Why the U.S. has a ‘blind spot’ that leads to the undervaluing paid caregivers

A few weeks ago, WGLT reported on the senior advocacy group AARP pushing for a new state tax credit to provide some modest relief to unpaid family caregivers.

Chris Wellin heard that interview and thought there’s more to the story. Wellin is an associate professor emeritus of sociology at Illinois State University who has researched and written about aging.

In an interview on WGLT’s Sound Ideas, Wellin said the U.S. instead needs to better support, fund, and integrate paid caregiving, even for those families who seek to carry much of the responsibility themselves.

This excerpt of Wellin’s interview has been lightly edited for clarity and length.

WGLT: You say we can’t hope to meet these big challenges of the retiring Baby Boomer generation only through unpaid family care. What do you mean?

Wellin: I’m fully in support of the tax credits for family caregivers. I think it’s helpful. I would say it’s sort of necessary but not sufficient.

We’re in a society, of course, that’s not only aging, but it’s also presenting us with a much greater challenge in terms of chronic illness and long-term care. There are about 80 million Baby Boomers born after the second World War and the next 15 years or so. And they’re living longer lives.

The Baby Boomers had fewer children. Their birth rates were lower than in the past. And so as they age into their 70s, 80s, 90s and beyond, we find that the demand for certain kinds of caregiving and support have increased very sharply, while the supply — if you can put it in that sort of clumsy term — of caregiving has contracted a lot.

And so tens of millions of older people — particularly older people who need this kind of care and support — simply don’t have family resources. And so that opened the door to my contribution today, which is to talk about this enormous army of paid caregivers. We’re talking about nurse’s aides, home health aides, personal care assistants, people who are in the community providing this care. Whether in institutional settings, like nursing homes, or in the community or intermediate settings, like assisted living.

This is part of the workforce that I think we need to pay greater attention to, and to support much more strongly than we have been.

If we were to put more effort, more resources, into this paid caregiving army, what should that look like? Give me some examples.

All told, there are according to the Bureau of Labor Statistics, in 2021, there was something like 1.5 million of these jobs that were added to this large army of workers. And yet still, knowing the issues of inflation and economic stress that people face today, the median annual wage for nursing assistants in 2021 was just over $30,000.

And so in some states, we’ve seen a creep up of the minimum wage, which is very important. But you have a case where people who are working full-time caring for other vulnerable people with all of the skill that that entails, often can qualify for food stamps and struggle to rent even modest apartments. So these are just basic economic and labor issues.

I think in the past, when we thought of paid caregivers, we might have thought first of a nurse’s aide in the hospital. We might have thought of them providing services and care that is essentially instrumental care — helping people go to the bathroom, helping people to eat or to transport them through the hospital. So we didn’t think of it in the sense as a skillful job. We thought of it as a job that didn’t really require much intuition, education or training.

But working in the community, in assisted living or for people individually like as a home health aide, is indeed a very complex job, which entails not only those kinds of physical, bodily kinds of care, but also care for the person as an autonomous human being with their own routines, relationships, other social networks. And so in a sense, there’s been a huge blind spot about the complexity and importance of this work. And that blind spot has allowed employers, particularly large corporate nursing home chains or home health agencies, to essentially minimize and distort the skillful nature of such work.

How do we do that? How do we pay these caregivers more money?

It’s a very important question. Again, it’s basic labor politics. In some regions of the country, the West Coast, particularly California, there have been good strides in terms of unionization. SEIU, the Service Employees International Union, has begun to organize people in hospitals and other community settings. And of course, traditionally, these were the kinds of jobs that were not unionized in the past.

I think another part of it is simply this kind of conversation that we’re having today, where people need to recognize the importance and subtlety of caregiving work.

One of the things that makes that recognition more difficult is actually the ethnic and racial composition of this labor force. Because in the past and still, direct caregiving is a labor force that is overwhelmingly women, disproportionately women of color, both native born and foreign born. And so just like every other aspect of American society, we sometimes see tensions and misunderstandings across those boundaries of ethnicity, race and social class and language, for that matter.

If we don’t get this right and keep doing what we’re doing, what happens?

We’re going to continue to see high poverty rates, particularly among women. Enormous stress and disruption among families. What we call “opportunity cost.” The inability to take a promotion — let’s say you’re a family caregiver — or to go to school or to move for another job, all those opportunities are lost.

So those are all costs, I think, that are daunting.