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Paid Leave is Essential for the Direct Care Workforce

By Jake McDonald (he/him) | November 28, 2023

The over 4.8 million direct care workers in the U.S. perform physically and emotionally demanding jobs that are essential to ensuring quality of life and dignity for millions of Americans. Yet their work continues to be deeply undervalued, as evidenced by poverty-level wages and limited benefits, such as, glaringly, a lack of access to paid leave.

Paid family and medical leave is a basic employment protection that allows workers time off to care for themselves or a loved one without losing their income source. But for low-wage workers, like those in direct care, paid leave is often out of reach. In fact, one study found that only 35% of direct care workers who took leave for family or medical reasons were able to take that time as paid leave.

Paid Leave Matters to Direct Care Workers

There are several reasons why access to paid leave is so important for direct care workers:

  • Caring for Children: Nearly a third of direct care workers have children under the age of 18 at home, including one in ten who live with at least one child under the age of five. Without paid leave, many could not afford to bond with their infant or care for a sick child.
  • Managing Family Caregiving Responsibilities: Many direct care workers not only provide paid care professionally, but they are also family caregivers, including 29% of home care workers, 31% of residential care aides, and 18% of nursing assistants. Paid leave is necessary to allow these workers to care for their families without jeopardizing their income.
  • Reducing Turnover: Turnover has reached crisis levels across long-term care settings, exacerbating an already critical workforce shortage. This became especially clear at the height of the COVID-19 pandemic when so many direct care workers left the field and did not come back. Paid leave is a key benefit needed to improve retention in direct care because it prevents workers from having to choose between keeping their jobs to survive financially or safeguarding their own health or that of their loved ones.
  • Promoting economic security: With median annual earnings of just $23,688 per year and many direct care workers relying on public assistance, paid leave is essential to help direct care workers meet their basic needs. Increasing access to employment benefits and protections, including paid leave, is necessary to ensure direct care workers have the total compensation they require to live a sustainable life. Without that, we will continue to struggle to attract and retain the workers needed to care for a rapidly aging population.
  • Advancing equity: Across our society, lack of access to paid leave disproportionately impacts women and people of color, who are at greater risk of taking unpaid leave or exiting the labor force if they experience a serious illness or need to care for a family member. Direct care workers fall largely into these demographic categories (86% are women; 62% are people of color), which is why paid leave is particularly important for this undervalued but essential workforce.

We Need a National Paid Leave Program

Paid leave is a basic necessity for all workers but is especially important for direct care workers who are more likely to need it and less likely to have access to it. However, state-level incremental progress has not been sufficient to ensure comprehensive access to this critical benefit. This is why PHI has joined dozens of other advocacy organizations in supporting the FAMILY Act. This bill would create a national paid family and medical leave program funded through employer and employee payroll contributions. Workers could take up to 12 weeks of leave with partial wage replacement to care for themselves or a family member with a serious illness or to welcome a new family member.

It’s Time to Value Those Who Are Caring for Our Loved Ones

Valuing direct care work starts with ensuring they have high-quality jobs, including having access to paid leave and other basic benefits that attract people to the workforce, help retain them, and ensure they do not have to choose between their paycheck and caring for a loved one. What direct care workers need is what so many, especially other low-wage workers need: bold reform that creates a comprehensive, national paid leave program.

Jake McDonald (he/him)
About The Author

Jake McDonald (he/him)

Senior State Policy Advocacy Specialist
As the Senior State Policy Advocacy Specialist, Jake McDonald improves job quality for direct care workers by deepening and expanding PHI’s state-based advocacy approach.

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