The Washington PostDemocracy Dies in Darkness

Too many essential care workers can’t afford the very services they provide

When care workers struggle to support themselves, everyone is worse off

A home health aide, wearing a pink mask, is shown assisting a woman during the pandemic. (Katye Martens Brier for The Washington Post)
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The United States faces a crisis of care. Throughout the pandemic, millions of families have had to choose between child care, health and financial security. The impact of those decisions has already been profound. Since March 2020, nearly 2.5 million womenmost of them women of color — have dropped out of the workforce. Meanwhile, care workers, such as child-care workers and home health aides, continued their jobs despite high risks and limited access to benefits and personal protective equipment. Yet the median annual incomes for these workers remain below the federal poverty line for a family of four.

Meanwhile, the cost of home health aides run over $50,000 annually, while 6 in 10 households make less than $75,000 a year, and low-income families spend up to a third of their income on child care. In this interconnected crisis, where families can’t afford care, and workers can’t afford to provide it, the situation is unsustainable — and just a glimpse of what lies ahead. Over the next five years, more than half the workforce will need to care for an aging adult. Will we choose to ignore this crisis, or face it head on?

Part of the challenge is that our broken care systems affect both people who seek care and those who provide it. When essential workers struggle to get by, our children, aging relatives and loved ones with disabilities cannot get high-quality, affordable care. And because we all, at some point, will need care, it’s imperative we fix how it works. For too long, we’ve considered separate parts of the care crisis — like paid leave, or care workers’ rights — rather than addressing the whole.

Child care has bipartisan support. But the culture war could wreck that.

A year after I gave birth to my first child, my father was diagnosed with Alzheimer’s. Suddenly, I was squeezed between the people I loved most, trying to navigate our impossibly complex system. I’d spent my career advocating in solidarity with domestic workers, health aides and trade unions, co-founding and co-directing two leading social justice organizations — Jobs with Justice and Caring Across Generations. As Director of the Ford Foundation’s Future of Work(ers) program, I am constantly thinking about these issues. But I understood them differently after I became a caregiver myself.

As an organizer, I would demand that families should have choices. But facing those choices was overwhelming. Would our parents move closer to us? Where would they live? Could we preserve their independence at home and agency in these decisions? How would we pay for the care and accommodations that they needed?

In the face of these thorny questions and demanding answers, I know I’m one of the lucky ones. Because my job provided paid family medical leave, I could dedicate time and attention to my parents. And because we could afford child care, I didn’t have to choose between tending to my infant daughter and supporting my aging parents. And because my sister was a federal employee, we had access to professional health navigators who explained our options and helped us understand Medicare and the long-term services and supports we had available to us.

Even with our privilege, the process was grueling, and we had to adapt as my father’s condition — and my mother’s — changed. I watched my mother provide primary care for my father, even as the stress wore her down. She’s not alone. One in 4 family caregivers report a decline in their physical or mental health due to care responsibilities. Were it not for the women who diligently, lovingly cared for my daughter, my family could not have provided the time and attention my father needed. And yet, these women have lives and stressors of their own.

The child-care crisis punishes women in health care

Care workers — whether they’re looking after the young, the elderly or those who fall somewhere in between — are not immune to the mental and physical toll of their work, yet many lack access to affordable health care, sick days or paid leave. If they do get sick, for many unpaid leave isn’t an option. On average, home-care workers make $13 an hour. In several states including New York, fast food minimum wage is higher than home-care worker pay. The cruel irony is too many care workers cannot afford the very services they provide to others, and are forced to rely on public assistance for their own families.

But sometimes a crisis creates a huge opportunity. The pandemic has revealed to the public and political leaders that care is essential to the very functioning of our economy. Advocates are joining forces at the state level and nationally to advocate for a unified agenda, bringing together their respective interest in issues ranging from paid leave to early education to job quality. Across the country, advocates have been breaking down silos and uniting around quality care and dignified care work. To support this broad-based movement for care, eight major philanthropies, including the Ford Foundation, launched a $50 million investment in the care economy through the Care for All with Respect and Equity (CARE) Fund, aiming to create an economy that treats all forms of care as a public good.

Care impacts all of us, across the life span, making this quite literally a generational moment for the federal government to step up and invest in care at scale. What our movement has long been calling for, is now on the lips of America’s policymakers — that care is infrastructure. Care work makes all other work possible, and a strong public investment in the future of care is critical to achieve a just recovery, so all families can afford and access care, and so the people who cared for my family can afford to care for theirs.

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