All of us, at some point in our lives, will require care for ourselves or for a loved one. By some estimates, 70 percent of people over the age of 65 will soon require long-term care, either at home or in an institutional setting. In particular, home care jobs are considered to be among the fastest-growing jobs in America, with the Bureau of Labor Statistics projecting that the employment of home care workers will grow by 25% over the next 10 years.
However, home care work is among the most troubled occupations in the U.S. labor market, with low earnings, limited access to benefits, high rates of injury on the job, and scheduling unpredictability. This is primarily due to the ongoing influence of structural racism and sexism. The Brookings Institution describes the US health care industry as “highly segregated” by race and gender. It also points to research showing that certain health care jobs are undervalued precisely because they are associated with “women’s work.”
Advancing the dignity of home care workers has the potential to transform an industry that all of us depend on to provide critical services, while also generating direct and indirect benefits for many other stakeholders in communities across America.
The Multisolving Potential of Dignified Home Care Work
Dignified home care, i.e., work that pays a living wage and takes into account the well-being and agency of both the care worker as well as the clients who receive care—is a powerful multisolver in the movement for well-being, equity, and racial justice. It benefits care workers themselves as well as their clients, their respective families, related organizations throughout the health care sector, and businesses across a region’s economy.
Efforts to advance dignity through fair wages and protection from harmful working conditions can improve the health, well-being, and economic security of home care workers. Doing so could also improve worker retention in the home care workforce, thereby enhancing the continuity of care for clients. These benefits would be experienced not only by caregivers and clients but would also extend to their families.
Improved and sustained access to dignified home care also benefits hospitals. High quality home care can not only lessen the likelihood of hospital readmissions but, crucially, can reduce the heavy bottleneck that hospitals often experience when people who no longer require hospital care are not promptly discharged. Delays in discharging patients not only lengthens recovery times, they also limit access for others who are in need of in-patient care.
Signs of a Leadership Vacuum
The Rippel Foundation’s ReThink Health Initiative, with support from the Robert Wood Johnson Foundation, spent 18 months exploring what it might take for changemakers to advance the dignity of essential care workers. We learned that the barriers to establishing home care worker dignity are not a lack of research, confusion over policy objectives, or absence of credible metrics. Indeed, many comprehensive analyses, policy recommendations, and metrics clearly point the way for system change. Our research* (see footnote) suggests that there is a conspicuous leadership vacuum that stands in the way of establishing worker dignity as a norm across the home care industry. This leadership vacuum refers to persistent, widespread failure to recognize the indignity that pervades the home care industry among most critical stakeholders.
This lack of leadership becomes even more apparent when one considers the many efforts underway to advance dignity among home care workers. Care workers across the U.S., such as Yan Zhen Guo and Yvette Beatty, are asserting their humanity and professionalism, urging for fair pay, and seeking to enforce safe, dignified working conditions. And there are many care worker associations, such as the U.S. Federation of Worker Cooperatives, Homebridge, Home Care Associates, and others that have assumed the responsibility to share personal stories and elevate the need to achieve racial and gender justice across the industry. However, what remains glaringly absent are large-scale, multi-sector collaborations by leaders who are willing to prioritize efforts to advance the dignity of this essential work.
Yan Zhen Guo’s story
Yvette Beatty’s story
An Opportunity for Shared Stewardship
There is an extraordinary opportunity for stewards to move forward a shared vision for a better, more equitable health system by advancing the dignity of essential home care workers. Stewards are people, organizations, and networks who work with others to create the conditions that everyone needs to thrive, beginning with those who are struggling and suffering. Everyone can be a steward. Stewards can make important strides toward closing the leadership vacuum by leading the development of transformative, multisolving ideas that bring stakeholders together in support of home care worker dignity. This can be done in the following ways:
- Expand support for advancing care worker dignity by bringing in leaders (both individuals and organizations) affected directly and indirectly by the state of home care in a region;
- Help other leaders to see not only their own roles within the context of dignified home care, but their own vested interests in crafting solutions;
- Leverage the power of storytelling to center unheard, undervalued voices of care workers and learn from their lived experiences; and
- Deepen the stewardship mindsets and actions that are critical for advancing equitable solutions.
The path to an equitable, thriving future, especially for those who have been marginalized and undervalued, lies in adopting the practices of shared stewardship. Doing so ensures many other benefits, including high quality care for clients, and economic security and well-being of care workers. Through these stewardship practices, those committed to equitable health and well-being are able to shift levers—mindsets, strategies, policies, resource flows, and power dynamics—that can dismantle systemic injustices and create meaningful and lasting change.
*ReThink Health’s 18 months of formative research consisted of approximately 60 individual interviews that included a core group of home care workers, secondary research to understand a dozen noteworthy innovations in worker-centered organizational models, a three-part series of design labs, and consultation with several strategic advisors.
**Insights for this article were contributed by Molly Belsky, Joann Kang, Bobby Milstein, and Tiona Moore.