Editor’s Note: ASA is focusing on immigration and aging, watch for a Generations Today issue on the topic March 23.
I am lucky to spend a fair amount of my time working with, speaking to, and meeting our field partners—family caregivers and individuals who receive care—and I can say, without hesitation, that the No. 1 issue I hear about is the workforce crisis and what it means to the lives of the workers and the individuals they serve.
When I say crisis, that word really doesn’t do it justice, because having a skilled, properly trained and fairly paid workforce is the lynchpin of success for so many people who receive these supports, enabling them to live the independent life that they choose. In some cases in can literally mean life or death. The work that direct care workers do varies, but it can include providing personal care, communication, household tasks, building relationships, and navigating the community.
The work that direct care workers do is invaluable to the people who rely upon their care, family caregivers, and the service system that relies upon their ability to keep people out of more costly, restrictive and often segregated institutional settings.
Currently, Medicaid reimbursement rates control low worker wages.
This workforce issue is compounded by factors beyond the control of the workers and the individuals they support, such as stagnant wages and immigration systems that don’t allow for more workers to flow into the country to support the care infrastructure.
Providers Partially Powerless to Set Pay
Providers (the employers that pay direct care workers), which provide services for people with disabilities all over the country, mostly provide home- and community-based services funded by Medicaid. These providers don’t set the rate they are paid by the state to provide specific services, the rates are set in advance between the state government and the federal government.
Neither the individuals served, the direct care worker, nor the provider have decision-making capabilities around setting these rates, there has been a lack of federal investment for decades, and states have not picked up the slack, either. Many states instead use any opportunity to cut human services budgets.
Rates providers receive to pay direct care workers do not take into account the wages of competing occupations, the need for benefits and the costs of services. As a result, rates and therefore wages have remained flat for decades, without even cost-of-living increases. In addition to stagnant wages, the lack of sufficient immigration policies to support bringing more immigrant care workers into the United States is a major concern.
Immigration Policy Potential
Immigrants have always made up a large proportion of direct care workers. According to PHI, there are approximately 1 million immigrants working in direct care jobs, meaning one in four direct care workers are immigrants. Also per PHI, in New York, California, New Jersey, Hawaii and Florida—the five states with the highest percentages of immigrant direct care workers—more than 40 percent of direct care workers are immigrants.
The ‘Domestic Workers Bill of Rights’ legislation would strengthen labor protections and expand opportunities for immigrant direct care workers.
With such high percentages of this life-giving workforce being immigrants, it is imperative to create more opportunities for these direct care workers to either enter the country legally or gain legal status while here. Especially when one considers the growing need for this work as the population ages, and the fact that more people with disabilities require supports.
A variety of policy measures support this workforce, including proposals in the Build Back Better Act that will increase wages for the entire workforce. This one change would disproportionately benefit immigrant workers, given that they make up 25% of this underpaid workforce. In addition, there are a variety of policy proposals on the docket that are specific to immigration status, including options to create a path to legalization for immigrant direct care workers, and to provide provisional visas for immigrants to enter the country and eventually gain legal status after their work as direct care workers.
More broadly, there is the sweeping “Domestic Workers Bill of Rights,” legislation that, as proposed, would strengthen labor protections and expand opportunities for domestic workers, including immigrant direct care workers, to gain paths to legalization.
The value of direct care workers cannot be overstated by the people who rely upon their support. Any efforts to expand the workforce, as we bolster the existing care infrastructure, must include immigration reforms to support this vital part of the direct care workforce to stay here, where they provide such important care and support.
Nicole Jorwic, JD, is chief of Advocacy and Campaigns at Caring Across Generations, in Washington, DC.