Labor Day 2018: Caregivers Are Needed. They Need Good Pay.

By Amy Rolph | Originally published on August 30, 2018 by Equal Voice News

Photo by Paul Joseph Brown for Marguerite Casey Foundation’s Equal Voice News.

As the U.S. honors workers on Labor Day 2018 and its population ages, a key question looms: Are caregivers and domestic workers receiving dignity, respect and good wages for themselves and their families?

Philemon Dushimire talks about 80-hour work weeks as a caregiver without batting an eye.

“One job wasn’t enough to cover my expenses and live decently,” said Dushimire, who came to the U.S. in 2010 from the Burundi, an inland country in Africa, seeking political asylum. “I’ve been working 80 hours a week for a while. If you don’t do that, you’re not going to have enough.”

Dushimire lives in Maine now, where he cares for people with disabilities in group homes. He was a judge in Burundi, and recently earned his master’s degree in political science from the University of Maine.

He’d eventually like to work shaping public policy, but for now, he keeps putting in long days as a caregiver, one of the nation’s fastest-growing industries.

The home caregiver industry is projected to add 1.2 million jobs between 2016 and 2026 – an increase of about 40 percent. The reason for that hiring spike is simple: As baby boomers age, they’ll need more help – both at home and in institutional settings.

As the U.S. celebrates the contributions of workers on Labor Day 2018, will they be able to find that help when they need it? That is the million-job question. The caregiver industry is plagued by low wages and high turnover rates, spelling out a mounting crisis and grim future for those hoping to age at home.

“The pay rate is the first obstacle,” Dushimire said. And he said poor benefits and a lack of training are other obstacles the industry must overcome.

The root causes of the care crisis are complex, ranging from good wages and benefits to federal funding to immigration policy to cultural attitudes toward aging. But one thing is crystal clear to community organizers, workers in the industry and supporters who are advocating for better conditions: Things have to change. And soon.

“It’s ridiculous to think you can have quality care without quality jobs,” said Janet Kim, director of communications for Caring Across Generations, a nonprofit organization working to bring dignity to caregiving. “These people are doing the most important work out there, taking care of our homes, of our loved ones.”

While some rely on family members for care, the costs incurred are still high; family caregivers may experience a loss of wages, diminished career opportunities and poor health. But paying someone to care for a loved one may not be possible.

“There is this real paradox,” said Howard Gleckman, a senior fellow at the Urban Institute and author of the book, “Caring for our Parents.” “Aides are not paid enough, but families cannot afford to pay them even what they’re paid.”

Christal Boutte, a home care aide seen in 2015, visits with a client in the Seattle area. Her client suffers from anxiety and depression and is unable to leave her apartment. Boutte often becomes friends with her clients, who are isolated in their homes. Photo by Paul Joseph Brown for Marguerite Casey Foundation’s Equal Voice News.

Low Wages, High Costs

The average hourly wage for home health aides (also called direct-care workers) in the U.S. was $11.12 in 2017, according to the Bureau of Labor Statistics. On average, aides made just $23,130 annually. And many caregivers – especially those working for families in individuals’ homes – don’t have employer-paid insurance or paid vacation and sick leave.’

The work also is emotionally and physically grueling. Gleckman said back injuries from lifting clients and depression are the most commonly reported health problems.

“Being a home-care aide is one of the most dangerous jobs in America,” Gleckman said. “You’re more likely to be injured on the job than you are being a coal miner.”

Home care workers, who are mostly women and often women of color, also might face sexual harassment on the job. As part of the Unstoppable Day of Action earlier in 2018, domestic workers and farmworkers met with members of Congress, asking that federal anti-harassment laws be expanded to include workplaces with fewer than 15 employees.

“It’s some of the most important, life-sustaining work in the nation,” said Ai-jen Poo, director of the National Domestic Workers Alliance, in a statement earlier in 2018. “Yet these women have faced systematic exclusion from protections at work.”

Personal costs for care workers don’t stop there. Kim recalled a conversation with one home care worker who broke down with feelings of guilt while describing her decision to stop working for a beloved client. The aide was struggling to pay her rent and bills, and she felt torn between loyalty to her client and the desire to be there for her children.

“At the end of the day, she felt like she would be hurting herself and her family if she stayed,” Kim recalled.

Stories like that account for why turnover in the care industry is high, with workers often leaving for other low-paying jobs. A recent survey from, a recruitment tool for care workers, found that 10 percent of respondents had worked at or interviewed to work at Amazon, which has large distribution centers all over the country.

Threats From Immigration Policy

Another variable that makes the equation even more damning for the care industry: federal policies that aim to limit immigration through travel bans, stringent requirements or the revocation of existing protections.

New York-based research group PHI recently estimated that 1 in 4 home-health aides, personal-care aides and nursing assistants are immigrants – and that percentage is notably larger in states like California, New York and Florida.

“It is pretty difficult to imagine that the long term care system would survive without immigrants,” said Robert Espinoza, vice president of policy for PHI.

Espinoza said the research doesn’t take into account the gray market for in-home care, where families pay for care under the table. There, workers are more likely to be immigrants and undocumented.

Christal Boutte, a home care aide seen in 2015, takes a moment to rest, as she commutes on public transit in the Seattle area to meet with her clients. Photo by Paul Joseph Brown for Marguerite Casey Foundation’s Equal Voice News

But whether documented or not, Espinoza said the threat of deportation weighs heavy on many immigrant workers.

“It makes you feel less secure, and it affects your ability to be present on the job,” he said. “In some ways, it strips you of your social capital. You may be documented, but the person taking care of your children may not.”

One possible proposal that immigration reform advocates are concerned about also bodes poorly for professional caregivers: denying permanent residency requests under the federal definition of “public charge” because applicants have accessed public benefits. PHI research showed that 52 percent of direct-care workers depend on public assistance to supplement low wages.

Looking Ahead

Without significant changes, the future of aging in America looks bleak. Community organizers, caregivers and those who support dignity for older residents and workers are holding rallies, raising their voices and speaking with lawmakers about the need for change.

More baby boomers are approaching the age where care becomes necessary, and the supply of care workers doesn’t show signs of rising to meet the demand.

“It will literally be an impossible situation,” Gleckman said. “We will have hundreds or thousands – if not millions – of people trying to age in the community without any possibility of getting the care that they need.”

He said an arsenal of changes may have to be deployed in order to change the trend. That could include Medicaid reforms, incentives to save for retirement, more informal communal living arrangements for seniors as well as more attractive compensation and education incentives for aides.

Kim said that a collective attitude of avoidance when it comes to aging might also be keeping many people in the country from addressing the crisis head on.

“I think one of the huge barriers, why we’re not planning for this, is because we’re avoiding it,” she said. “In order to address something and see it, you need to not fear it. Fear around aging is kind of part of the human condition. But it doesn’t help.”

Dushimire said everyone should be invested in the movement to create a strong care system for the coming decades.

“It’s something everyone will end up needing, one way,” he said. “It’s in everyone’s interest to make it happen.”

Amy Rolph is a journalist based in Seattle. She has worked as a writer and editor for national and regional news sites and publications as well as public radio.

This story was originally published by Equal Voice News, the Marguerite Casey Foundation’s publication featuring stories of America’s families creating social change.

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