There are about 800,000 people, elderly and disabled, who qualify for subsidized home care on waiting lists to get that care. Some will end up in nursing homes, where they don’t need to be and where the threat of COVID-19 lingers indefinitely. President Joe Biden and the majority of congressional Democrats want to fix that. They originally proposed $400 billion over the next 10 years to provide home and community-based health services. That’s since been whittled down to $150 billion, one indication that it’s a huge sector of society that just doesn’t have the power of, say, a defense contractor to fight for itself.
“We Don’t Fix This Because We Just Don’t Care About Old People,” Joanne Kenen, Commonwealth Fund journalist-in-residence at the Johns Hopkins School of Public Health, writes in a op-ed for Politico. As a society, we don’t care about old people. It’s not just old people, but also disabled people. People who aren’t infants who need help feeding, bathing, and clothing themselves don’t have value in this society. The ancillary point is that those who provide that care, whether they’re family members or paid caregivers, don’t matter either.
Kenen cites a Kaiser Family Foundation survey last month that found that 1 in 5 Americans is relying on family for friends for care, and 20% of respondents providing that care are uncompensated. They report that they need help from a paid professional nurse or aide, but don’t have the money to pay for it. That means lost wages for family caregivers and for the people who aren’t hired to provide the care.
Those people, by the way, certainly wouldn’t be able to afford to provide care for their own loved ones. Home health care workers, the Economic Policy Institute (EPI) found in a new report, make on average $13.18 an hour, about half what the average U.S. worker is paid. That’s slightly better than a child care worker, who makes on average $13.50 an hour. Just under 26% of home care workers have employer-sponsored health benefits; only 20.7% of child care workers do. Despite the fact that children are our future, we don’t really care about them, either.
Or the deeply ingrained “historical and current ableism, sexism, xenophobia, and racism” the EPI posits causes the devaluation of care providers at all levels: “Child care workers are overwhelmingly women (94%) and disproportionately Black (15.6%, compared with 12.1% in the overall workforce) and Hispanic (23.6%, compared with 17.5% in the overall workforce),” the EPI found. “Similarly, home health care workers are also largely women (88.6%) and disproportionately Black (23.9%) and Hispanic (21.8%). More than one in five child care workers and roughly three in 10 home health care workers were born outside the U.S.” EPI says the hourly wage for these workers should be, at a minimum, between $21.11 and $25.25.
Care advocates are applauding any movement on this, though the $150 billion that passed in the House bill just scratches the surface of what’s needed. “[The] historic vote of support for home care comes at a time when the country needs it more than ever,” National Association for Home Care & Hospice (NAHC) President William A. Dombi said in a statement shared with Home Health Care News. “Health care at home is widely recognized as high value, high quality and highly preferred.”
Vicki Hoak, the executive director of the Home Care Association of America, told NBC News that her organization was “disappointed” by the reduced funding, “but we also recognize that this is a very big step and it’s about consensus and reaching compromise.”
“I just hope that people realize that we really do need to have some kind of strategy for taking care of this growing elderly population in this country. So it’s really critical,” she said. It’s critical for both families and for caseworkers. With an aging population, the need is only going to grow.
“Addressing the wage suppression of care workers is unmistakably an intersectional gender, racial justice, disability, and immigrant rights issue. Strong labor standards and well-paying careers, along with centering the needs of people with disabilities and older adults, should drive our efforts to build a well-functioning and rewarding care economy. High-quality care is a moral imperative,” says Marokey Sawo, state economic analyst at EPI and co-author of the report.
“The care system is unaffordable for many families while simultaneously stranding many care workers in poverty,” says Elise Gould, EPI senior economist and co-author of the report. “Investing seriously and significantly in care infrastructure—in which higher wages for care workers is a key plank—would be transformative. Care workers deserve to share in the economic security and happiness that their work helps to provide for millions of people.”
The status quo is unsustainable, and only going to become moreso because the population of the U.S. is getting increasingly old and increasingly sick.