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Rhode Island must invest in critical service workers and the care economy

Two state representatives say that as long as the state doesn’t view human services and community-based care agencies as an opportunity for economic development, the care sector and its workers will be left behind.

Every day now we hear stories about overextended, underpaid and incredibly stressed workers who provide critical healthcare and social services for Rhode Islanders.

In a Jan. 21 Boston Globe article about Rhode Island’s First Connections program (One of R.I.’s most critical programs for newborns is at risk of folding), former program employee Steffy Molina spoke the unfortunate truth, saying “I realized that the further away I got from working with families directly, the more money I could make.”

Many workers in critical health care and social services positions are making decisions like Ms. Molina’s to leave work they love for financial reasons. This includes doctors or nurses in hospitals, CNAs in nursing homes, direct support workers providing critical services to elderly and disabled people living at home, or early intervention, direct service or child care — it is clear our care systems need more support and better pay.


The care sector’s challenges weren’t created by the global COVID pandemic, but the pandemic has led workers to reassess how they spend their time and how much they need to be paid. Pre-pandemic, employers struggled to hire workers at historically low wages. The wages were low not because the employers don’t value these highly dedicated workers, but because reimbursement rates have been kept low, not reflecting the true costs of care. Now, with the risk of contracting COVID and related stressors; lack of child, elder and dependent care; and wages that do not cover the cost of living, workers simply cannot afford to return to or fill the many open caregiving positions.

As long as Rhode Island doesn’t view human services and community-based care agencies as an opportunity for economic development the way it views the technology, tourism and small business sectors, the care sector and its workers will be left behind.


The state sets and pays rates for healthcare and social services. Nursing home care, early intervention services, child care and community-based supports for elderly and disabled Rhode Islanders are covered by Medicaid or other state-funded programs. Workers and families statewide are directly impacted by the availability of these services. Yet decades of budget decisions to keep rates low have stifled the sector’s wages.

For many years, the organizations employing care economy workers have been able to rely on the dedication of their employeesto retain workers at historically low wages. But no more. Workers can be dedicated to their clients in nearby Massachusetts and earn higher wages. Or they can work in the private sector. We are seeing a market correction for wages in the nonprofit and health care sectors, and a workforce with more options in the marketplace for their labor.

Paying Rhode Islanders fair and living wages supports the state’s economy. It makes economic sense to prioritize a path to a living wage for a thriving care sector not just once, but as an ongoing commitment to our families, our communities and our state. Investment in the care economy stabilizes all sectors and makes them more efficient through its support of all workers.

We must pass a budget that provides immediate and urgent wage supports to ensure that we have the critical workforce we need; the budget that Gov. Dan McKee submitted last week falls short.

We must also start a longer-term conversation about the true costs of providing critical services that Rhode Islanders depend on. How much does it actually cost to provide these services in the current labor market? And, knowing how much it costs, how will we pay for this?


Now is the time to launch a Critical Service Worker Task Force. Action this year through the budget and ARPA funding is only an interim step for Rhode Island’s healthcare and nonprofit sectors. We need to take this opportunity to clarify how we will invest in the services our communities need. Careful planning can help us build systems that we can rely on, as workers, consumers, and Rhode Islanders.

State Representative Rebecca Kislak is a Democrat representing District 4 in Providence. State Representative Liana Cassar is a Democrat representing District 66 in Barrington and East Providence.