‘I’m taking care of everybody, and now I want somebody to take care of me’ — How the care worker crisis threatens the U.S. economy
Finding educators to staff Schnell Price Lambert’s child care centers in Milwaukee, Wis., has been so difficult that she’s considering resorting to drastic measures.
“We are even thinking of going to Puerto Rico and seeing if we can recruit from Puerto Rico, that’s how challenging it is,” she said.
There’s plenty of demand from families who need child care in Milwaukee — Lambert said she was even offered an opportunity, including financing, to expand — but she doesn’t have enough staff to make it work.
“We’re trying to come up with creative ways to find teachers,” she said.
About 330 miles southeast in Greenville, Ohio, Kara Allread, the chief administrative officer at Brethren Retirement Community, a nonprofit that works with seniors living in assisted living and nursing home facilities as well as in their own homes, has made tough decisions about how much care she can provide. In some cases she’s had to cut down on the number of days a client receives a visit from an aide in their home performing non-medical work, like help with meal preparation.
“We know our clients and we know their families,” said Allread. “Our kids are in school together, we go to church together. We know what the need is there, we don’t have the staff to provide those very critical services from a home care standpoint.”
Care economy in crisis
Lambert and Allread’s stories are indicative of a crisis in the care economy that’s impacting Americans ranging from infants to seniors and their families in between. Both the child care sector and long-term care field, which provides services for older people and people with disabilities, were already in the midst of years-long worker shortages when COVID-19 hit U.S. shores. The pandemic has only accelerated those challenges.
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The child care sector has 88% of the workers it had in February 2020, according to the Center for Child Care Employment at the University of California, Berkeley. About 80% of respondents to a survey carried out this summer by the National Association for the Education of Young Children reported having one open role unfilled for at least one month. Half of those experiencing a staff shortage reported serving fewer children.
The pool of workers caring for older adults is projected to shrink in the coming years. Between 2016 and 2060, the number of adults age 65 and older is expected to nearly double, but the population of adults who would potentially care for them — those ages 18 to 64 — is projected to remain static, according to PHI, a direct care worker research, advocacy, and consulting organization. Right now there are 31 adults between the ages of 18 and 64 for every adult at least 85 years old. By 2060, that ratio will be 12 to 1.
Without government intervention, the quirky economics of both industries mean the shortages are likely to continue. The Biden administration and Democratic lawmakers have proposed ambitious investments in child and long-term care that are aimed at defraying the costs for families and increasing wages for workers. But given the wrangling in Congress both between Republican and Democratic lawmakers and within the Democratic party, the funding isn’t guaranteed.
Implications for the broader economy
If the shortage in both spheres persists, it could pose challenges not only for providers and families, but the economy more broadly.
“Whether you have children who need care or you have a spouse or perhaps an elderly relative, if you are unable to hire somebody to provide that care it’s not safe for you to leave them alone in many circumstances,” said Elise Gould, a senior economist at the Economic Policy Institute, a labor-focused think tank. “You really have no option but to be there for them, which means that you are forgoing the ability to work in the formal labor market.”
This burden tends to fall disproportionately on women, who have already borne the brunt of the pandemic-induced downturn.
“Women have taken on and have historically taken on more of the caregiving roles in their households and that means that if the schools closed or if the long-term care facility wasn’t safe, then it was much more likely to be women who would be taking on those responsibilities,” said Gould.
‘These are such challenging jobs’
Both sectors are characterized in part by their low pay. Home health care workers make $13.81 per hour on average, according to the Economic Policy Institute, while child care workers earn an average of $13.51 per hour.
Not surprisingly, that low pay is an obstacle to hiring and retaining workers.
“These are such challenging jobs and for the most part not adequately recognized or valued or compensated,” Kezia Scales, the director of policy research at PHI. “That has become exacerbated during the pandemic when the work itself became so much more risky.”
Child care has a similar dynamic. Rhian Evans Allvin, the chief executive officer of the National Association for the Education of Young Children, said given the sector’s typically low pay, lack of benefits and the challenges involved in the work, “we shouldn’t be doing a lot of hand wringing on why we don’t have people to fill those jobs.”
“‘We shouldn’t be doing a lot of hand wringing on why we don’t have people to fill those jobs.’”
The current staffing challenges are in part the result of a “mass exodus,” when, at the beginning of the pandemic, some child care centers closed, Allvin said. “Now they’re having to rebuild and people aren’t coming back.”
In both sectors, there’s a mismatch between the importance and challenge of the job being performed and the pay. In the case of caring for young children, running a child care center is expensive in large part because the ratio of adults to children is required by law to be low. To maintain high-quality care, centers need even more adults — typically one adult for every four infants, Allvin said.
“Where you’re going to actually break even or have a net profit is by having those costs be reduced, which means no health insurance and low wages,” said Allvin.
With child care costs exceeding the price of in-state college tuition across the country, many parents don’t have room in their budget to pay more. And while the government subsidizes the cost of child care for families earning between 100% and 150% of the federal poverty level, the subsidy rates don’t cover the actual cost of care, Allvin said.
“Parents can’t pay more and early childhood educators can’t earn less,” Allvin said. “For families, they’re not asking for free child care, they are willing to pay their fair share, they are paying dramatically more than their fair share right now.”
Similarly in long-term care, a combination of public and family funds pay for services — both resources that are constrained in how much more they can spend. Medicaid, which is often under pressure from state budget constraints, is the largest payer in the direct care space, said Scales.
“The prospect of increasing wages to a living wage or a family sustaining wage will always carry a large price tag,” Scales said. “Where services are not covered by Medicaid they’re for the most part covered by individuals out of pocket. There are limits to what individuals can pay per hour for services.”
“‘There are limits to what individuals can pay per hour for services.’”
The role of racial and gender discrimination
But it’s not just the economics of the care industry that are responsible for the low pay. America’s history of racial and gender discrimination plays a role as well. The majority of workers in both industries — 88.6% of home health care workers and 94% of child care workers — are women, according to EPI. More specifically, many are women of color; 46% of home health care workers and 36% of child care workers are Black or Hispanic women.
Historically, that discrimination has found its way not only into cultural beliefs surrounding the value of those workers, but into policy as well. For example, the New Deal-era Fair Labor Standards Act, which created the minimum wage, among other labor provisions, excluded farm and domestic workers — jobs which, at the time, were performed largely by Black Americans.
“It’s partly because of deep-rooted definitions of caregiving work in our society and how valuable that work is and how it should be compensated,” Scales said of the reasons these workers are paid so little. “This is work that is historically understood as a labor of love,” performed by women and women of color in particular, she said.
Working seven days a week, but not earning enough to pay the bills
Jacinth Finch has been working in elder care for nearly a decade, driven in large part by a passion for helping her clients. “Looking after these people, I see myself in some years to come, I see myself in their bed and in their places,” she said. “I do this because this is what I would want for me.”
“‘I do this because this is what I would want for me.’”
She works seven days a week and logged 44 hours during a recent three-day stretch — at $10 or $12 an hour, depending on the client. Despite her dedication to her job, she still isn’t earning enough to cover her bills, which include a $409 monthly car payment and $1,150 in rent.
“My eyes are bad, I have to have surgery on my eyes. I can’t afford the surgery, which is $500,” she said. “I have to work all these hours, I’m 62 and I have to do this.”
In the pandemic era, her job also comes with expenses. Finch, who lives in Opa-locka, Fla., said she often has to buy her own masks, gloves and other personal protective equipment. Because the pay is so low and the prospect of contracting COVID-19 has added more risk to entering people’s homes, fewer workers are signing up for the job, Finch said. That’s meant she’s had to take on a larger workload, essentially doing the jobs of two or three people.
“When you have workers, the work becomes less, but when you have less workers you have to pitch in and do everything there is to do,” which includes preparing food for and feeding her clients, giving bed baths, changing diapers, monitoring vital signs and more, Finch said.
Despite her efforts, Finch said doesn’t always receive the same recognition from the community as other essential workers. Recently, she was at a casino that was offering a special for nurses and doctors. When Finch inquired about the special, explaining she is a certified nursing assistant, the casino said she didn’t qualify for the deal.
“It was a slap in the face,” she said.
“‘Those children need me.’”
“We need help, I’m taking care of everybody, and now I want somebody to take care of me,” Finch added. She’s advocating for Congress to invest in the care economy and for a union.
Up at 4:30 a.m. and done with work around 8 p.m.
Like Finch, Patricia Moran, 62, is passionate about her work, which is why she keeps the daycare in her home open even though she doesn’t earn enough to pay for her own health insurance. On her block in San Jose, Calif., five child care centers have closed over the course of the pandemic because the owners are struggling to pay educators, their medical bills, cleaning supplies and other expenses, Moran said.
“Those children need me,” Moran said of the reasons she stays open despite the challenging economics. “How am I going to say to a child, a family, ‘I’m sorry, I can’t do that’?”
Every morning, Moran wakes up at 4:30 a.m. to prepare her home for the children, some of whom arrive at 5 a.m. so their parents can get to work. She keeps working — feeding the children, providing them with activities and constantly cleaning — until around 8 p.m.
“After my staff is leaving I have to continue because they can’t stay for long and I can’t afford to pay” to keep them later in the day, Moran said.
Part of the challenge for Moran and other providers doing similar work is managing the costs of caring for children on the payments she receives through a state subsidy program for low-income families.
Moran is working with the Child Care Providers United, which represents child care providers in negotiations with the state over pay, benefits and other workplace issues. In 2019, California lawmakers passed a law allowing child care providers who work with families receiving government subsidies to bargain with the state. Through the union’s advocacy, providers like Moran won funds to address increased costs to their business due to COVID, as well as the first boost in subsidy payments in five years.
“In the pandemic we raised our voice,” Moran said. “Finally they noticed that we are here because we are the only ones who keep our doors open for the community, for children — risking our lives.”
Vaccine requirement in a low vaccination region
At Brethren, the retirement community in Greenville, Ohio, the COVID-19 protocol has exacerbated challenges hiring and retaining staff, Allread said. Brethren’s routine testing, PPE requirements and additional infection control measures haven’t changed since March 2020, which has impacted staff’s resilience. In addition, the vaccine mandate at facilities receiving Medicare and Medicaid funding announced by the Biden administration in August has created obstacles to hiring in a county where the vaccination rate stands at 35%, Allread said.
“We have really seen a stop in applications since that announcement in late August,” she said.
At the same time, competition from employers in other sectors that have more flexibility to offer higher wages and signing bonuses, and less stringent COVID-19 protocols, have also played a role, she said.
“I went through a chain coffee place last week, they were advertising wages of $22 an hour,” Allread said. “Our reimbursement in the state of Ohio for community-based Medicaid services is $18.56 an hour.”
In Milwaukee, Lambert said the recent push from other employers to lure workers has also made it more difficult for her to hire educators at her centers. “You can either work in a child care center or a school or you can work at Walmart,” she said. “That’s what we’re competing against.”
But trends that have been building for decades are also posing challenges, she said. The level of education required for child care educators is increasing in some regions — an idea Lambert says she agrees with, given what’s required to provide children with quality care — but the mismatch between the cost of a degree and the pay means that there are fewer workers to choose from.
Lambert and other providers and advocates said they’re hopeful that the pandemic raised the profile of care workers and providers in a way that will translate into increased funding they can use to recruit and retain staff, among other priorities.
“We realize that things like child care can shut down the world,” Lambert said.