Caring Across Generations

COVID-19 has called public attention to the impact of those who provide us with care. Working families have had to carry the crushing weight of care, whether it’s for their kids or aging parents as the economy has slowed down to a crawl and wages have remained stagnant. Quality care is costly, and it’s in increasing demand as baby boomers age, life expectancy grows, and millennials become parents. The rising costs of care and competing life demands make it a hardship for families to shoulder the weight of caring for those they love.

But our national policies don’t acknowledge the conflict that families face. For the most part, we’ve considered caregiving a personal duty. If you’re a parent and you can’t afford child care, it’s because of some failure on your part. If you’re a daughter of a parent with Alzheimer’s, and you can’t afford the home care you need, it’s because you didn’t plan ahead and save up for the expense. And many daughters face this dilemma because the weight of caregiving falls heaviest on women.

Many of these women are part of the sandwich generation that provides care for both children and an aging or disabled family member. Their lives became even more difficult as COVID-19 reduced their access to professional care. The longstanding, do-it-yourself approach to providing care no longer worked for them as they found themselves unable to handle the burden of both caregiving and working.

Many have had to leave their jobs, and I recently found myself thinking about their plight when I attended a webinar on child care held by the Center for American Progress. As the speakers talked about ways to rebuild the early child care sector in the wake of the pandemic, the issue of advocacy came up. One of the suggestions for helping our early childhood teachers earn the benefits and wages they deserve is to hold hands across sectors. And one natural ally for our field would be the home care sector. Though home care workers tend to serve the opposite end of the age spectrum, they face many of the same roadblocks as our early childhood teachers in the fight for respect, recognition and appropriate pay.

They are largely women of color and immigrant women who struggle to make ends meet and often depend on public assistance while they’re meeting the needs of society’s weakest members. Their hourly wages range from $10.72 for child care workers in all settings to $11.89 for non-agency home care workers, frequently without health insurance, retirement security or other benefits. They often contend with challenging working conditions, and COVID-19 has only made their lives harder. The pandemic has made a heavy impact on this workforce—either causing them to quit their jobs out of safety concerns or forcing them to risk their health. Child care workers, like home care workers, cannot social distance. And though they don’t get the kudos other essential workers do, they’re also right on the front lines.

They perform work that we cannot automate or outsource as they care for those who are unable to fend for themselves. This is because quality caregiving depends on empathy, understanding and strong personal bonds. Home care and child care workers come to know the needs of those they serve—how someone likes their coffee or the best way to soothe a fretful child. They know the medications that a senior citizen needs and how to handle a young child’s asthma attack. Working parents hand their children over to educators for nurturing and learning. Families trust home care workers to keep their aging relatives safe and make sure their dignity is preserved.

The value of the work they do is rising because of advances in technology and science. Increasing use of telehealth and innovations in medical equipment have brought the hospital to the home, especially for patients with chronic conditions. Home care workers now do increasingly complex tasks to cut down on costly emergency room visits and help their patients live healthier lives. Similarly, advances in brain science have led to a better understanding of how children develop and best practices for helping them learn. Skilled early childhood educators can cut down on the incidence of social ills, such as poverty and crime, since children who receive early education tend to live happier, more productive lives. Quality early child care, like quality home care, leads to long-term savings for taxpayers and society as a whole.

The importance of the services these workers provide points to the need for professionalization. Training enhances the care they give and allows them to climb the career ladder in their field. Yet we don’t give these workers much support in honing their skills. Tuition for a home health aide certification program typically costs between $300 and $650—high for someone who’s barely scraping by—and training programs don’t always meet the requirements to get certified by the state. Educators have it even harder since they’re increasingly required to earn an associate or bachelor’s degree. The high costs of training, combined with low wages and the burden of student loans, make many of these workers quit the caregiving field.

Turnover in caregiving fields is high, and it inflicts high costs on our children and our parents, our siblings, our neighbors and our friends. Every time a teacher leaves a classroom because they can’t afford to stay, a child’s heart breaks, and their learning takes a step back. Every time, a home care worker leaves her job, a senior loses someone they trust. And these tragedies take place far too often, leading to shortages of seasoned staff. In the face of rising demand, the quality and the continuity of care suffers a striking blow.

And the rest of us also suffer, especially the many women who’ve struggled, often without success, to juggle the demands of caregiving and work. “The pandemic has really highlighted the inequalities and precarity of women’s work,” Rep. Katherine D. Clark (D.-MA) recently pointed out. “If we are not addressing the health needs of women, the policies that allow women to work, we are not going to be able to restore the health of communities, families and our economy.”

The need for care crosses generations, and we must recognize the crucial role our caregiving workforce plays throughout the lifespan. The passage of the American Rescue Plan Act marks a start by providing funding to rebuild the infrastructure of care. This important piece of legislation has added $12 billion to Medicaid’s home and community-based services to expand services to older adults and support the workers who serve them. It has also infused more than $50 billion into the child care sector—both steps that are critical to paving the path ahead for working families.

But we need long-term policies and systemic change to support our caregiving workforce. We need to treat our early educators and home care workers with respect and give them the pay they need to stay on the job. They deserve training and career ladders to higher-paying jobs, the choice to join a union and bargain collectively, along with other basic work-related rights and protections. These workers are the foundation of a care infrastructure that is essential for our economy to recover after COVID-19. Even more fundamental, the way we treat this workforce—which is mainly made up of women of color and immigrant women—is a measure of our commitment to equity and justice.

The policies we make to support these workers will determine how history judges us in the future. So, we should take care to give our caregiving workforce the dignity it deserves. “The moral test of government,” as former Vice President Hubert Humphrey once movingly said, “is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick the needy and the handicapped.” Investing in our caregivers is an investment in the children, seniors, and struggling families they serve. It will be a mark of America’s progress in living up to its ideals.