Carmel Foster, 53, has been a senior caregiver for five years. After her divorce, she worked as an executive assistant for a while before realizing that she could become a professional caregiver for the elderly. She’d cared for her mother through kidney disease and her father with dementia back home in South Africa, and she’d enjoyed the hard work of caring for others.
But Foster has had a tough time making ends meet. The inconsistency of the work has forced her to register with four different agencies. Some weeks that leads to maybe 20 hours of work, if she’s lucky, and the rest of the time she works cleaning houses to help put her daughter through medical school. Sometimes she can earn more if she travels farther from her home outside San Francisco, California. But then she also runs the risk of a last-minute cancellation or shifting schedules leaving her in the lurch with no pay and a bill for gas for a three-hour round trip.
Like most home caregivers, Foster is considered an independent contractor, meaning she doesn’t qualify for benefits and that’s why most agencies won’t give her anything approaching the 36 hours a week she’d need to be considered full time, as they don’t want to pay for things like health care and retirement savings.
Foster’s challenges represent those facing the rapidly growing home care workforce. “Workers like myself should be able to get work through the gig economy,” Foster says, “but we shouldn’t have to be deprived from basic worker rights, like no medical, health care, state disability insurance.”
To address these issues, this week Democratic Sen. Kamala Harris of California Democrat and Rep. Pramila Jayapal, D-Wash., are introducing a Domestic Worker’s Bill of Rights. The bill would require a written agreement— the Department of Labor already has templates — that clearly outlines pay, work, schedules and would allow workers to earn up to seven paid sick days. It would also protect against discrimination and sexual harassment and establish an independent wage and standards board that would make recommendations to the Labor Department. Finally, it allots money for grants for community organizations to help proliferate the work of the bill, and it increases federal spending to help low-income folks to afford caregiving.
“This is the work that makes all other work possible,” wrote Ai-jen Poo, head of the National Domestic Workers Alliance, in an op-ed in Monday’s New York Times announcing the introduction of federal legislation this week to address these issues. “Congress should quickly pass this bill so these precarious and undervalued jobs can become good, dignified ones.”
We are only at the beginning of what is already a crisis. With more than 10,000 Baby Boomers reaching retirement age every day, the industry will require more than 1 million additional workers by 2026, making it the single fastest growing labor sector in America. But a critical labor shortage already leads to more than 75 percent turnover annually in most senior care communities and home care agencies, and the problem is only getting worse.
In many ways, domestic workers were the gig economy before the gig economy existed. They cared for America’s children, elderly and disabled. But because of objections from the southern states during President Franklin Roosevelt’s New Deal, largely minority domestic workers were left out of the legislation that ensured fair practices in the office place. So, for the last 80 years, these workers have been chronically underpaid, as they aren’t subject to minimum wage laws; overworked, as they also don’t qualify for paid leave laws; and often abused, since they aren’t governed by the harassment, ergonomic and other safe working place laws.
“Home care workers are the least well-paid of all the direct care workers. And on top of that you have all these other challenges, getting to work, being alone in a home with no supervision or support, and often without adequate training,” says Robyn Stone, vice president for research at LeadingAge, the industry association for non-profit assisted living. “It’s a very complicated job, but it’s basically seen as being a baby sitter and a maid.”
The demand for this undervalued profession is poised to grow even higher.
By the time the last Boomers hit 70 in 2030, America will be short more than 4 million caregivers. So just as the need for care will be the greatest, the supply and quality of it will be the lowest. This will lead to a ballooning of the cost of care — by some estimates long-term care costs will quintuple by 2050 —threatening to bankrupt most middle-class Americans by 2050, unless something is done to change the system.
Last year, Congress passed the RAISE Act, which increased federal money for research on caregiving solutions and created a panel to study the issue, but much more needs to be done. States such as Hawaii and Washington have led the way by passing long-term care funds, and San Francisco has raised its minimum wage to $15.59 an hour, in large part to help better the lives of home care workers.
But the issue wasn’t even mentioned in the first Democratic debates, in which Harris took part. And few candidates have comprehensive plans to address the issue. Sen. Bernie Sanders, a Vermont independent seeking the Democratic nomination, introduced a Medicare-for-all bill that included a long-term care provision with Jayapal. Another Democratic 2020 contender, Senator Elizabeth Warren of Massachusetts, has a plan for universal child care.
Various members have introduced paid family leave schemes — currently family leave is only unpaid. But the sad fact is that little is likely to be done in the midst of a presidential election. Like these other initiatives this new bill faces an uphill battle for media attention and political capital.
Foster believes that as more Americans age and need care, and care becomes prohibitively expensive, that will force political action. “The system doesn’t work for us,” she says. “Our culture needs to value care, and our system needs to value caregivers. So, the problems and challenges are both cultural and political— but so are the solutions.”
Jay Newton-Small is founder and CEO of MemoryWell. She was previously a national correspondent for TIME Magazine.