Giving direct care workers a raise is a win-win — here's proof
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Throughout the coronavirus pandemic, essential workers have been thrust into the limelight as Americans came together to applaud the health care, food service, and public transportation workers who put their lives on the line each day to keep critical services from shutting down.

Health care workers account for roughly one-third of this revered group of essential workers. More than 3.5 million of those health care workers are known as direct care workers — the nursing assistants, personal care aides, and home health aides who work each day in private homes and long-term care settings to provide life-sustaining care to older adults with chronic conditions and younger people with disabilities.

An Undervalued Workforce

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Despite the important work they do, direct care workers are in trouble. They are so poorly compensated that one in eight lived in poverty and more than half received public benefits in 2018. No wonder these workers are in desperately short supply at a time when we need them the most. In fact, we’ll need millions more of them to help us contain the coronavirus in the coming months, and to care for our rapidly growing older population in the years ahead.

We must strengthen this workforce and do it quickly. Recent research from LeadingAge shows that paying direct care workers at least a living wage must be our first step in reaching this goal.

Why do we undervalue workers who are the foundation of our health and economic well-being? Our country’s broken system of paying for care is partly to blame. Medicaid, the primary source of funding for long-term care, does not give providers of aging services the resources they need to cover the full cost of care for financially vulnerable elders, or to pay their caregivers adequately. Older people with limited incomes who do not qualify for Medicaid face similar challenges as they shoulder the cost of care by themselves.

Hope for the Future

There is some hope for the future, even in these bleak times. Our shared COVID trauma has led to a national consensus that direct care workers are our most valuable asset in keeping high-risk elders healthy and safe. Now is the time to capitalize on this consensus and work together on a new approach to investing in this essential workforce.

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Paying direct care workers at least a living wage might seem like an unaffordable, impossible dream. But our economic models show that wage increases for this critical workforce — estimated to cost $9.4 billion in 2022 — would actually pay for themselves, and save money in the long run. Most important, many Americans would benefit:

  • Three-quarters (75.3 percent) of direct care workers — mostly women and people of color —would receive a raise, allowing them to enjoy increased financial security and reducing their need to hold multiple jobs to make ends meet.
  • Communities would benefit as workers spent their additional income in local economies and depended less on government assistance.
  • Employers would experience lower turnover, thus reducing hefty recruitment costs.
  • Productivity would surge as workers stayed on the job longer, deepening their expertise while increasing care quality.
  • More workers would be attracted to the long-term care field, helping us fill a projected 8.2 million direct care job openings over the next eight years.

The Beginning of Progress

We are not alone in calling for increased support for direct care workers. A variety of experts, including Harvard Professor David Grabowski, have applauded our efforts to focus attention on the benefits of paying a living wage. Some providers, including National Church Residences in Columbus, Ohio, are already seeing those benefits as they strive to achieve a minimum wage of $15 per hour for every worker.

But providers can’t do this alone. That’s why we are heartened by efforts in several states —including Wisconsin and Colorado — to convene special workgroups to identify achievable strategies for raising wages and professionalizing the direct care workforce through enhanced training, certification, specialization, and career advancement.

These workgroups are a critical component of what must become a national effort to build strong coalitions of diverse stakeholders who will ask — and answer — hard questions about how we can support our direct care workers more fully for the good of all.

This is the moment of truth. If we truly believe direct care workers are “essential,” we must act immediately to bring policymakers, researchers, employers, and consumers together at the state and national levels so they can develop policies and practices that value and reward the contributions direct care workers make each day to the American health care system — and to older adults.

Katie Smith Sloan is President and CEO, and Robyn Stone is co-director, LeadingAge LTSS Center @UMass Boston and Senior Vice President, of LeadingAge, the association of nonprofit providers of aging services.