A job in home-based health care, America’s quickest-growing industry, felt like a step up the ladder for Shawanna Ferguson when she left her fast-food job a decade ago. But in terms of pay and security, it didn’t turn out to be much of an advance.
It’s taken a public-health emergency to shine a spotlight on the precarious conditions and low pay in this key corner of America’s direct-care economy — a key employer for Black women, in particular — and turn it into an issue for presidential politics. Democratic candidate Joe Biden is promising a $775 billion investment in the industry, which he says will help give care workers a pay raise.
Ferguson was earning $10.50 an hour when the coronavirus arrived in her town of Walterboro, South Carolina. She had to buy her own sanitizer and face masks. When her mother, who also works in home care, tested positive for COVID-19, Ferguson decided the risks were no longer worth the reward. In the middle of the worst economic crisis in generations, she quit.
“We’re putting ourselves at risk,” says the 30-year-old a few weeks later, as she fixes lunch for her four kids in the kitchen of her subsidized house. “We’re becoming sick, and getting our family members sick, and it just goes unnoticed. They think: ‘Well, they’re going to come to work anyway, because they need the money.’ ”
Demand for home-care has surged as the population ages. Rapid hiring in the industry is one reason why South Carolina, a potential battleground in November’s election, had the country’s lowest unemployment rate for Black women last year.
But that went into reverse in the past six months, as Black and female unemployment skyrocketed above the overall rate. About 110,000 home-care jobs vanished in March and April, though almost half have since returned. The next update on labor markets is due on Friday when the jobs report for September will be published.
Even when they keep their jobs, Black women are likely to receive less pay and live below the poverty line. The national median pay for a home-based health aide is $12.15 an hour. “It’s confounding that a job that is so valuable to all of us, and all of our family members, would pay so little,” says Robert Espinoza, vice president of policy at PHI, a New York-based advocacy organization for care-workers and their clients. “We don’t have a properly financed long-term care system, and it creates all kinds of dysfunctions.”
Ferguson’s duties included feeding, bathing, grooming, and calming elderly and disabled patients for up to 12 hours a day.
Biden says his investment in the care economy will help deliver a pay raise for workers who look after the elderly and preschool children, without specifying how much. President Donald Trump has praised health care workers, likening them to soldiers, but hasn’t outlined plans for the industry in his reelection platform.
Scholars say that the prominent role of Black women in the caring professions dates back to slavery and the Jim Crow era. And the industry was historically left out of legislation to protect workers’ rights, even during the 1930s New Deal era that revolutionized so many other jobs.
One result of all that history is the low wages earned by so many care workers today.
“Black women never have a problem getting a job in home care,” says Daphne Berry, associate professor of management at Hartford University, who has studied the industry. “But they might have trouble getting enough hours, making rent, eating, and paying their bills.”
Kim Thomas, a 55-year-old home health care worker in Conway, South Carolina, has experienced some of those troubles. She earned a degree in business administration and worked as a property closer in law firms and real estate offices for more than a decade in several states. But she struggled to find suitable work after moving to North Carolina about 20 years ago.
“I ended up working at fast-food restaurants like Bojangles,” she says. That spurred her to qualify as a CNA, or certified nursing assistant — a direct-care job which includes administering medicine, and earns slightly more.
“I went to school, got my license, and then I ended up with a job right out the gate,” making $8 an hour, says Thomas. Two decades later, she’s earning a bit less than the roughly $14 national average for the position. Her agency provides health coverage and pays gas money.
But Thomas lost three-quarters of her clients indefinitely when their nursing homes stopped accepting outside visitors because of the pandemic. She now works half the week delivering groceries for Instacart.
Like Ferguson, who lives a three-hour drive away, Thomas says she wants to become a nurse -— a more stable job which pays about three times as much. All 15 nurses that her agency employs are white, reflecting the national picture where about three-quarters of nurses are white.
“The lower you are on the health-care totem pole, the darker the workforce,” says Anton Gunn, diversity officer at the Medical University of South Carolina, one of the nation’s oldest medical schools.
“The ‘why’ is around credentials,” says Gunn. “The profile of a person who becomes a neurosurgeon and someone who becomes a home health care worker is very different. I can’t disconnect the reasons for that from race.”
Nursing requires at least two years of full-time study. For Ferguson in Walterboro, that feels out of reach right now. “There’s a lot I have to get in order before I can just say ‘I want to go back to school,’ ” she says. “What am I going to do about these children? The gas money?”
She trails off. “I’m not trying to complain. I just feel like things could be a little bit better.”
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