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Robert Espinoza Knows Professional Care Workers Deserve More

This policymaker fights for better jobs — and therefore better care

By Grace Birnstengel

2020: a marked year for nursing homes, assisted living facilities and others in professional caregiving. It's also been a momentous year for racial justice and injustice.

Robert Espinoza's work exists at the convergence of these worlds. He's vice president of policy at the nonprofit PHI (Paraprofessional Healthcare Institute) that works to improve care for older adults and people with disabilities through quality jobs for the caregiving workforce — made up of predominantly people of color, women and immigrants.

"It's often mischaracterized as low-skilled work, too, which is not true."

Espinoza's role in policy advocacy, research and public education has always been urgent. But the pandemic and national uprisings around inequity have pushed his name even more into the center of solutions.

Often quoted in The New York Times, The Washington Post, The Wall Street Journal and elsewhere, the whole world turns to minds like Espinoza's to guide the future of elder care.

Next Avenue: How is the pandemic affecting the care workforce, and how is PHI responding?

Robert Espinoza: The pandemic has had a profound impact on the direct care workforce since day one. Too often these jobs are poor in quality. They don't pay enough; they don't offer enough training; they don't offer enough career advancement.

It's a workforce that has seen significant shortage over the years, and all of that came to a head during the coronavirus. Employers are struggling to recruit and retain enough workers. Too often, workers don't feel like they have enough PPE supplies or other supports to manage the crisis, and many workers are leaving the sector because it's not safe and because it doesn't pay enough. So more than ever, we need high-quality jobs in this workforce.

How is PHI responding to all of this?

We have advocated for intensified support for the workforce and for their employers, more funding at the federal and state level that would allow them to have the supplies, the PPE and the training to get through this moment and also to succeed in the long-term.

We [at PHI] have a strong workforce innovations division where we work closely with providers across the spectrum to understand what they need to succeed and to help them — everything from training to recruitment and retention challenges.

What have been some wins from this advocacy?

We've seen a number of states pass hazard pay measures, and then in the last few months increase compensation for workers and to make the job easier to recruit for.

Unfortunately, we haven't seen as much change as we'd like to see. And we haven't seen a lot of leadership at the federal level. In the years ahead, we're hoping that more states will throw themselves into the fray and help improve these jobs because this is a workforce that is incredibly valuable.

It's actually larger than every occupation in the country, and so it tells us the demand and it tells us how valuable these workers are to older adults and to people with disabilities.

You've been working in the aging and care fields for a while, but I imagine the pandemic has shown and taught you things you didn't know previously. Can you speak to that?

It's offered more examples of how undervalued these workers are in the health care sector and in our broader society.

When the crisis first hit, there were a number of mainstream telethons all around the country that were meant to raise money for all of the essential workers. What we saw was that home care workers and direct care workers weren't usually included in those telethons.

Journalists did a good job covering the challenges that home care workers in particular were facing, and we saw some pretty dramatic examples — like workers spraying themselves in Lysol before visiting a client because they didn't have the support from their employers or from the sector.

That was devastating to see and a clear reminder of all the ways in which we need to strengthen these jobs.

I'm not sure that the crisis has brought to light many new things that PHI and others have been long advocating for, but it did bring new examples to longstanding arguments.

What do you think that lack of recognition is about?

I think there is kind of a pecking order of who's most valuable within health care, where we really pay attention more to doctors and nurses over home care workers and nursing assistants. It's often mischaracterized as low-skilled work, too, which is not true.

The vast majority of [direct care] workers are women, people of color and immigrants, and I think that these are workers struggle in general with being devalued in our broader society by being marginalized and discriminated against.

And the people they support — our older adults and people with disabilities — are also invisible in our society because of deep-seated ageism and ableism. I think the confluence of all of that: the sexism, racism, ageism and ableism, ultimately create an undervalued and chronically-underfunded sector. These workers struggle, and that shouldn't be the case.

As you said, the professional caregiving workforce largely consists of people of color, and the U.S. is currently reckoning with its long history of racial injustice. You have been a longstanding advocate for these intersections of aging and racial equity. What's this moment like for your work?

It's an important moment. We have seen the ways in which systemic racism and gender injustice have shaped the jobs for direct care workers in negative ways. There is a historical record showing that for decades, racist arguments were used to deny direct care workers things like wage and overtime protections.

"Strengthening the job for direct kind of workers is in itself a racial justice strategy."

I think for us to have a moment in which we're asking how long-term care and the aging services field have contributed to [systemic racism], and what are ways in which all of us who work in this sector can tackle racism and sexism and improve not just care for consumers but also these jobs... I think that's really important.

I have seen an uptick in leaders who want to have that conversation, and I think that's promising. I hope it says and that it's not just a moment.

You've said that racial justice needs to be centered in the world of long-term care. Let's talk about that and how PHI is doing so.

We want to identify which policy reforms would promote equity and justice for this workforce. We recently announced a multi-state advocacy initiative in Michigan, North Carolina and New Mexico aimed at passing policy reforms that strengthen this workforce in years ahead. We're working with organizations in those states that have a long history of working with communities of color and on justice issues.

We're also interested in understanding how have providers, how have nursing homes, how have home care agencies, how have assisted living and other residential care settings, how have they crafted interventions and programs that promote equity?

I think we need to take more risks in promoting policies that support this sector. Strengthening the job for direct care workers is in itself a racial justice strategy, so why not pass policies that improve compensation, create career paths, improve training, all of that?

These workers need a stronger safety net, access to paid sick days, paid family and medical leave, child care support and long-term care supports. If we made long-term care more affordable to everyone, that's really a social justice strategy.

Two Questions for Our Influencers

If you could change one thing about aging in America, what would it be? 

I would transform the public financing for long-term care so that consumers can afford the services they need, and direct care workers can thrive in their jobs and careers.

How has the COVID-19 pandemic changed your perspective on aging?

COVID-19 has provided new examples to a painful reality that this country has grappled with since its beginning: people of color have been forced to face the brunt of every major health crisis, and the human cost has been devastating. Long-term care leaders must center racial, gender and social justice in every aspect of this sector.

Grace Birnstengel
Grace Birnstengel was an editor, reporter and writer for Next Avenue. She focused on in-depth storytelling and the intersections of identity and aging. Read More
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