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In Recognition of Caregivers, White House Readies to Help Nursing Home Workers

Last month, President Biden announced comprehensive government actions to improve access to quality child care and long-term care. The executive order, signed by the president, directed an array of federal programs at the departments of Health and Human Services and Veterans Affairs, and other departments to do more to meet the care needs of working families who rely on either paid or unpaid caregivers to participate in our economy and our society.

The president’s announcement, which comes during Care Workers Recognition Month, is a landmark effort to highlight the role of care work in our economy. As the president noted, one in five Americans is a caregiver, helping raise a child or caring for a person with a disability, either at home or in a nursing home.

The attention on caregiving comes naturally for this president. During his remarks at the signing event, he recalled the help he needed raising his sons after his first wife and daughter died in a car crash and the care he and the first lady provided to their parents near the end of their lives. For many people, however, the hardest part is finding a caregiver. We will need millions of new caregivers to meet the needs of our aging society. 

How do we get more people to do this physically demanding and often emotionally draining work? Recruitment and retention is challenging because this important work is routinely undercompensated. The median annual income for a certified nurse assistant in a nursing home is $24,200so low that one-third are on some public assistance. The median annual income for a home care worker is even less. 

One way to ensure caregivers are paid more is to make it easier for workers who want to join a union. We know labor law is fundamentally brokenit is simply too hard for workers to exercise our right to collective action. To support the needs of America's families and our economy, we need to make sure caregivers have a voice at work.

When it comes to nursing homes, there is an immediate opportunity to address the quality of care for residents. The Biden administration can follow through on its promise to do what previous administrations lacked the political courage to do: set a science-based, national minimum staffing standard for nursing homes that participate in Medicare and Medicaid. 

We know that powerful forces in the nursing home industry, including private equity investors, vigorously oppose a minimum staffing standard. Private equity investors often turn a profit by manipulating personnel: hiring fewer workers and slashing pay and benefits at the cost of patient care. Setting a staffing standard would mean having to pay higher wages to attract more people to the industry; it would mean paying a living wage, so working in a nursing home would be a sustainable, family-supporting job. 

Nursing home experts across the board agree that current staffing at most nursing homes is inadequate, and that poor staffing puts residents at risk for ulcers, falls, and other adverse medical events. One has to look no further than Health and Human Services' findings in 2001 for the bare minimum staffing levels needed to avoid harming patients. Yet too many nursing operators want to compromise this medically based standard of care. We are glad to work with the industry to address issues around implementation of a staffing standard, but there should be no doubt about what experts say is the best way to improve nursing home care: stop the understaffing that compromises resident care and makes caregivers pursue other work. 

The AFL-CIO commends the administration for its focus on the care economy. Making sure current federal programs are more accessible is critical for families who need care and caregivers who want to do the work. However, it is time to do more than re-direct existing resources. We need to invest new resources and set new standards for good care and workplace conditions in businesses where care is provided. This year, we can start with nursing homes and address similar policy and fiscal questions around home care and the child care workforce. Our kids, grandparents, friends and family members with disabilities deserve no less.

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