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POLICY INSIGHT
BEYOND THE NUMBERS

To Honor Women’s History Month, Strengthen Care Infrastructure and Care Workforce

Care work, whether paid or unpaid, makes all other work possible. From child care workers who help raise the next generation to home health care workers who support older adults and people with disabilities or illnesses, families rely on domestic and care workers for the most precious aspects of their lives. Care workers perform work that is essential for families and the economy: strengthening care infrastructure is not only critical to help workers in the care industry thrive and adequately provide for themselves and their families, but also to ensure a more secure workforce with less turnover and higher quality care services. Further, doing so would promote gender and racial equity. Women — disproportionately Black, Latinx, and immigrant women — make up 94 percent of child care workers and 90 percent of home health care workers.

Despite performing the labor that underpins the nation’s economy and maintains families’ health and well-being, workers in these sectors are among those lowest paid in the economy and are three times likelier to experience poverty than other workers. Work traditionally performed by women has long been systemically undervalued. And racism has played a profound role in how care work is valued; some of the first domestic workers in the United States were Black women who were enslaved, and racial exclusion from New Deal-era labor protections has shaped their working conditions for generations. Domestic workers, despite being excluded from labor rights and mainstream labor organizing, have a long history of innovative labor organizing that endures today with organizations like the National Domestic Workers Alliance, which are at the forefront of efforts to strengthen care infrastructure and improve conditions for workers.

The COVID-19 pandemic has laid bare the United States’ lack of investment in care infrastructure and family-work policies and the need for substantial increases in several areas. There are a set of policies that can help families get the care they need, better balance their work and family responsibilities, and improve care jobs so that people who care for children, older adults, and people with disabilities can afford to make ends meet for their own family. These policies can boost labor force participation rates among women, reduce turnover in care jobs, and boost economic security for care workers by improving both their wages and working conditions. They also can promote equity across lines of race and ethnicity: large numbers of care workers are women of color and immigrants. These policies include:

  • Paid leave. Paid leave policies can help workers remain employed by helping them take time off when they need it without having to leave or lose their jobs, facilitating their return to work when they are able to do so. Federal law provides a little over half of workers with access to unpaid family and medical leave, but the U.S. has no national paid leave. Due to occupational segregation, women — especially women of color — are overrepresented in low-wage jobs and part-time work and are less likely to have access to any leave, paid or unpaid.

    The benefits of paid leave are well established. Providing parents with paid time off to care for a new child contributes to improved maternal and infant health outcomes, supports fathers’ involvement in care, and enhances household economic security. Policymakers should create a permanent federal paid leave program that prioritizes the needs of people in low-paid jobs and includes comprehensive reasons for leave, including a worker’s serious health condition and caregiving for an ill loved one.

  • Child care. The pandemic showed how indispensable child care is for families’ well-being and economic security but also exacerbated the industry’s challenges, with many child care programs closing and many care workers leaving the field. Programs that help families afford child care and that invest in workers in the field have been underfunded for decades, leaving many families priced out and many providers struggling to stay afloat – just 1 in 7 children eligible for federal child care assistance receives it, in large part because of inadequate funding. In turn, providers operate on razor-thin margins and most workers in the child care field are not paid enough to keep themselves and their families out of poverty. Although employment of child care workers has risen since the lowest point during the pandemic, employment remains 12 percent below pre-pandemic levels as child care workers leave the industry for higher-paid sectors, citing inadequate pay, lack of benefits, and burnout.

    Although the recently passed federal funding bill for fiscal year 2022 increases child care funding by $585 million, this is far less than is needed to make long-term progress in both ensuring that families can access quality, affordable care and that care jobs pay reasonable wages and have good working conditions.

  • Home health care. The pandemic has brought increased attention to the need to increase home- and community-based services (HCBS) for older adults and people with disabilities and to address the shortage of workers who provide the care they need. Medicaid is the primary payer for HCBS; but HCBS, unlike nursing home care, is an optional Medicaid benefit so large numbers of people are on waiting lists for care.

    By providing increased funding as part of a new economic package this year, policymakers could allow states to increase the availability of HCBS and improve pay and working conditions for direct care workers. That legislation should create financial incentives for states to strengthen the HCBS workforce by ensuring payment rates are sufficient to enhance and expand access to HCBS and requiring that workers benefit from the increased rates, and by updating qualifications and training opportunities for direct care workers.

Other policies that have a broader scope can also have important positive impacts on care workers. This includes making Affordable Care Act marketplace coverage more affordable so lower-paid workers have access to more affordable coverage, providing coverage to people — including care workers — with very low incomes in states that have refused to adopt the Medicaid expansion, and expanding the Child Tax Credit and making the full amount available to the lowest-income workers, including care workers.

CBPP intern Lauren Nip contributed to this post by conducting research on women and the care economy.