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A Salute to America's Elder Care Workers

They're often invisible and grossly underappreciated

By Abby Marquand

Back in April, at the Stevens Institute of Technology in Hoboken, N.J., a motley group of social scientists, researchers, artists and activists convened to discuss the value of the work of our nation’s “maintainers.” They’re the unheralded bunch who don’t get showered with attention as innovators (think Steve Jobs and Mark Zuckerberg) do.

elder care workers
Credit: Getty Images

To make his point, Lee Vinsel, a conference organizer and an assistant professor at Stevens, argued that the world needs more Mary Poppins. The famed nanny’s story, Vinsel believes, “asserts that the most important thing in life is an ethics of care, that we can only see the world with clear eyes if we choose to value one another, and that an essential way of doing this is by undertaking underappreciated and undervalued mundane, ordinary labor.”

The 'Maintainers' Who Keep People Running

With Labor Day still fresh in our memory, I think we should all show respect and admiration for a particular group of “maintainers ”: direct-care workers, known by an array of occupational titles including home care workers, nursing assistants, attendants, and direct-support professionals. Unlike some maintainers who keep our bridges operating and our trains running, these maintainers keep people “running.”

Direct-care workers provide the bulk of all paid, hands-on care to those who need assistance due to age or disability. They are the backbone of our nation’s elder care system — helping the oldest Americans bathe, eat, get dressed, remember their medications, get to and from doctors’ appointments and participate in meaningful social engagement. The work they do is essential. Yet even more than other “maintainers” who make technology or government work, they are often invisible and grossly underappreciated.

Home care workers make just over $10 an hour, on average, and work largely part-time, unpredictable schedules. Their annual income is often barely more than $13,000; one in four live below the federal poverty line.

The situation is slightly better for nursing assistants in nursing homes — median wage: over $12 per hour. Yet they suffer injuries at more than three times the rate of the typical American worker. Turnover in this industry is consistently high, too. More than half of the 600,000 nursing assistants leave their jobs every year. Due to high vacancies, nursing homes are short-staffed, workers are overextended and patients may not get the care they need.

Reasons for Their Poor Job Quality

You can point to a host of reasons for such poor job quality: a dysfunctional long-term care financing system, jobs that have historically been associated with unpaid “women’s work,” marginalization of the people who need long-term care and political disenfranchisement of low-income workers, to name a few. (See this recent Next Avenue article for more on this — America's hidden long-term care problem.)

But like other maintainers, and perhaps even more so, the labor of direct-care workers is mundane and ordinary. They help with some of the most basic activities we all take for granted every day: eating, bathing and sleeping. Basic, yes, but without being able to do these tasks, we fail to thrive, to feel human, to exist.


What They Do for The Rest of Us

The “maintenance” that direct-care workers provide enables family members to go to work each day knowing their loved ones are cared for. A direct-care worker can be the difference between living well, remaining part of a community and being confined — whether in an airless room, a chair or a hospital bed.

In some cases, her work (and it’s generally a “her”) can be the difference between life and death. This is as primal and perhaps as mundane as it gets, but arguably the most important thing we have: the ethics of care.

How to Honor These Unheralded Workers

So let’s tell more stories about these heroic workers and elevate them in our public discourse.

Let’s rethink why we so easily accept direct-care workers living in poverty, despite their giving so much of themselves to maintain the lives of some of the most vulnerable Americans.

Let’s invest our public resources in maintaining people and not just things, ensuring that care is affordable and that those who provide care are paid for the value they bring to our lives.

We must recognize that without direct-care workers and other maintainers, we will not survive, but with an economy that puts value on this type of labor we will thrive.

Abby Marquand is director of policy research at PHI, where she is responsible for research and analysis on policy issues affecting the direct-care workforce and the eldercare/disability service industry. Read More
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