structural reforms to finally create universal child care for all families, regardless of their income, employment or immigration status.
One way to treat caregivers as the committed professionals that they are is to provide education and training opportunities with paid time off. But too many caregivers — more than half of whom are Black or Latina — can’t afford to take time off, pay for school and still pay their bills. One survey
found that private healthcare and social assistance workers have an average of $685 in monthly student loan payments. Biden can cancel up to $50,000 for every student loan debt holder and lift this crushing burden from caregivers.
Finally, caregivers deserve a pathway to citizenship, and any caregiving legislation must provide one. Thirty-one percent
of home care workers and 22%
of child care workers are immigrants. These dedicated caregivers deserve stability and a chance to live without fear, no matter their citizenship status or country of origin. A pathway to citizenship means caregivers can focus on providing quality care, rather than worrying about their families’ security.
As Congress and the White House begin drafting caregiving legislation, we believe it must make bold, structural changes to the ways in which people receive and provide care. This isn’t the time to nibble around the edges. We must reckon with what caregivers already know: The status quo is unacceptable, and we must build back better.