Center for American Progress

Direct Care Worker Pay and Benefits Are Low Despite High Demand for Services
Report

Direct Care Worker Pay and Benefits Are Low Despite High Demand for Services

National policy action is needed to increase worker compensation and meet demand for direct care services.

In this article
Photo shows two workers moving a hospital bed, with a couple of other beds in the foreground and background.
Direct care workers move a patient bed into a new room so that other hospital rooms can be cleaned at a hospital in Louisville, Colorado, on January 6, 2022. (Getty/Andy Cross)

Direct care workers are an essential part of the care infrastructure in the United States. These workers—primarily comprising personal care aides, home health aides, and nursing assistants—help older adults and individuals with disabilities with everyday tasks such as eating and dressing, and some perform clinical medical tasks as well, such as administering medications and assessing vital signs. They work in private homes, nursing homes, hospitals, and residential care facilities.1

The demand for direct care workers2 is high and is only expected to increase, due to an aging U.S. population and an increase in the use of home-based care.3 In 2022, 1,361,300 people were employed as nursing assistants and 3,715,500 people worked as personal care assistants or home health aides.4 According to the National Center for Health Workforce Analysis, demand is expected to rise for nursing assistants by 48 percent, for personal care aides by 43 percent, and for home health aides by 42 percent between 2020 and 2035.5 (see Figure 1)

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In the face of such high demand, this country is grappling with a severe shortage in direct care workers. This was only exacerbated by the COVID-19 pandemic, during which about two-thirds of U.S. states saw a Medicaid home- and community-based care provider—including adult day health programs, providers of home-based services, and group homes—permanently close due to staffing shortages; these events revealed weaknesses in the long-term care system.6 Exacerbating this dire worker shortage is the fact that direct care workers face poor working conditions, with extremely low wages and little access to vital employment benefits.

Exacerbating this dire shortage is the fact that direct care workers face poor working conditions, with extremely low wages and little access to vital employment benefits.

This issue brief examines the low wages and inadequate benefits faced by the direct care workforce and why the workforce disproportionately comprises women of color. It then highlights the need for policymakers to take steps to address these severe shortages and improve working conditions in order to meet the country’s needs, such as increasing Medicaid reimbursement rates and ensuring those funds go to workers, as well as promoting unionization.

Direct care workers earn low wages and have inadequate access to benefits

Along with orderlies and psychiatric aides, direct care workers earn the fifth-lowest average hourly wage among U.S. occupational groups. (see Table 1) In May 2022, this group made an average of $15.60 per hour, or $32,440 per year. This is below the 2022 national average living wage for an adult employed full time with no children, which was $36,311 annually.7

Compounding these low wages, direct care workers also often lack access to vital employer benefits such as health insurance and retirement savings plans. At almost 14 percent, the proportion of direct care workers who lack any health insurance is only slightly higher than the average for the U.S. labor force of about 11 percent; however, more than half (about 53 percent) of direct care workers lack access to employer- or union-provided health insurance specifically, compared with just more than 32 percent of the general labor force. (see Figure 2) Like other low-wage workers, many direct care workers also lack access to paid sick time—nationwide, most workers in the lowest 10 percent of income earners have no paid sick time.8

Lack of access to a retirement savings plan is common among the U.S. labor force at large, with about 68 percent of the labor force reporting that they were not included in a retirement or pension plan at work in 2022.9 (see Figure 2) However, this number is significantly higher for direct care workers at about 82 percent, meaning many of these workers lack access to tools that could help them accumulate savings for their futures.

In addition to this lack of access to wages and benefits, direct care workers report health issues at slightly higher rates than the general U.S. labor force. (see Figure 3) These workers perform highly demanding jobs, including physically assisting adults and often working during the night, which is associated with negative health effects.10

Despite such demanding work, training requirements for direct care workers vary widely across states, and while some states have or are developing training programs, workers in many areas receive very little training.11 Without adequate training, workers are more likely to suffer from back injuries, muscle strains, and infectious diseases such as COVID-19;12 in fact, direct care workers face “some of the highest rates of occupational injury and on-the-job violence” in the United States.13

Compared with the entire labor force, more direct care workers report that they have a disability that limits or prevents them from completing their work, and just more than 13 percent of the direct care workforce reports that their health status is only fair or poor, compared with about 7 percent of the general labor force. (see Figure 3) These workers both experience health issues and lack the benefits and wages that could help them address them.

Low pay and poor working conditions: History and current state of play

It is no accident that direct care workers receive low pay and benefits, even though they are in demand and their jobs involve skilled work. The quality of these jobs has been shaped by policy at both the federal and state levels. The 1938 Fair Labor Standards Act (FLSA), which first set federal minimum wage and overtime pay, and the 1935 National Labor Relations Act (NLRA), which guaranteed workers collective representation and bargaining rights, excluded many of these workers.14 Similar to today, a disproportionate number of U.S. direct care workers at the time were Black women and other women of color.15 To gain support for these bills from Southern Democrats, lawmakers excluded many occupations in which Black workers were overrepresented—for instance, by exempting workers doing “domestic service.”16 These laws also excluded public sector workers, and many direct care workers work for the government either directly or indirectly.17

Today, Medicaid is the largest funder for both institutional and home- and community-based care, so direct care worker pay is largely determined by Medicaid funding and the rates at which Medicaid reimburses providers for direct care services.18 These rates are low relative to the real costs of direct care overhead, administration, and labor, and they vary considerably between states. Furthermore, some states set a maximum for the amount that can be paid to direct care workers or restrict worker overtime pay.19 Given that reimbursement rates are set through policy, they are also slow to respond to changes in overhead costs and supply and demand.20

Low direct care worker wages also stem from forces beyond reimbursement rates, including the historic devaluing of the skills of direct care workers in the medical field and institutional restrictions on the tasks they are allowed to perform.21 Due to these forces, direct care worker pay is likely to remain low without policies dictating the amount that must be paid to the workforce and facilitating collective bargaining and training.

Marginalized populations are overrepresented among direct care workers

As with other care occupations—including child care and domestic work—women, Black or African American workers, and immigrant populations are overrepresented in the direct care workforce,22 with women being particularly overrepresented. Care work has historically been presented as work performed by women, and consequently very few men work in these jobs: Compared with just more than 47 percent of the general labor force, women make up about 86 percent of the direct care workforce. (see Figure 4)

This is part of a larger trend of occupational segregation in the U.S. labor market, in which women and marginalized racial and ethnic groups are relegated to poor-quality jobs that have clear social benefits but are economically devalued. Care work has historically been portrayed as women’s work and as a job for women of color.23 This pattern of occupational segregation, along with undervaluing of vital service occupations, deepens the gender and racial wage gaps in the United States.24

The myth of unskilled care work

Beyond the overrepresentation of people of color and women in the direct care field, the low value attributed to this sector is also connected to a false perception that this work is unskilled. Contrary to this view, direct care workers perform taxing physical labor to help clients with activities of daily life, including helping them to the bathroom and about the home, assisting them with eating and bathing, helping them get dressed, and cleaning their houses.25 These workers also manage client schedules, including medical needs, while acting as advocates for their clients with other medical providers.

Furthermore, their jobs require complex interpersonal skills to ensure the health and well-being of their clients.26 Care work requires the worker to perform emotional labor, to be adept at ensuring that their clients feel their health needs are understood, and to be in tune with their clients’ moods to ensure their basic needs are being met.27 Beyond requiring emotional skills, direct care work can entail negative emotional experiences, such as isolation and discrimination or abuse from clients or client families.28

Given these job requirements, there is a mismatch between the importance of this work and how these workers are compensated.

The trend of occupational segregation is also clear when looking at the proportions of racial and ethnic groups that make up the direct care workforce: Black or African American workers are especially overrepresented, constituting about 12 percent of the general labor force but about 29 percent of the direct care workforce, while white workers are underrepresented, making up 59 percent of the general labor force but only 38 percent of the direct care workforce. (see Figure 5)

Black or African American workers in these occupations are also likely to live in particularly precarious economic situations. While Black or African American direct care workers have the highest personal median annual income among racial or ethnic groups at $25,000, they have the lowest family median annual income at $41,700.29 They are also the most likely of racial and ethnic groups to live at or below the federal poverty threshold (46 percent) and to receive benefits from the Supplemental Nutrition Assistance Program (34 percent).30 While less overrepresented than Black workers, Hispanic or Latino direct care workers make by far the lowest personal median annual incomes among racial or ethnic groups at $22,200.31 (see Figure 6)

Women of color are vastly overrepresented in the direct care workforce, constituting only about 20 percent of the general labor force but about 53 percent of the direct care workforce. (see Figure 7) About 44 percent of women of color in the direct care workforce live at or below the federal poverty threshold, and about 40 percent are immigrants, which may make them especially vulnerable to employer exploitation.32

The direct care workforce also comprises a disproportionate number of immigrants. About 27 percent of all direct care workers are immigrants, compared with about 17 percent of the general labor force.33 Especially large proportions of Asian or Pacific Islander (84 percent) and Hispanic or Latino (45 percent) direct care workers are immigrants.34

Direct care workers are especially vulnerable to being exploited, especially in cases where they work in private homes, both because they are isolated and because enforcement of employment regulations requires that workers file a complaint about their employer.35 Fears of retaliation for reporting employers may be especially high for immigrant workers, and if they are undocumented, these workers may fear that their employer may report them to immigration authorities.36Consequently, immigrant direct care workers may be especially vulnerable to poor working conditions and wage theft.37

Improving job quality for care workers

Fortunately, worker advocates and progressive policymakers have made some gains to support direct care workers. Reforms to the FLSA under the Obama administration in 2015 extended minimum wage and overtime protections to most direct care workers.38 Some states have passed reforms to require an increased base pay for direct care workers.39 Meanwhile, other states have used funds from the American Rescue Plan Act to require increases to direct care worker base pay for Medicaid home- and community-based care—Colorado, for instance, has raised base pay to $15 per hour for direct care workers—but it is unclear if these changes will continue into the long term.40 Some states have also established direct care worker training and certification programs to raise both job quality and care quality.41

Similarly, progressive action in some states has led to an increase in collective bargaining and representation rights for direct care workers, though many still lack bargaining rights. Only about 10 percent of direct care workers were covered by unions in 2022.42 Eleven states currently allow direct care workers paid through Medicaid to organize and collectively bargain with the state or local government as their employer.43Unionized direct care workers earn about 13 percent higher hourly wages than comparable nonunion direct care workers.44 This is consistent with the union wage premium enjoyed by all workers throughout the economy, and unionized workers are also much more likely to have health benefits, as well as a retirement plan.45 Union collective bargaining is also critical to closing gender and racial pay gaps, as well as to improving conditions for workers with disabilities.

The Biden administration has also focused on increasing job quality for direct care workers. While the administration’s proposed American Jobs Plan included an increase in funding toward Medicaid intended to bolster direct care worker pay, this provision was ultimately not enacted.46 In the absence of congressional action on the issue, a rule proposed by the Biden administration in May 2023 would require that at least 80 percent of Medicaid payments for care services go to direct care workers.47 Still, in order to meet demand and raise standards across the board for workers, large-scale federal intervention, including congressional action, is needed.

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Conclusion

Direct care workers are skilled and in high demand but unfairly compensated, with low pay and inadequate access to benefits. Despite performing jobs that require technical knowledge, emotional skill, and physical labor, their work has been undervalued by the market due to a historical lack of protection by labor regulations, limits dictated by health policy and the medical field, and broader social patterns of gendered and racial occupational segregation.48

Despite performing jobs that require technical knowledge, emotional skill, and physical labor, the work of direct care workers has been undervalued by the market.

The nature of direct care work means that these workers are especially vulnerable to workplace injury, harassment, discrimination, and exploitation.49 They are also likely be from marginalized social groups, including women, Black or African American workers, and immigrants.50 Since addressing workplace harms usually involves standing up to an employer or government authority, marginalized social groups may hesitate to seek enforcement of their rights for fear of retaliation or a lack of confidence in the enforcement system.51 Compounding this, few direct care workers are represented by unions, which can help support workers’ rights.52

While lawmakers in some states have made strides toward improvements through wage and collective bargaining legislation, policymakers at the national level need to act to guarantee higher job quality for all direct care workers. It’s past time that this critical workforce receive benefits and compensation that reflect the importance of their work.

Endnotes

  1. Stephen Campbell and others, “Caring for the Future: The Power and Potential of America’s Direct Care Workforce” (New York: Public Health Institute, 2021), available at https://www.phinational.org/resource/caring-for-the-future-the-power-and-potential-of-americas-direct-care-workforce/.
  2. The data reported here for “direct care workers” include data for individuals listed as personal care aides, home health aides, and nursing assistants in data gathered by the U.S. Census Bureau. See Steven Ruggles and others, “Integrated Public Use Microdata Series, U.S. Census Data for Social, Economic, and Health Research: Version 13.0 (dataset)” (Minneapolis: Minnesota Population Center, 2023), available at https://doi.org/10.18128/D010.V13.0; Sarah Flood and others, “Integrated Public Use Microdata Series, Current Population Survey Data for Social, Economic, and Health Research: Version 10.0 (dataset)” (Minneapolis: Minnesota Population Center, 2022), available at https://doi.org/10.18128/D030.V10.0. This is based on the definition used by the Public Health Institute. However, direct care workers more broadly include hospice aides, direct support professionals, and job coaches.
  3. Ibid.
  4. U.S. Bureau of Labor Statistics, “Table 1.2 Employment by detailed occupation,” available at https://www.bls.gov/emp/tables/emp-by-detailed-occupation.htm (last accessed August 2023).
  5. National Center for Health Workforce Analysis, “Long-Term Services and Support: Demand Projections, 2020-2035” (Bethesda, MD: Health Resources and Services Administration, 2022), available at https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/LTSS-Projections-Factsheet.pdf.
  6. Molly O’Malley Watts, MaryBeth Musumeci, and Meghana Ammula, “State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey” (San Francisco: Kaiser Family Foundation, 2021), available at https://www.kff.org/coronavirus-covid-19/issue-brief/state-medicaid-home-community-based-services-hcbs-programs-respond-to-covid-19-early-findings-from-a-50-state-survey/.
  7. Kavya Vaghul, Kelley-Frances Fenelon, and Amy Glasmeier, “What a Living Wage Is and Why Businesses Should Use It as a Benchmark,” JUST Capital, October 7, 2022, available at https://justcapital.com/reports/living-wage-guide-for-business-just-jobs-explained/.
  8. Molly Weston Williamson, “The State of Paid Sick Time in the U.S. in 2023” (Washington: Center for American Progress, 2023), available at www.americanprogress.org/article/the-state-of-paid-sick-time-in-the-u-s-in-2023/.
  9. The data used here are from the U.S. Census Bureau Current Population Survey (CPS). See Ruggles and others, “Integrated Public Use Microdata Series, U.S. Census Data for Social, Economic, and Health Research: Version 13.0 (dataset)”; Flood and others, “Integrated Public Use Microdata Series, Current Population Survey Data for Social, Economic, and Health Research: Version 10.0 (dataset).” The CPS is known to underestimate the proportion of people who are covered by some form of retirement or pension plan. However, large disparities in retirement coverage do exist in the workforce. See John Sabelhaus, “The Current State of U.S. Workplace Retirement Plan Coverage” (Philadelphia: Pension Research Council, 2022), available at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4049143; Irena Dushi and Brad Trenkamp, “Improving the Measurement of Retirement Income of the Aged Population” (Baltimore: Social Security Office of Retirement and Disability Policy, 2021), available at https://www.ssa.gov/policy/docs/workingpapers/wp116.html.
  10. Sunniva Grønoset Grasmo, Ingeborg Frostad Liaset, and Skender Elez Redzovic, “Home care workers’ experiences of work conditions related to their occupational health: a qualitative study,” BMC Health Services Research 21 (962) (2021), available at https://doi.org/10.1186/s12913-021-06941-z; Tracy Zontek and others, “Psychosocial Factors Contributing to Occupational Injuries among Direct Care Workers,” American Association of Occupational Health Nurses Journal 57 (8) (2009): 338–347, available at https://doi.org/10.1177/216507990905700807.
  11. Jake McDonald, “The Value of Statewide Direct Care Worker Training and Credentialing Systems,” Public Health Institute, October 4, 2023, available at https://www.phinational.org/the-value-of-statewide-direct-care-worker-training-and-credentialing-systems/; Jennifer Craft Morgan and others, “Testing U.S. State-Based Training Models to Meet Health Workforce Needs in Long-Term Care,” Ageing International 43 (1) (2018): 123–140, available at https://doi.org/10.1007/s12126-017-9286-6; Paul Osterman, Who Will Care For Us? Long-Term Care and the Long-Term Workforce (New York: Russell Sage Foundation, 2017), available at http://muse.jhu.edu/book/52642.
  12. Campbell and others, “Caring for the Future: The Power and Potential of America’s Direct Care Workforce.”
  13. Ibid.
  14. Premilla Nadasen, “Citizenship Rights, Domestic Work, and the Fair Labor Standards Act,” Journal of Policy History24 (1) (2012): 74–94, available at http://muse.jhu.edu/article/466436; Phyllis Palmer, “Outside the Law: Agricultural and Domestic Workers under the Fair Labor Standards Act,” Journal of Policy History 7 (4) (1995): 416–440, available at https://doi.org/10.1017/S0898030600004905; Evelyn Nakano Glenn, Forced to Care: Coercion and Caregiving in America (Cambridge, MA: Harvard University Press, 2012); Francesca Cancian and Stacey Oliker, Caring and Gender (Thousand Oaks, CA: Pine Forge Press, 2000).
  15. Glenn, Forced to Care: Coercion and Caregiving in America; Cancian and Oliker, Caring and Gender.
  16. Palmer, “Outside the Law: Agricultural and Domestic Workers under the Fair Labor Standards Act”; Juan Perea, “The Echoes of Slavery: Recognizing the Racist Origin of the Agricultural and Domestic Worker Exclusion from the National Labor Relations Act,” Ohio State Law Journal 72 (4) (2011): 95–138, available at https://lawecommons.luc.edu/cgi/viewcontent.cgi?article=1150&context=facpubs.
  17. Alexis Walker, “Labor’s Enduring Divide: The Distinct Path of Public Sector Unions in the United States,” Studies in American Political Development 28 (2) (2014): 175–200, available at https://doi.org/10.1017/S0898588X14000054.
  18. National Conference of State Legislatures, “Strengthening the Direct Care Workforce,” March 10, 2023, available at https://www.ncsl.org/health/strengthening-the-direct-care-workforce; Kirsten Colello, “Medicaid Coverage of Long-Term Services and Supports” (Washington: Congressional Research Service, 2022), available at https://crsreports.congress.gov/product/pdf/R/R43328.
  19. Cici Yongshi Yu, “Medicaid Mandate on Home Health Pay Prompts Calls for Leeway,” Bloomberg Law, July 12, 2023, available at https://news.bloomberglaw.com/health-law-and-business/medicaid-mandate-on-home-health-pay-prompts-calls-for-leeway; Courtney Roman and others, “Direct Care Workforce Policy and Action Guide” (New York: Milbank Memorial Fund, 2022), available at https://www.milbank.org/wp-content/uploads/2022/05/DirectCareWorker_Toolkit_final.pdf.
  20. Paul Osterman, “Improving Job Quality for Direct Care Workers,” Economic Development Quarterly 33 (2) (2019): 151–156, available at https://doi.org/10.1177/0891242418777355.
  21. Ibid.
  22. Eve Mefferd and Dawn Dow, “The US Child Care System Relies on Women of Color, but Structural Barriers Systematically Disadvantage Them,” Urban Institute, June 14, 2023, available athttps://www.urban.org/urban-wire/us-child-care-system-relies-women-color-structural-barriers-systematically-disadvantage; Asha Banerjee and others, “Domestic Workers Chartbook 2022” (Washington: Economic Policy Institute, 2022), available at https://www.epi.org/publication/domestic-workers-chartbook-2022/#:~:text=The%20typical%20(median)%20domestic%20worker,dollar%20that%20their%20peers%20make.
  23. Glenn, Forced to Care: Coercion and Caregiving in America.
  24. Marina Zhavoronkova, Rose Khattar, and Mathew Brady, “Occupational Segregation in America” (Washington: Center for American Progress, 2022), available at https://www.americanprogress.org/article/occupational-segregation-in-america/.
  25. Madeline Sterling and others, “Utilization, Contributions, and Perceptions of Paid Home Care Workers Among Households in New York State,” Innovation in Aging 6 (2) (2022): 1–9, available at https://doi.org/10.1093/geroni/igac001; Zontek and others, “Psychosocial Factors Contributing to Occupational Injuries among Direct Care Workers.”
  26. Livia Lam and Karla Walter, “Quality Workforce Partnerships: Strategies To Create a More Equitable Workforce” (Washington: Center for American Progress, 2020), available at https://www.americanprogress.org/article/quality-workforce-partnerships/.
  27. Murray Devine, “What Being a Home Care Worker Taught Me About Emotional Labor,” Public Health Institute, May 29, 2019, available at https://www.phinational.org/what-being-a-home-care-worker-taught-me-about-emotional-labor/#:~:text=Over%20two%20years%20in%20the,field%27s%20high%20rates%20of%20turnover.
  28. Ibid.; Chunhong Xiao and others, “Certified Nursing Assistants’ Perceived Workplace Violence in Long-Term Care Facilities: A Qualitative Analysis,” Workplace Health & Safety 69 (8): 366–374, available at https://doi.org/10.1177/2165079920986159; Farida Ejaz and others, “Racism Reported by Direct Care Workers in Long-Term Care Settings,” Race and Social Problems 3 (2) (2011): 92–98, available at https://doi.org/10.1007/s12552-011-9045-3.
  29. Ruggles and others, “Integrated Public Use Microdata Series, U.S. Census Data for Social, Economic, and Health Research: Version 13.0 (dataset).”
  30. Ibid.
  31. Ibid.
  32. Ibid.
  33. Ibid.
  34. Ibid.
  35. Abigail Rosenfeld, “Consider the Caregivers: Reimagining Labor and Immigration Law to Benefit Home Care Workers and Their Clients,” Boston College Law Review 62 (1) (2021): 314–355, available at https://bclawreview.bc.edu/articles/77; Eileen Boris, Merita Jokela, and Megan Unden, “Enforcement Strategies for Empowerment: Models for the California Domestic Worker Bill of Rights” (Los Angeles: UCLA Institute for Research on Labor and Employment, 2011), available at https://escholarship.org/uc/item/7q25m73q.
  36. Rosenfeld, “Consider the Caregivers: Reimagining Labor and Immigration Law to Benefit Home Care Workers and Their Clients.” It is difficult to accurately measure the proportion of direct care workers who are undocumented immigrants, but one report has estimated it to be about 4.3 percent, while noting that this is probably an underestimate. See Leah Zallman and others, “Care For America’s Elderly And Disabled People Relies On Immigrant Labor,” Health Affairs 38 (6) (2019): 919–926, available at https://doi.org/10.1377/hlthaff.2018.05514.
  37. Rosenfeld, “Consider the Caregivers: Reimagining Labor and Immigration Law to Benefit Home Care Workers and Their Clients.”
  38. U.S. Department of Labor Wage Hour Division, “Domestic Service Final Rule Frequently Asked Questions (FAQs),” January 1, 2015, available at http://www.dol.gov/agencies/whd/direct-care/faq.
  39. National Governors Association, “Addressing Wages Of The Direct Care Workforce Through Medicaid Policies,” November 1, 2022, available at https://www.nga.org/publications/addressing-wages-of-the-direct-care-workforce-through-medicaid-policies/.
  40. Ibid.
  41. Lam and Walter, “Quality Workforce Partnerships: Strategies To Create a More Equitable Workforce.”
  42. Unionstats.com, “Union Membership, Coverage, and Earnings from the CPS,” March 22, 2023, available athttps://unionstats.com/.
  43. Christian Collins and Alejandra Londono Gomez, “Unionizing Home-Based Providers to Help Address the Child Care Crisis” (Washington: The Center for Law and Social Policy, 2023), available at https://www.clasp.org/wp-content/uploads/2023/04/4.3.2023_Unionizing-Home-Based-Providers-to-Address-the-Child-Care-Crisis.pdf.
  44. Ruggles and others, “Integrated Public Use Microdata Series, U.S. Census Data for Social, Economic, and Health Research: Version 13.0 (dataset).”
  45. Aurelia Glass, David Madland, and Christian E. Weller, “Unions Build Wealth for the American Working Class” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/unions-build-wealth-for-the-american-working-class/.
  46. The White House, “FACT SHEET: The American Jobs Plan,” March 31, 2021, available at https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan/; Katie Lobosco and Tami Luhby, “Infrastructure Package: Here’s What’s in It,” CNN Politics, November 15, 2021, available at https://www.cnn.com/2021/07/28/politics/infrastructure-bill-explained/index.html.
  47. Centers for Medicare and Medicaid Services, “Medicaid Program; Ensuring Access to Medicaid Services,” Federal Register 88 (85) (2023), available at https://www.federalregister.gov/documents/2023/05/03/2023-08959/medicaid-program-ensuring-access-to-medicaid-services.
  48. Osterman, “Improving Job Quality for Direct Care Workers”; Glenn, Forced to Care: Coercion and Caregiving in America.
  49. National Academy of Social Insurance Older Workers’ Retirement Security Task Force, “Older Workers in Physically Challenging Jobs Need Stronger Social Insurance Supports” (Washington: 2023), available at https://www.nasi.org/wp-content/uploads/2023/09/OlderWorkersTaskForce-Report-FINAL.pdf; Devine, “What Being a Home Care Worker Taught Me About Emotional Labor.”
  50. Ruggles and others, “Integrated Public Use Microdata Series, U.S. Census Data for Social, Economic, and Health Research: Version 13.0 (dataset).”
  51. Rosenfeld, “Consider the Caregivers: Reimagining Labor and Immigration Law to Benefit Home Care Workers and Their Clients”; Boris, Jokela, and Unden, “Enforcement Strategies for Empowerment: Models for the California Domestic Worker Bill of Rights.”
  52. Unionstats.com, “Union Membership, Coverage, and Earnings from the CPS.”

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Author

Claire Connacher

Doctoral candidate at University of Massachusetts Boston; former intern for the CAP Inclusive Economy team

Team

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