Economics of Caring: Improving Population Health by Valuing Care Workers: Proceedings of a Workshop (2023)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

3 Perspectives from Care Sector Leaders Highlights The inequities affecting care workers are deeply rooted in history, especially •  in extracted labor of enslaved people, and deliberate decisions to devalue through policy the labor of care and other workers during the Reconstruction and the New Deal. (Ignatius) Responding to the care crisis requires all-of-society solutions because every- •  one is touched by caregiving and this is a non-partisan issue, but part of being a human and living a human life. (Cannon, Ignatius) Those who are directly affected have the best solutions. (Ignatius) •  Care workers themselves must sit at the decision-making tables. (Cannon) •  Everyone is touched by caregiving and should be a vocal proponent of •  strengthening caregiving. “If you get cancer, it does not matter if you are a Republican or a Democrat or an Independent. If you have a . . . premature baby . . .” political affiliation does not matter. (Ignatius) Providing support, benefits, training, dignity, and respect to care workers can •  help them soar, with growing contributions to their organizations, communities, and the nation. (Cannon) NOTE: This list is the rapporteur’s summary of points made by the individual speakers identified, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They are not intended to reflect a consensus among workshop participants. 13 PREPUBLICATION COPY—Uncorrected Proofs 

14 ECONOMICS OF CARING Kosali Simon, professor of health economics at the O’Neill School of Public and Environmental Affairs at Indiana University, introduced ­Terrell Cannon, director of training and workforce development at Home Care Associates in Philadelphia, a worker-owned company, and Mary Ignatius, statewide organizer for Parent Voices. In her opening comments, Cannon expressed surprise at how slow society has been to acknowledge the universality of the need for care. All people will grow old, their loved ones will grow older, and all will need care at some point. She also noted that home health workers are not considered professionals, but rather, as “the help.” Ignatius shared how her organization talks with families who are consumers of child care and public services and asks them what changes are needed. She added that when families that work in a low-paid industry and need government assistance accessing child care, or housing or other services, they are required to complete extensive paperwork that seems premised on an assumption that the applicant is trying to commit fraud. This is based on a harmful myth of the welfare queen, but Ignatius shared that in her 25 years in the field, she has met “women of color working multiple jobs while attending school and raising a family.” There is a history of stigma associated with care workers—in home care or in child care—who are not considered professionals, Cannon noted. She echoed Poo’s remarks in the opening panel about the ways in which care work makes all other work possible and it is essential. But “if we are essential workers,” she asked, “where are our essential benefits, where are our essential resources?” She called for looking at the common humanity of all people and looking beyond class and race. Simon asked Ignatius to reflect on how Cannon’s assertion, which seemed so clear and obvious, could be translated into policy. Ignatius said that centering the needs of historically marginalized people is nec- essary to move toward more equitable policies. Decision makers should ask Black, Indigenous, immigrant, and families of color, “what are the things that keep you up at night? What are the things that make you lose your assistance before you are ready?” Cannon added that care­givers themselves should not be seen as low-wage, unprofessional workers, but should be supported and valued. Her co-op, for example, offers free training to open paths to career advancement for care workers, and that investment is leading people to contribute to society, to teach and connect with others, and to strengthen their organization and their community. Simon noted that the recognition that care provision is a concern from the cradle to the grave was facilitated by the pandemic and the circumstances it created, with an unprecedented proportion of families losing their care coverage and recognizing the shared challenges of care needs going unmet. What can local and regional leaders do to support PREPUBLICATION COPY—Uncorrected Proofs 

CARE SECTOR LEADERS 15 cross-sector collaboration, Simon asked. Cannon said that her home care co-op provides case management supports for workers themselves, but there are many gaps in resources that require policy solutions. Care­giving and receiving care are deeply personal, Cannon said, but they also are structural challenges, and co-ops are a mechanism for supporting ­workers while providing essential caregiving services. Ignatius added that the plight of the sandwich generation—adults with caregiving ­responsibilities for both their older parents and for their young children—has shown the importance of care work, and that it requires all-of-society ­solutions because everyone is touched by caregiving. She added this is a non-­ partisan issue, but part of being a human and just “getting through the day.” Cannon called for shifting the current view of caregivers that ­devalues them and considers them unprofessional and does not provide the pay, benefits, and recognition needed for workers to thrive. She added that in the context of the home care co-op, employees receive support to further their training, and that allows them to “take off,” leading to greater value, quality, and connection. The fastest growing occupation by 2030 requires societal and policy attention, she added. Child care, Ignatius said, was created to serve the smallest number of people, for the shortest time, and offering as little as possible, and the system works as it was designed. To repair the systems that all commu- nities depend on, a wide range of partners are needed to work together. There are no “six-figure paid lobbyists in the care economy, or proof yet that we are voting in numbers that require elected officials listen to us” so what is needed are researchers who will partner to co-design research that is quantitative and qualitative, media that will partner with workers in the care economy to tell stories of strength and societal contribution, and stories of the dignity and pride of care workers. What is the role of immigration in the care economy, Simon asked. Cannon acknowledged what she described as some people’s perception of immigrants as competition to low-wage work. Cannon shared that her co-op is highly diverse, and the stigma associated with immigration is disappointing; for example, hearing people say that “they” (immigrants) are coming to the U.S. to take something away from us, and “not under- standing that those people are us to some extent. . . . It is sad that the only time that we may need an immigrant is when we need a caregiver, when we need a house fixed, when we need a child care provider.” Immigrants, Cannon added, “are human beings like we are. Those are caregivers. Those are moms, dads, daughters, brothers, uncles, aunts.” Ignatius said that as the daughter of an immigrant, this is an important topic to her, and she estimated that 60 percent of the membership in Parent Voices are immigrants. The pandemic highlighted the vulnerability of immigrants PREPUBLICATION COPY—Uncorrected Proofs 

16 ECONOMICS OF CARING working in a variety of jobs with minimal or no protection, janitors, grocery workers, farm workers, and other “essential” workers in reality treated as expendable, undervalued, and invisible. She added: We are actively co-signing onto that exploitation. It is terrible and it is on us to call on making sure they are getting access to stimulus checks or child tax credits or other unemployment, other federal and state and local relief because it should not matter if you have a Social Security Number. Your humanity and your ability and your contributions to our society and our economy are valid. Simon relayed an audience question about establishing co-ops. ­Cannon said investing in co-ops offers people the opportunity to buy shares and play a role in transforming the industry. Caregivers, she added, have other skills and abilities, e.g., they can be entrepreneurs, and in co-ops, they have a voice, and can participate in forums that allow them to speak to policymakers directly. In her closing comment, Ignatius said that sup- porting steps to economic security for workers will improve workers’ health—they will sleep better, have lower cholesterol, and experience less stress and anxiety. PREPUBLICATION COPY—Uncorrected Proofs