Home-care workers are increasingly vital to the future of our health-care system, but the problems they face are rooted in a racist and sexist history.
The people who will save American health care likely don’t wear lab coats or perform complicated procedures in operating rooms. They probably don’t have doctorates or years and years of graduate experience. These saviors on average make a tenth or less of what physicians earn each year in salary, and they often perform some of the most thankless tasks of the allied health fields. But as the American population gets older and the health-care system caters more and more to the needs of elderly and disabled people, this growing army of millions of home-care workers will be one of the most valuable elements in keeping the whole system afloat.
Home-care workers are not, however, afforded wages or protections commensurate with their importance, with over a quarter living under the poverty line and more than half reliant on public assistance. That economic vulnerability is especially notable because of just who tends to work in home care: Women of color are the largest demographic group within the home-care workforce. Their vulnerability reflects a long history of exploitation of women of color working in-home jobs, and highlights a growing inequality in the health-care workforce, even as health coverage expands to more and more Americans.
Their vulnerability reflects a long history of exploitation of women of color working in-home jobs, and highlights a growing inequality in the health-care workforce, even as health coverage expands to more and more Americans.
A new report from the Paraprofessional Healthcare Institute describes home-care workers as personal aides, independent providers, home health aides, nursing assistants, and even informal networks of family members that provide living assistance, housekeeping chores, medication management, and a host of other services for elderly people and people with disabilities. About 1.4 million of these workers fulfill the kind of formal roles tracked by the Bureau of Labor Statistics—working for firms or insurance companies—while almost a million more are ad hoc “independent providers” who are employed directly by patients or their families. Almost three-quarters of the payment for services provided by home-care workers comes from public-insurance programs Medicaid and Medicare.
REPORT: PARAPROFESSIONAL HEALTHCARE INSTITUTE
The home care workforce—primarily comprised of women and people of color—has doubled in size over the past 10 years as the delivery of long-term services and supports has increasingly shifted from institutional settings, such as nursing homes, to private homes and communities. In coming years, the rapidly growing population of older adults will drive demand for home care workers even higher. By 2050, the population of people over the age of 65 will nearly double, from 47.8 million to 88 million.
Recruiting adequate numbers of home care workers to fill these jobs is becoming increasingly difficult, as evidenced by continual reports of workforce shortages. One reason for the shortages is the poor quality of home care jobs: wages are low and access to employer-provided benefits is rare. With a median hourly wage of $10.11 and work that is often part time or part year, home care workers earn on average $13,300 annually. As a result, one in four home care workers lives below the federal poverty line (FPL) and over half rely on some form of public assistance.
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