The Bureau of Labor Statistics projects that personal care aides, combined food preparation and serving workers (including fast food workers), registered nurses, home health aides, and software applications developers will be the five occupations with the most job growth between 2016 and 2026. Among these five occupations, all except software applications developers are female-dominated, with workforces that are at least 60 percent women—and personal care aides, home health aides, and combined food preparation and serving workers have median wages of less than $11.50 per hour. Women of color—especially Black women—are particularly overrepresented in these three low-wage, high-growth jobs, which often also lack benefits and pose particular challenges for women with caregiving responsibilities. View our fact sheet to learn more.
Source: Linda Mabry, Kelsey N. Parker, Sharon V. Thompson, Katrina M. Bettencourt, Afsara Haque, Kristy Luther Rhoten, Home Health Care Services Quarterly, Volume 37 Issue 3, 2018
From the abstract:
The Community of Practice and Safety Support (COMPASS) program is a peer-led group intervention for home care workers. In a randomized controlled trial, COMPASS significantly improved workers’ professional support networks and safety and health behaviors. However, quantitative findings failed to capture workers’ complex emotional, physical, and social experiences with job demands, resource limitations, and the intervention itself. Therefore, we conducted qualitative follow-up interviews with a sample of participants (n = 28) in the program. Results provided examples of unique physical and psychological demands, revealed stressful resource limitations (e.g., safety equipment access), and elucidated COMPASS’s role as a valuable resource.
Source: Emily Franzosa, Emma K Tsui, Sherry Baron, The Gerontologist, Published: August 17, 2018
From the abstract:
Background and Objectives:
Interventions to strengthen the home care workforce focus on workers’ economic and physical well-being, without acknowledging the caring labor affecting emotional well-being. Our study examined workers’ perceptions of the emotional effects of caring work, coping mechanisms, and desired support.
Research Design and Methods:
We conducted 4 worker focus groups (n = 27). Moderators cross-checked codes and themes, and aides provided input through report-backs.
Building close, trusting relationships with clients was central to aides’ emotional well-being. Well-being was also influenced by relationships with client families and agency supervisors, work–life balance, and the level to which aides felt their work was valued. Aides were largely alone in managing job stressors and desired more communication, connection, and support from supervisors and peers.
Discussion and Implications:
Recognizing and supporting the emotional demands of caring work is crucial to strengthening the workforce. Policy makers and agencies must realign reimbursement systems, job descriptions, and care plans to include measures of emotional labor, improve communication between workers and supervisors, and provide training, mental health benefits, and peer support.
In 2016, three community-based organizations that operate in the Texas–Mexico border region collaborated on a participatory research project. A.Y.U.D.A. Inc., Fuerza del Valle Workers’ Center and Comité de Justicia Laboral/Labor Justice Committee trained 36 women from the local communities as surveyors. The surveyors, most of them domestic workers themselves, interviewed 516 housecleaners, nannies and care workers for people with disabilities or for the elderly who work in private homes. The survey was conducted in Spanish and was composed of a standardized set of questions focused on work arrangements, working conditions, the impact of low pay on workers’ lives, injuries and abuse on the job and citizenship status.
This report, the result of the surveyors’ hard work knocking on doors, gaining trust and gathering data, is the very first quantitative study of a sizable number of domestic workers in the Texas–Mexico border region. The data provides us with a fact-based portrait of the difficult conditions domestic workers in the region face. The report findings will be used to shape ongoing organizing and advocacy to improve conditions and end workplace abuse. Our hope is that it will also shape the thinking of policy makers and encourage further research about working conditions along the border.
The Price of Domestic Workers’ Invisible Labor in U.S. Border Towns
Source: Sarah Holder, The Atlantic, June 25, 2018
Source: Sarah Thomason, Lea Austin, Annette Bernhardt, Laura Dresser, Ken Jacobs and Marcy Whitebook, Center for Labor Research and Education (UC Berkeley), Center for the Study of Child Care Employment (UC Berkeley), and COWS (UW-Madison), May 2018
From the introduction:
In November 2012, fast-food workers in New York went on strike and the Fight for $15 was born. Over the last five years, the movement has lifted wages for more than 17 million workers across the nation by fighting for and winning numerous minimum wage policies (National Employment Law Project 2016).
Substantial minimum wage increases are underway in California, New York, Oregon, and more than 30 cities and counties around the country. In states and cities covered by them, these new minimum wages will increase earnings for 25 to 40 percent of workers (Reich, Allegretto, and Montialoux 2017; Reich et al. 2016). After four decades of wage stagnation and rising inequality, the movement has delivered real, much needed, and meaningful progress in a remarkably short period of time.
Fast food has been iconic in the discussions of the minimum wage, from the influential mid-1990s research that found no negative employment impact of wage increases in the industry, to the fast-food workers who have walked out on strike in cities across the country in recent years (Card and Kruger 1995). But of course the reach of these wage increases extends well beyond fast food to underpaid workers in multiple industries. The dynamics of minimum wage increases vary across industries based on each industry’s specific structure.
Nowhere are the distinct dynamics more pronounced and challenging than for those employed in human services industries. This paper focuses on an important subset of these workers: those who provide homecare and early care and education services to the very young, people with disabilities, and those who are frail due to age or illness. We explain the pressing need to raise these workers’ wages and the unique structure of their industries that results in a funding squeeze for wage increases—at the root of this is the fact that most families are unable to afford all of the homecare and child care they need, never mind pay enough to ensure that workers earn a living wage, and public human services are chronically underfunded.
These workers provide a critical (but too often unrecognized) public good; as such, we argue that a significant public investment is a necessary part of the solution, both to deliver minimum wage increases to these workers and to cover the significant unmet need for care. We provide background about the shared and divergent challenges in the homecare and early care and education industries, as well as review emerging policy initiatives to fund wage increases for homecare and early care and education workers and identify principles for public policy going forward.
As the largest growing occupation in the country, the direct care workforce represents a critical segment of the long-term services and supports field and the U.S. economy. Direct care workers are the paid frontline of long-term care, supporting millions of older people and people with disabilities in residential settings and in their homes and communities. The need for direct care will surge over the next few decades, as millions of people reach retirement age, and as people live longer with higher rates of chronic illness and functional limitations (Administration for Community Living, 2014).
Unfortunately, jobs in this sector are characterized by low wages and high turnover, which impairs both the livelihood of workers and the quality of care they provide. In the face of growing demand for long-term care, policymakers have increasingly begun strengthening this workforce, largely by increasing wages and benefits, promoting better training and advanced roles, collecting reliable data on the workforce, expanding access to long-term care, and supporting the relationship between paid and unpaid caregivers. States around the country are also steadily adopting laws that increase wages for workers and government funding for paid caregiving, create advanced roles and training opportunities for workers, establish working groups to study this workforce, and explore universal long-term care insurance options. Heightened attention on this sector, paired with a health framework that elevates the role of the worker in care delivery, can improve both the quality of jobs for workers and the quality of care for families nationwide…..
From the summary:
In the closing months of 2016, we asked home care workers (i.e., caregivers who provide non-medical in-home assistance with daily living tasks such as mobility, eating, dressing, toileting, and bathing) to participate in an online survey about their jobs and their lives. More than 3,000 workers located in 47 states and the District of Columbia responded to a short survey; 2,600 of them went on to complete a second, more detailed section. These responses reveal an experienced and committed workforce that puts in long hours caring for consumers but receives unsustainably low pay and few benefits. A sizeable percentage of respondents are treated as independent contractors and may be misclassified. These workers are overwhelmingly women of color, many of whom are in their prime earning years. Despite the importance of the work they do, they frequently have to supplement their home care work with other jobs to make ends meet.
In addition to examining the experience of the workforce as a whole, we also compared the responses of unionized versus non-unionized home care workers. In doing so, we found several trends that speak to the difference that unionization makes—not only for home care workers but for the consumers they care for as well. To gain additional insight into the impact of home care unionization, we conducted phone interviews with four unionized home care workers whose stories are included in this report…..
From the abstract:
A rate-based understanding of home care aides’ adverse occupational outcomes related to their work location and care tasks is lacking.
Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides’ demographic and work characteristics. Injury narratives and focus groups provided contextual detail.
Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern. Conclusions: Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides’ improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce.c
The American Health Care Act (AHCA) – passed by House Republicans in May, and currently under consideration in the Senate – would dramatically change Medicaid’s financing structure. Currently, Medicaid operates as a federal-state partnership where each pays a percentage of Medicaid’s costs and federal financial support increases with need. Under the per capita cap system proposed in the AHCA, the federal government would provide states with an aggregate amount of funding based on the number and category of eligible beneficiaries in the state, with nominal differences in the amount per beneficiary category. The proposed per capita cap system would adjust for overall population growth, but would not account for other relevant factors affecting Medicaid expenditures, such as changes in health care needs or costs. The Congressional Budget Office estimates that this change in the financing structure along with other changes proposed in the AHCA would cut $834 billion from the Medicaid program. States would likely have to account for the decreased funding by cutting benefits, cutting payments to providers, changing eligibility requirements, and/or adding to program waiting lists.
A per capita cap system would have serious implications for people receiving long-term services and supports (LTSS) – including millions of older adults with functional and cognitive impairments. LTSS include a range of typically non-medical services designed to help individuals perform activities of daily living such as bathing, dressing and eating. Medicaid is the primary payer for LTSS so reductions in Medicaid funds would have serious consequences for people receiving LTSS.
States provide LTSS both in the community and in institutional settings. Per capita caps would cause a shift away from home and community based services (HCBS) toward institutional care such as nursing homes. This is because providing LTSS services through HCBS is optional under Medicaid rules while institutional care is mandatory. HCBS varies by state but generally includes home health services and other services such as adult day care.
This brief provides information on some of the factors that would affect states’ abilities to provide LTSS in a per capita cap system. Additionally, we look at a portion of the labor force that provides LTSS – home health aides and personal care aides specifically – and predict that across the United States, between 305,000 and 713,000 home health aides and personal care aides would lose their jobs if the proposed per capita cap system in the AHCA were to be implemented.
Source: Nancy Glass, Ginger C. Hanson, W. Kent Anger, Naima Laharnar, Jacquelyn C. Campbell, Marc Weinstein and Nancy Perrin, American Journal of Industrial Medicine, Vol 60 Issue 7, July 2017
From the abstract:
Background: The study examines the effectiveness of a workplace violence and harassment prevention and response program with female homecare workers in a consumer driven model of care.
Methods: Homecare workers were randomized to either; computer based training (CBT only) or computer-based training with homecare worker peer facilitation (CBT + peer). Participants completed measures on confidence, incidents of violence, and harassment, health and work outcomes at baseline, 3, 6 months post-baseline.
Results: Homecare workers reported improved confidence to prevent and respond to workplace violence and harassment and a reduction in incidents of workplace violence and harassment in both groups at 6-month follow-up. A decrease in negative health and work outcomes associated with violence and harassment were not reported in the groups.
Conclusion: CBT alone or with trained peer facilitation with homecare workers can increase confidence and reduce incidents of workplace violence and harassment in a consumer-driven model of care.