Improving Job Quality for the Growing Number of Care Workers In the United States

By Jane Henrici, Ph.D., Nina Pasha, and Mansee Khurana

The demand for nursing assistants, home health aides, and personal care aides is increasing as Baby Boomers move into retirement. The Paraprofessional Healthcare Institute (PHI) estimates that these and other direct-care jobs will be among the fastest-growing occupations in the United States, with significant increases having started in 2008 and expected to continue until 2018.

To address these and other ongoing issues with direct-care workers, Caring Across Generations, a national campaign consisting of 200 coalition partners, has developed the “Five Fingers of the Caring Hand” as a way to reform federal policies on long-term care. One of the components is to improve labor standards for direct-care workers by supporting the rights of unionization, providing access to health insurance benefits, and establishing minimum-wage and overtime protections for home health aides. With support from the Ms. and Open Society Foundations, IWPR is working with the National Domestic Workers’ Alliance (NDWA) and others to provide research for the Caring Across Generations campaign.

As PHI reports, over half (55 percent) of all direct-care workers—from nursing assistants or aides through personal care aides—have only a high school degree or even less education. Approximately 23 percent of all direct-care workers are foreign-born. Roughly 45 percent of direct-care workers live in households with earnings below 200 percent of the federal poverty level.

All of these concerns fall heavily on women. The intersection of immigration and care work is a feminist issue, as Ai-jen Poo, Director of NDWA emphasizes in her outreach .  The vast majority (89 percent) of direct-care workers across the United States are women. The majority of individuals 65 years old and over in the United States are also women, as are the majority of those who are unpaid family caregivers to the elderly or disabled. A recent Gallup poll found that 20 percent of women and 16 percent of men working part- or full-time in the United States also help with the caregiving for family members and friends.

“[T]here are still home care workers that provide quality [care], but have no access to affordable health care for themselves or their families, and there are still home care workers who cannot afford to get sick because it means they will not get paid,” said Dr. L. Toni Lewis, Health Care Chair with the Service Employees International Union, at the July 2011 launch of the Caring Across Generations campaign. “It may not happen this year, and it may not happen next year, but together, we are going to change this and make it right.”

On December 15, 2011, the U.S. Department of Labor (DOL) announced that it is proposing a new regulation for the wages of home care workers. As Secretary of Labor Hilda Solis pointed out in a DOL blog post on December 15, 2011, women make up more than 92 percent of those who would be covered under this proposed revision to the Fair Labor Standards Act.

Policymakers are beginning to take note of the issue of protections for caregivers, which is of special concern to women and to a growing number of American workers and families. IWPR will continue to research the quality of jobs available to care workers and to shed light on their needs.

Jane Henrici, Ph.D., is a Study Director with the Institute for Women’s Policy Research (IWPR). Nina Pasha, and Mansee Khurana are former research interns with IWPR.

To view more of IWPR’s research, visit

Top 5 Findings of 2011

Women with lightbulbsby Caroline Dobuzinskis, with Jocelyn Fischer and Rhiana Gunn-Wright.

In 2011, IWPR released several important findings on relevant topics such as the continuing impact of the recession, increased reliance on Social Security among older Americans, and the value of paid sick days for improving public health. Read the top findings below and continue to follow IWPR or sign up for our e-alerts to stay informed on our latest research on women, families, and communities.

1. During the recovery, men gained more jobs overall than women. Contrary to the image presented by a new, widely-panned sitcom, the recovery is not proving to be easier for female job seekers. Overall, men have regained one out of three jobs lost in the recession, while women regained one of every four jobs they lost. But the last quarter of 2011 saw women making some gains in the job market: men and women had equal job growth in the past three months at 206,000 jobs each.

2. Many Americans are living paycheck to paycheck and some cannot afford to put food on the table. Last September, IWPR released findings from the IWPR/Rockefeller Survey of Economic Security showing that only 43 percent of women and 61 percent of men would have the savings to pay for living expenses for a period of two months. In households with more than one person who experienced unemployment for one month or longer in the two years prior to the survey, 27 percent of women and 20 percent of men went hungry because they could not afford food.

3. Americans strongly support Social Security and have grown increasingly reliant on the program in the last decade. A large majority of Americans (74 percent of all women and 69 percent of men in the IWPR/Rockefeller survey) say they  don’t mind paying Social Security taxes for the benefits they will receive when they retire. Between 1999 and 2009, the number of men aged 65 and older relying on Social Security for at least 80 percent of their incomes increased by 48 percent to equal more than a third of all men aged 65 and older in 2009. The increase for comparable women was 26 percent to equal half of older women in 2009.

4. The number of on-campus child care centers has declined and presently can only meet five percent of the child care needs of student parents. There are 3.9 million student parents pursuing postsecondary education in the United States, 57 percent of whom are also low-income adults. Access to affordable, on-campus child care has decreased, partly due to the increase of for-profit postsecondary institutions.

5. Paid sick days would reduce emergency department visits–saving $1 billion in health care costs. Access to paid sick days would eliminate 1.3 million emergency department visits per year and would save $500 million to taxpayers through public health insurance costs because regular doctors’ office visits would substitute for expensive emergency room care. Informed by research from organizations such as the Institute for Women’s Policy Research, paid sick days legislation gained significant momentum across the country last year.

Caroline Dobuzinskis is the Communications Manager at the Institute for Women’s Policy Research. Jocelyn Fischer is Assistant to the President and Rhiana Gunn-Wright is this year’s Mariam K. Chamberlain fellow.

To view more of IWPR’s research, visit