How home health aides could save the economy

It often feels like the financial security of millions of Americans is at the mercy of unpredictable global forces that no one can really understand or predict. Chinese monetary policy changes, yield curves start looking funny, or some kind of shiny object spooks Wall Street investors, and suddenly we're all out on the streets. But that focus on the changing whims of the market obscures something fundamental: There's a lot of work that needs to be done in this country, and when the economy does falter, there will be lots of unemployed and underemployed people happy to do it — for a fair wage.

It's been common knowledge since the 1930s that putting money in consumers' pockets can cushion or even prevent economic disasters. The Obama stimulus plan, which produced about 2.5 million jobs, almost certainly staved off a much worse recession, and would have helped a lot more if it had been bigger and lasted longer. When the next recession comes, the government would be well advised to learn from that example and get a whole lot of people to work at decently paid jobs right away.

There are abundant examples of critical work that private companies don't have an incentive to do, from building renewable-friendly electrical grids to getting the lead out of water pipes around the country. But one of the biggest and most urgent needs is caring for people who need help with daily life tasks. One big step toward mitigating some of the worst consequences of recession would be creating well-paid jobs for home care workers.

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As The New York Times recently noted, a lot of older people, and people with disabilities, need help with daily tasks like bathing, cooking, and taking care of themselves. But many can't afford a home care aide, leaving them to depend on unpaid family and friends, or go without care. Even those who are eligible for Medicaid-funded home care programs, or who can afford to pay out of pocket, may find there aren't workers available.

Just like in many fields, when someone says "worker shortage," we should hear "shortage of workers willing to work for low pay in bad conditions." Nationally, home care workers make an average of under $12 an hour for work that may include cleaning bodily fluids, physically lifting clients, or providing emotional support to people who are suffering from pain and dementia. Some work long hours, including nights, while others pick up hour-long assignments here and there with no pay for travel between clients. Turnover is high. Many of those who stay do so only because they know how grim things would be for their clients if they quit.

A number of states are already making moves to address the situation. This spring, Washington state created a groundbreaking public insurance program to help older and disabled people pay for long-term care, including home care. Several other states, including California, are considering following suit. States have also been gradually expanding their Medicaid programs to provide more funds for home care. In a dream world where serious things actually get done at the federal level, we might hope for a health-care plan that includes long-term care, or for a stand-alone federal program similar to the Washington state plan.

In any case, seriously stimulating the economy and drawing more people into this desperately-needed work would have to include a major wage boost, essentially transforming home care into a stable career.

If giving a big raise to home care workers seems far-fetched, it's largely because Americans have traditionally viewed caretaking jobs as inherently low-wage work. That, of course, is because — historically and today — women have often been expected to do care work for free. Even the "unskilled" label often applied to the work is the result of that history. Obviously, caring for people physically and emotionally involves a lot of skills, but they're skills we don't usually learn in school or formal job training. The people who do these jobs exceptionally well have often learned them in the course of unpaid labor, caring for their siblings, children, parents, and friends. If we think they're not real skills on par with driving an 18-wheeler or updating a spreadsheet, it's because we're used to care work being a hidden piece of the economy.

Even if we do want to lift care work up and recognize its value, the idea of using it as a hedge against recession might raise an obvious objection: What happens when the economy booms again? If we continued public funding for the well-paid caring jobs the country needs, wouldn't that distort the market and pull workers away from the growing private sector?

Well, yes. It's entirely possible that people with limited job prospects might choose stable, well-paid home care jobs over private-sector employers like fast food places or call centers. That might force those private employers to raise wages, and, thus, prices. At the margins, companies unable to make that math work might even go out of business. The question here is, in terms of whichever values we want to consider — human dignity, ecological balance, the chance to take part in meaningful work, or whatever — what kinds of economic activity do do we want to prioritize? For my money, I'd take caring for our elders over ensuring that fast food burgers stay as cheap as possible.

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