The following is a guest post from Nancy Hooyman, Co-Principal Investigator for the Council on Social Work Education’s Center for Gerontological Social Work Education and Dean Emeritus and Hooyman Endowed Professor in Gerontology, University of Washington School of Social Work.
Nancy Hooyman
The vitally necessary Direct Care Workforce Empowerment Act is deserving of the support from a wide range of stakeholders – social workers, other eldercare providers, those committed to social justice as well as those focused on the economics of long-term care. Direct care staff are second only to families as the primary providers of long-term care — the “hands, voice, face” and core of the long-term care system. The care they provide is “high-touch” intimate, personal, and physically/emotionally challenging (Harahan and Stone, 2009; Institute of Medicine, 2008). These hands-on providers are expected to be compassionate yet usually do not feel prepared, respected, or appreciated, in part because our society does not value the socially and economically important work of caregiving.
Supporting this Act is also a matter of social justice and congruent with social work’s commitment to improve the lives of historically disadvantaged groups. The intersections of gender, race, and immigration status are reflected in the low status and negative work conditions of direct care workers. Advocates for women’s equity should also support this Act; nine out of ten of direct care staff are women, oftentimes single mothers, with minimal education, frequently holding more than one job but still living in poverty or near-poverty, and increasingly dependent on food stamps and other public benefits to get by. The Act is also an issue of racial justice; inequities in education and employment across the life course partially explain the predominance of African American, Asian, and Latina women (many of whom are immigrants) among direct care workers. Foreign-born women, generally educated in another country, comprise 20 to 25 percent of the direct care workforce, with the highest rates among immigrants from Mexico, Haiti, Puerto Rico, Jamaica, and the Philippines. Immigrant women are especially vulnerable to financial exploitation if such work is paid under the table (Harahan and Stone, 2009; Leutz, 2007; Stone and Dawson, 2008).
Sexism, racism and ageism are reflected in negative working conditions faced by many direct care workers. Ageism underlies the fact that long-term care for older people, especially women, is viewed as a low status task, with low-income women of color increasingly providing care for low-income older women. They receive only poverty-level wages, with no or limited benefits (particularly health insurance) and inadequate training and supervision. In fact, the current direct care workforce has median hourly earnings that are more than 30 percent lower than that of the overall female workforce in the U.S., due in part to the high proportion of nonwhite and foreign-born workers and their lower education levels (Smith and Baughman, 2007). Additionally, direct care work is physically and emotionally draining, with the risk of personal injury second only to truck drivers (Stone and Dawson, 2008).
It is imperative that other elder care providers and advocates support this Act., since the low societal value placed on long-term caregiving is problematic not only for the direct care staff, but also for older adults, family members, and other formal providers of care. Quality of care for our oldest citizens is inextricably interconnected with the direct care workers’ quality of life, and is markedly diminished when worker’s morale is low, turnover high, and labor shortages persistent. Supporting this Act is the right thing to do from a social justice and human rights perspective; it also is makes good economic sense for owners and employer, since a well-documented pattern exists that when wages and health benefits are increased, recruitment and retention are improved.
