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Nurse Carla Brown administers a COVID-19 vaccination dose to Maxine Moses, 92, on August 17, 2021 in Baton Rouge, Louisiana. (Photo by Mario Tama/Getty Images)

To Build Back Better, Congress Must (Finally) Invest in Black Caregivers Like Us

We cannot confront or disband the links between structural racism and poor job quality in long-term care and create an equitable caregiving system for all without intentionally investing in a critical workforce that is majority women-of-color.

Charlene DickersonShantonia Jackson

As Congress is considering making a once-in-a-generation investment in workers and families to enact President Biden's care infrastructure plan through the Build Back Better Act, our country is at a crossroads. Over the past 19 months, caregivers like us have borne the brunt of the COVID-19 pandemic, with this time being among the most challenging of our combined 60 years of service within our industry. But our challenges did not begin with the global pandemic. Even before the pandemic, we've had to work two or three jobs just to make ends meet and support our families while providing the vital care that millions of older adults, people with disabilities, and their families depend on.

America's long-term care system has disregarded and exploited Black women caregivers like us for generations.

America's long-term care system has disregarded and exploited Black women caregivers like us for generations. The roots of inequity within American healthcare, particularly in caregiving, date back to chattel slavery. For centuries, enslaved Black women were forced to provide coerced, unpaid domestic care to wealthier white families, seeding the generational racial wealth gap that persists today. After Emancipation, domestic work was still one of the only jobs available to Black women. The legacy of caregiving being perceived as "Black women's work" endures today through the systemic devaluation of benefits of caregivers' services to our society and economy.

One way the impact of structural racism and poor job quality in long-term care still shows up today is how low our pay is compared to other fields. Home care aides and certified nursing assistants like us are some of the lowest paid (yet fastest growing) occupations in the country. The median hourly wage for a direct care worker in 2019 was $12.80, having grown just 2% since 2009. Bringing home so little to show for our backbreaking work forces us to make impossible choices like buying groceries or prescription medications, not both. The poverty pay keeps us locked into working multiple jobs to survive, which negatively impacts our physical and mental health. Overworked and severely underpaid, we see the consumers we care for more than we see our own families, and our children and communities suffer in our absence.

In a moment when racial justice and health equity is suddenly a hot topic, the ugly truth is that we cannot confront or disband the links between structural racism and poor job quality in long-term care and create an equitable caregiving system for all without intentionally investing in a critical workforce that is majority women-of-color.

Despite the daily challenges we face choosing a career in caregiving, we are proud of the compassionate, essential care we provide each day. And through organizing alongside fellow caregivers, we've come to deeply understand the inequities our workforce faces and what needs to be done to address them. This year, we joined the Advisory Board of H-CAP's newly launched Center for Advancing Racial Equity and Job Quality in Long-Term Care (Center for Equity) to confront the ties between structural racism, sexism and the poor quality of jobs in long-term care and offer recommendations for change. Through our lived experience working in this system day in and day out, we know that if the U.S. finally centers workforce policy reforms on women of color caregivers, our country has a shot at ending the care crisis.

At this consequential moment, Congress has the chance to stand on the right side of history to finally create pathways—not roadblocks—for caregivers like us to live quality lives doing the work we love, through this first-ever federal job reform program directed to a majority women of color workforce.

Time is of the essence. Congress is considering drastically reducing the $400 billion investment amount proposed by President Biden and outlined in the bicameral Better Care Better Jobs Act, but we urgently need our lawmakers to honor the labor of caregivers of all backgrounds by fully funding the expansion and strengthening of our home- and community-based services (HCBS).  The full $400 billion investment will create at least 700,000 new care jobs to meet the booming demand and establish a pipeline of home care workers into the next generation by transforming care jobs into good, living-wage, union jobs with training opportunities and real career pathways. Any less will not transform the caregiving system to address generations of scarcity and inequities. At this consequential moment, Congress has the chance to stand on the right side of history to finally create pathways—not roadblocks—for caregivers like us to live quality lives doing the work we love, through this first-ever federal job reform program directed to a majority women of color workforce.

Generations of Black and brown women have provided the scaffolding and support for the U.S. economy since the country was founded, yet we've gotten little for our own families in return. Fully funding the HCBS provisions of the Build Back Better Act is vital to curb our caregiving crisis and establish racial and gender equity for our communities. It's time we put our money where our mouth is in tearing down centuries of racial injustice. Investing in care infrastructure is the first step.


Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

Charlene Dickerson

Charlene Dickerson is a Home Care Aide in Springfield, MA.

Shantonia Jackson

Shantonia Jackson

Shantonia Jackson is a Certified Nursing Assistant (CNA) at City View Nursing Home in Cicero, IL.

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