Taking care of people has long been an undervalued job in American society. Tending to the needs of young children, older adults, and people with disabilities is demanding, low-paid work that for decades was left out of labor reforms.
And the fact that the vast majority of workers in these jobs are Black, Latino, and immigrant women is no coincidence, according to a new Boston Foundation report being released Thursday that explores extensive racial and economic injustice in one of the fastest-growing sectors of the state’s economy.
The pandemic shone a glaring light on this “often overlooked backbone to our social and economic structure,” the report notes. Childcare facilities shut down, nursing homes were overrun with COVID, and home care was harder to find but desperately needed.
In Massachusetts, women make up about 85 percent of home care workers and employees in long-term care facilities such as nursing homes, and 92percent of child-care workers, according to the report, while Latino, Black, and immigrant women account for a disproportionate share of those working in home and long-term care. Black workers account for 24 percent of home care workers and 43 percent of those employed in long-term care facilities in the state, despite making up just 7 percent of the workforce.
These workers are less likely than the average employee to have employer-provided health insurance or retirement plans, and are more likely to be on MassHealth, the state’s Medicaid program. Nearly a third of the state’s home care workers are enrolled in SNAP, the program formerly called food stamps.
The median hourly wages in all three subsectors ranged between $13 and nearly $16 an hour based on 2016-2020 Census data used in the report — slightly more than half the median hourly wage statewide. Wages have risen across the economy in the past two years, but care worker pay is still likely half that of the statewide median.
Even when controlling for education levels, skill requirements, and job characteristics, care workers are paid 5 to 15 percent less than similar workers, the report notes.
The roots of this inequity go back to slavery, the report says, when many Black women were forced into caregiving roles. And this didn’t end with Emancipation. Many freed slaves were coerced into indentured servitude caring for white families, and then were excluded, along with other women of color, from higher paying, less physically taxing jobs, said Mignon Duffy, a sociology professor at UMass-Lowell whose research is featured in the report. These jobs were later left out of early 20th century labor protections that elevated many other occupations. In fact, it wasn’t until 2015 that federal minimum wage protections were expanded to include most care workers.
All these factors, along with cultural norms that women are natural caregivers, have culminated in today’s workforce of women of color in low-paying, largely invisible jobs, Duffy said. All together, care work extends into a number of sectors, from health care to education to social services, that account for about a quarter of all jobs.
“Care work is very central to understanding race and gender inequality in the world and the US,” Duffy said. “They are inextricably intertwined.”
“For those of us who are interested in dismantling sexism and racism, you’ve got to pay attention to the care sector in particular.”
The findings don’t come as a surprise to Maria Castro, 55, a personal care attendant from Roslindale who works 64 hours a week taking care of three people for $17.71 an hour, plus overtime. Castro, who is from the Dominican Republic, worked throughout the pandemic, preparing food, administering medicine, and otherwise providing assistance — like family would do, she said. She supports her 85-year-old mother, who lives with her, as do her two 20-something daughters, whom Castro has helped pay for college and esthetician training.
Castro served on her union’s bargaining committee and recently ratified a new contract that includes a racial justice committee to address discrimination.
“It feels like only people of color do this job — that’s why [society doesn’t] see it as important,” Castro said in Spanish, through an interpreter. “Back in the day it was a slavery job.”
And as the population ages, the demand for workers in the care sector is expected to grow substantially.
The number of Greater Boston residents over age 65 is anticipated to rise by more than 50 percent between 2020 and 2040, and the number of those over 85 nationwide is set to triple by 2060. Between 2018 and 2028, personal care and home health aide jobs are expected to increase by nearly 20 percent statewide, while jobs overall are expected to grow less than 3 percent.
“I’ve really become convinced through this research that improving the quality of care work ought to be at the top of any agenda for advancing racial equity in Massachusetts,” said report coauthor Luc Schuster.
Upgrading these jobs would also decrease turnover and provide more stability for the families receiving care, he noted: “There’s a really direct relationship between the quality of jobs that we’re offering in this sector and the quality of care they’re able to provide.”
The risk of contracting COVID made these jobs more dangerous in recent years, but they’ve always been hazardous. In 2019, nursing assistants who work in care facilities and at people’s homes had a higher rate of nonfatal injury or illness than any other worker — more than truck drivers, laborers, and movers, the report notes.
To improve these jobs, the report recommends increasing the minimum wage and Medicaid reimbursement rates, making training and career advancement more accessible, and licensing home care agencies, among other policy changes. Many institutions in the care sector have limited budgets, the report acknowledges, making it essential to pair changes that raise labor costs with public funding increases.
The problems in the care industry go far beyond the jobs themselves, noted James Fuccione, head of the Massachusetts Healthy Aging Collaborative, which consulted on the report. A licensing process for home care agencies in particular would mean more oversight and policies that could strengthen jobs. Workers also need affordable housing and a reliable transit system. “This is a community-wide issue,” he said.
Significant investment and policy change is also needed in early education, according to the advocacy group Strategies for Children, which provided input for the report. The Massachusetts Senior Care Association said it was working to retain nursing facility workers and promote career growth, noting that increased government funding was vital to paying employees a living wage.
Preschool teacher Kiya Savannah would welcome improvements to a job she loves but isn’t sure she can afford to keep. The only place Savannah, 31, can afford to live with her 3-year-old daughter is an in-law apartment she rents from her parents in Brockton.
Savannah, who is Black, worries about what’s going to happen when she has to resume making student loan payments in January on the $40,000 she’ll still owe after the federal loan forgiveness program kicks in. To avoid dipping into savings set aside for her daughter, she might start making deliveries for DoorDash again, as she did when her hours were reduced early on in the pandemic. She’s also considering getting a master’s degree, which could mean taking on more debt.
“I haven’t figured out a way to fix this problem,” she said.
It has become increasingly difficult to steer job seekers toward care jobs, said Andre Green, executive director of SkillWorks, a workforce development partnership between the Boston Foundation and the City of Boston that contributed to the report. Jobs shouldn’t simply make people “less poor,” he said, especially crucial caregiving roles that many people will need at some point in their lives.
“We know how important these jobs are,” he said. “Why as a society don’t we act like that?”
Katie Johnston can be reached at firstname.lastname@example.org. Follow her on Twitter @ktkjohnston.