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David Ward Headshot

Invest in Direct Care Jobs to Strengthen U.S. Economy

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The 113th Congress starts work today with a mandate from voters to rebuild our economy. While we've made some progress over the past four years, there is clear bipartisan agreement that we have not made enough. High unemployment and poverty persist, 93 percent of the wealth created in 2010-2011 went to the top 1 percent, and the greatest job growth over the next few years is projected to occur in low-wage sectors like direct care, where 47 percent of the workforce relies on public benefits such as food stamps or Medicaid to make ends meet.

So what are we going to do about this problem? The budget deal that was just passed aims to reduce our national debt. Deficit reduction is an important step toward rebuilding the American economy, but it's no silver bullet. The best way to reduce debt over the long term is to get people to work in quality jobs, where they can earn enough to pay for food and health care rather than being forced to rely on public benefits.

Over the past few years, Congress and the Obama Administration have pursued job creation initiatives that focus on improvements to our nation's infrastructure, education, and green jobs. These are important actions to take, but they continue to ignore what is the fastest growing and is projected to become the largest sector of our economy by 2020: the direct care workforce.

Direct care workers -- nursing assistants, home health and home care aides, personal care aides, and other caregivers -- provide the lion's share of the paid care for our long-term care system. The rapid increase in demand for their services is fueled by an aging baby boomer population and the wounded veterans returning from a decade of combat. And while the opportunity to pursue a noble career helping others maintain their dignity and independence is appealing to job seekers, there's a catch: Direct care jobs typically provide near-poverty level wages and limited or no benefits. Nationwide, the median annual salary for direct care workers is just $17,000, and more than a quarter of all direct care workers -- close to a million in 2010 -- have no health insurance.

This lack of respect and adequate compensation for direct care jobs -- which includes the exclusion of home care workers from basic labor protections -- is a result of a widespread perception that caregiving is labor that requires little or no skill. But that perception is not consistent with the reality of this mentally and physically demanding job, or with the rapid growth of this workforce.

The government essentially sets the wages for direct care workers. According to the Kaiser Family Foundation, Medicaid (which is jointly funded by states and the federal government) and Medicare (which is federally funded) reimburse over 75 percent of the paid long-term care provided in our country, with out-of-pocket payments accounting for most of the remainder. Direct care worker wages tend to be stagnant at best -- personal care aides nationwide earned less in 2011 than they did in 2001, after adjusting for inflation -- and Medicare and Medicaid are now being targeted for deep cuts. Many states are already reducing their Medicaid long-term care reimbursements, resulting in further wage and benefit reductions for the workers who provide this critical service to vulnerable seniors and people with disabilities.

It's important that policymakers understand that reducing one source of government funding often just means increasing another. The chair of the Direct Care Alliance's board, Tracy Dudzinski, is a home care worker for a worker-owned co-op in rural Wisconsin. In 2011, Wisconsin's governor, Scott Walker, approved cuts to a long-term care program that forced the co-op to eliminate health benefits for its workers. Now many of those workers are receiving health benefits from Badger Care, Wisconsin's Medicaid program. I doubt that when Governor Walker approved these cuts he intended to increase the number of Wisconsin residents receiving Medicaid benefits, but that's what happened.

Our nation is divided about how we should balance cuts and revenue increases to help improve the economic security of seniors, people with disabilities, and hard-working folks like direct care workers. It's time for policymakers to demonstrate their leadership and find a solution that benefits us all. Direct Care Alliance's 2013 Congressional Agenda offers a practical strategy to strengthen the direct care workforce and help rebuild our economy by improving wages and basic benefits such as health care and paid sick days; increasing funding to train this workforce; and creating opportunities for specialization and advancement.

America's long-term care system depends on a strong and dependable direct care workforce that's compensated well enough to be able to afford to stay on the job, providing older adults and people with disabilities with consistent, high-quality care. Improving direct care jobs will pay off for us all in many ways: improving financial security for direct care workers and their families, improving quality of care and quality of life for the growing number of people who depend on these crucial workers, and strengthening our economy.