Build a Better Care Infrastructure: Support Family and Professional Caregivers

A healthy care economy—one that supports a healthy paid economy—requires that workers and families have access to high-quality, affordable childcare, paid leave, adequate financial resources, and workplace policies that offer flexibility in time, manner, and place of work, as well as stable and predictable schedules. A healthy care economy also requires a paid professional care workforce that has decent, dignified, and well-paying work that enables them and their families to thrive. Even before the pandemic, the infrastructure for a healthy care economy was broken, and right now many parents and guardians still can’t afford consistent and high quality care. In many states, infant care is more expensive than in-state college tuition, and for many lower-income and rural families living in childcare deserts, finding quality care is difficult. On top of the lack of affordability and accessibility, most care workers earn poverty wages. Nationwide, the median wage for childcare workers is $11.65 per hour and home care workers are paid $12.15 per hour. There is a clear need for public policy intervention to create a robust care infrastructure that guarantees high quality, affordable care to all families and livable wages to care educators and care workers.

Even prior to the pandemic, the U.S. care infrastructure was in crisis. Not one state does cost, quality, and availability well—on average, married couples spend 10 percent of their income, and single parents pay 34 percent of their income, on childcare. Despite the high costs, childcare workers earn poverty wages. High quality care is hard to find, and childcare deserts impact communities across the country.

During the pandemic, childcare providers and teachers have had to make impossible trade-offs between staying open—risking their and their families’ health—or shutting down and risking their financial security. Nearly half of all surveyed childcare providers reported that, without additional support, they would have to close their doors permanently. The pandemic’s devastating impact on the care system threatens not only the livelihood of care providers—many of whom are women, women of color, and immigrants—but the economic security and labor force participation primarily of women, who have disproportionately reduced work hours or been forced out of work because of the lack of care—potentially setting their progress in the workplace back an entire generation. The childcare economy needs significant public financial investment so that families, businesses, communities, children, and those who care for them are healthy and thrive as well.

Congress included $3 billion in the first pandemic relief bailout package in March to send to states in Child Care Development Block Grants, targeted at helping the very poor. Though advocates, economists, and others called for at least a $50 billion immediate infusion during the crisis—and the House passed such a provision—the Senate and Trump administration had not taken any action as of early December. “Child care is a critical piece of our economic infrastructure, just like roads and bridges, allowing parents to work if they choose,” the economists wrote. “A major federal investment to stabilize child care programs will ensure greater parental employment, save roughly one hundred thousand small businesses, and contribute to a more efficient economic recovery.”

Justin Ruben, co-founder of ParentsTogether and a parent himself, discussed the child care challenges parents are facing alone while managing work during the pandemic. “This is the hardest thing that's happened to families in 80 or 90 years, right? Absolutely parents feel abandoned and desperately in trouble right now. Either because, in some cases they don’t have enough to eat or they can’t make rent, or they’ve had to cut back on work, or quit work entirely to do childcare, or because they're doing remote learning and it's not going well…” Ruben explained that personal economic and childcare problems drives parents to the polls, “[W]e did a survey last week on the election…Of the parents that we surveyed, 95 percent said they were going to vote, and 36 percent of them said that the pandemic and the economic crisis have made them more likely to vote.” (Crisis Conversations: “A Parents’ Movement?”)

Adriana Garcia was furloughed at the salon where she worked because of the pandemic. As a mother of four and a social justice advocate, Garcia explained that her stress levels have been sky high as she tries to manage remote learning for her children. Now, more than ever, we as a society need to recognize and value the care work that has for so long been invisible and undervalued: “We have to raise awareness that this is not okay and that our children are the future. We’re investing our lives and raising these little people to be the next generation. So we should take care of our daycare workers, our teachers, all these people that we trust our babies with for hours and hours.” (Crisis Conversations: “Childcare Reckoning”)

Immediate Pandemic Response: Provide immediate support and funding for professional caregivers, centers, and providers

Before the pandemic, things were already difficult for childcare providers —they had low pay, not many benefits, and little support. “Now with this crisis, imagine how hard it is for a provider…we are working very closely with parents [and] with the community,” shared Patricia Moran, owner of Creative Learning Center, a family home childcare center in San Jose, California. Although Moran applied for a Paycheck Protection Program loan for her small business, she, like so many small businesses, didn’t get any help. Still, she chose to stay open for parents who were deemed essential workers and needed a safe place to leave their children while they continued working. Moran had seen the needs of “the parents, single moms, [and] children.” Like many care providers, Moran also experienced difficulty accessing cleaning supplies and personal protective equipment (PPE), stretching her already thin resources even thinner: “We were trying to find cleaning supplies and food for these kids in this crisis…working with the health departments and state governments to keep our children safe.” (Crisis Conversations: “Is our childcare system nearing its breaking point?”)

Rashonda Anderson, a lead child care teacher in Binghamton, N.Y. who is struggling to balance her work, education, and caring for her own school-age daughter told us she finally decided to leave the job she loves—even after going back to school and going into debt for a degree in early education—because, with the low pay, she can’t make the finances work for her family: “I decided to change career paths because financially, I’ll be able to provide my daughter more and have health benefits…[which] I don't have right now.… I just know that I just want more for myself and my daughter.” (Crisis Conversations: “Is our childcare system nearing its breaking point?”)

Long-term Policy Solutions: Invest in designing, creating and maintaining a robust, easily accessible, affordable, high-quality child care infrastructure with decent and dignified work for care educators and providers

Kari McCraken, a mother of five, had the opportunity to resume her position after months of being furloughed due to the pandemic. Although she loved her job and wanted to return to work, a lack of childcare meant that she would have no place to leave her children. In the end, because she couldn’t access childcare and did not qualify for emergency paid leave—her employer had been exempted from the emergency provision—she was pushed out of the workforce: “I loved the company. I loved my job. I was so excited to still have a job…[but] then it hit me once I started calling around for child care that this is not possible. Our childcare centers were operating around 15 to 20 percent capacity which means there was was no hope if you were someone new coming in.” (Crisis Conversations: "Setting Working Moms Back a Generation?")

Alison Griffin, a single mother and senior vice president for Whiteboard Advisors, strives to balance working full time and supervising her school-age children who need assistance with distance learning: “It’s just me and my boys...I’m helping with homework while on five to six hours of calls…There isn’t anybody else who can pitch in…in the pre-pandemic era I would rely on friends and family, or I would pay a sitter. I can’t have anyone else in the house to help me with those things right now.” (Crisis Conversations: “Parenting Alone in the Time of COVID-19”)

Nahsis Davis, a nurse practitioner, became a single mother to three young children through the foster care system just as the pandemic hit. When daycares began closing, Davis had to scramble to find childcare and wasn’t able to take time off due to an unsympathetic work environment. She shared, “My job itself is not that helpful or understanding. I didn’t cause this pandemic… and I need time off for these kids because I have no one to watch them. [And] that's been a huge nightmare. Money-wise it’s been very tight…I have more than one mouth to feed and milk is not free out there, neither are the [daycare] services, obviously.” (Crisis Conversations: “Parenting Alone in the Time of COVID-19”)

Personal and home health aides are the fastest growing occupation in the United States. The work they do is essential to the growing population of seniors as well as those in need of long-term care, especially now in the midst of a pandemic. Yet despite this, home health aides earn poverty level wages with few labor protections.

Families that care for aging adults and people with disabilities face difficult financial compromises. AARP released data that found family caregivers spend about 20 percent of their income on caregiving activities, amounting to about $7,000 per year in out-of-pocket expenses. Funding elder care programs that allow people to receive care at home, rather than in a nursing home, saves money and improves the quality of life for those in need of care, as shown by Washington state’s Health Home program, which saved Medicare more than $107 million over three years.

Immediate Pandemic Response: Support home health workers who care for older adults and people with disabilities throughout this pandemic

Jennifer Olsen, executive director of the Rosalynn Carter Institute for Caregiving, noted, “Caregivers have often been some of the most resilient and creative problem solvers in this country. I actually think there’s a moment to say, ‘Well, we could learn so much from the way caregivers adapt to challenges.’” (Crisis Conversations: Family Caregiving)

Marilyn Washington, the home health aide in San Antonio, Texas from earlier, had to use her own money to buy PPE because her agency didn’t supply it. She shared, “They don’t give us a mask…they don’t even give [us] gloves. But I made sure I had gloves. I went and bought myself two boxes and hand sanitizer.” (Crisis Conversations: Doing Essential Work in One of the few Countries that Resists Paid Sick Leave”)

Brittany Williams works as a home health care worker in Seattle, Wash., which has passed support for professional elder and home health care workers through public-private partnership, and she is an active member of SEIU 775. The agency she works for stepped up. She said, “[We] get a full PPE bag, which consists of face masks, hand sanitizers, bar soap, paper towels, [and] disinfecting spray to clean down surfaces.” (Crisis Conversations: “For Elder-Care Workers in the Pandemic, One State (Mostly) Gets It Right”)

Long-term Policy Solutions: Support professional and family caregivers and their need to combine work and caring for themselves or loved ones

Through the innovative partnership of the state of Washington, private businesses, and her union, Williams is paid a decent wage. She has benefits like health care, paid time off, retirement savings, professional development, and a path to advancement. Quality of care has also improved. More people receive care in their homes, rather than in expensive and inadequate nursing homes, and are healthier, which means less public spending.

“In Washington state, they realized that caregivers are essential a long time ago,” Williams said. Her mother, a home health aide in Arkansas, makes $11 an hour. “I’m a third generation caregiver and my mom and grandma do the same job in Arkansas, where there are no unions for caregivers. Up here, we won a starting wage of $15 for caregivers, they don't have that. We have health insurance for caregivers, they don’t have that. We have a retirement plan and provide our caregivers with a free pair of shoes. These are things that caregivers in Arkansas don’t get.” (Crisis Conversations: “For Elder-Care Workers in the Pandemic, One State (Mostly) Gets It Right”)

Twenty-nine year old Jessica Mills of Georgia has been caring for her mother, who has dementia, for the past 10 years. Due to the increasing weight of her caregiving responsibilities, Mills has had to drop out of college, leave the labor force, and rely upon savings to keep her family afloat: “We’ve been very fortunate to be able to [care for my mom from home] so far, but my dad had to go into early retirement. I worked as long as I could part time until her needs [required] care 24/7 care. Neither one of us can work now. Even with hospice nurses coming in a couple times of the week, a lot of the care still falls on us.” Continuing, Mills says, “I haven’t been working in the past two years, and we were lucky enough to have savings that have gotten us through; unfortunately, [that’s] not going to last much longer. I have been looking into starting school again online and I’m looking into getting back into the workforce in whatever way possible.” (Crisis Conversations: “Family Caregiving”)

Debbi Simmons Harris is a family caregiver in Minnesota who had to stop working to care for her son, Joshua, who has required complex 24-hour medical care for more than two decades. While she and her family are trained to provide care, they must also rely on three nurses to fill the gaps, which has been difficult during the pandemic. Simmons recalled being anxious about the pandemic and “having so many people coming in and out…knowing that every contact that every single person made outside of the home was another risk of exposure for Joshua.” (Crisis Conversations: “Family Caregiving”)

Simmons also shared that while she loves her son and finds joy in caregiving, caring for a family member with chronic illness wears family caregivers down over time. “In addition to the weariness, there is joy in all of this too because it impacts our lives so profoundly. That aspect needs to be shown, too, but there’s a weariness to caregiving over such a long period of time. In addition to the custodial care that we provide, there are days upon days where you're doing high-level nursing assessment and interventions that would be done perhaps in an intensive care environment.” (Crisis Conversations: “Family Caregiving”)