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Structural Inequalities Are Harming the Direct Care Job

August 2, 2021

The Biden-Harris administration is exciting news for direct care workers and the long-term care field.

As the COVID-19 pandemic has reinforced, direct care workers are essential to the health and survival of millions of older adults and people with disabilities. Yet the poor quality of direct care jobs—as evidenced by low compensation, inadequate training, limited career paths, and much more—harms workers’ financial security, hinders quality care, and drives many workers out of this sector, a costly and unsustainable trend.

How should President Biden transform the direct care workforce?

Our new report—Caring for the Future: The Power and Potential of America’s Direct Care Workforce—provides a blueprint for this transformation. This report offers a comprehensive, current-day analysis of the direct care workforce and its critical role in the long-term care system. It also provides an extensive list of recommendations across eight key areas, all of which present federal policy opportunities, as well as options for state and local officials. This article, the seventh in an eight-part series, describes a few critical ideas for rectifying structural gender and racial inequities for direct care workers.

Now is the time for federal leaders to strengthen direct care jobs—and here’s one place to start.


Rectify structural gender and racial inequities for direct care workers

To address the structural inequities that harm the lives and employment experiences of direct care workers who are women, people of color, and/or immigrants

  • Develop strategies to address systemic barriers and strengthen diversity, equity, and inclusion within this job sector. To ensure that women, people of color, and immigrants (among other marginalized groups) can succeed in these roles, employers must design interventions that explicitly target the systemic barriers these workers experience. A critical step is to collect gender and race-related outcomes data across various job quality indicators in order to identify and address disparities in recruitment, hiring, retention, and other workforce outcomes.
  • Build the evidence base on equitable direct care workforce interventions. Interventions focused explicitly on supporting marginalized segments of the direct care workforce should be adequately funded and evaluated to help build the evidence base on equity in this job sector. Further, as workforce development leaders and other innovators design and test new interventions for direct care workers (related to training, advanced roles, and more), they must evaluate whether women, people of color, and immigrants benefit equally from these approaches—in the short and long-term.
  • Bolster supports for immigrant direct care workers. Immigrants are a significant part of the direct care workforce, and they need targeted supports to make it easier to fulfill their roles. These workers would benefit from more research to understand their unique challenges, public policies that address their recruitment and employment needs, culturally and linguistically competent workforce supports (especially for workers with limited-English proficiency), stronger access to community-based resources (legal and housing assistance, etc.), and a pathway to citizenship.

 * The recommendations above are taken from Caring for the Future: The Power and Potential of America’s Direct Care Workforce.

Read the executive summary of Caring for the Future >>

Download The 5 Pillars of Direct Care Job Quality >>

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.