The nation can’t just train its way to the ‘future of care.’ We need a big rethink.

Investments in education are critical to the future of professional caregiving—but they alone won’t be enough, writes Van Ton-Quinlivan, CEO of Futuro Health. The economics and equity of the whole system need to be rethought.

The pandemic uncovered a fact that most of us have known all along: Our nation is not set up to support a reality in which most citizens, particularly women, can provide care for their families while earning a living wage. In fact, more than 5 million women left the workforce during the pandemic, with women of color suffering the greatest proportional job losses.  

Across the country, Americans have left work to care for their aging parents or children. Our nation’s aging population is expected to double in the next 20 years, with many of our elderly suffering from multiple chronic health conditions including dementia and diabetes. Harried families will carry more of the burden as health systems increasingly favor care moving into the home. Meanwhile, even before adding on the cost of elder care, households with children use a sizable portion of their paychecks for expenses ranging from daycare costs to college debt.  

This pandemic has created a care quandary many did not previously want to acknowledge. It is now time to reimagine a society in which our able-bodied citizens are not forced to choose between their careers and their families. If we want to emerge from the pandemic stronger and better positioned to take care of our young, our elderly, and our vulnerable loved ones, the nation must relook at and upgrade our human infrastructure. 

How do we fix this? Biden’s plan starts the conversation. Increased access to quality education and training, and better pathways into careers will be an important part of any long-term solution. But that alone won’t be enough—we also must invite solutions that address inherent inequities and inequalities, restructure the economy of healthcare to grow the caregiving workforce, and encourage innovation.  

Daniel Bustillo, executive director of the Healthcare Advancement Program, said in a WorkforceRx podcast that the healthcare industry needs to understand the cycle of workforce shortages is caused by “the racialized and gendered nature of caregiving. It’s really a direct result of a history steeped in intentional and exclusionary policy practice, such as exclusion from labor law, which really does require social policy solution.” 

Inequity and exclusion, combined with poor pay for a taxing, underappreciated job lead to workers quitting the field or retiring early, further straining the system. Take, for example, home caregivers, who are doing important work but being paid too little to make a decent living. In the United States, the typical home health aide only makes $24,200 per yearThat’s a wage of less than $12 per hour. These are the people, many of them women, who have put their lives on the line during the COVID-19 pandemic. Modern Healthcare put it bluntly: “Women in healthcare are at a breaking point—and they’re leaving.” And it’s not just entry- or lower-level professions exiting the field, nurses are quitting too. According to a Vivian Health survey published this year, 43 percent of nurses reported considered leaving the health care profession in 2021. By comparison, at the start of the pandemic, 80 percent of respondents said they were likely to continue working in their field. 

These substantial changes signal that the country needs to move quickly and strategically to ensure this dearth doesn’t end in disaster. In higher education, we tend to think of more and better education and training as the solution to these kinds of supply-and-demand challenges. Yet, fewer future allied health students are enrolling, and those who do are saddled with crippling student loan debt.  

“Higher education has been hit hard by COVID-19, including allied health education,” wrote the National Healthcare Association. “Postsecondary educators and students are worried, and many allied health educators are concerned that over 350,000 fewer students renewing their FAFSA for the 2020-21 cycle points to trouble ahead.” We need to figure out how to convince future students that a higher education is worth their investment of time and resources, and we need to make it affordable for all. 

While investments in education and training are paramount to ensure a quality and inclusive workforce to provide care in the home, they alone are not enough. Innovative leaders like Howard Brodsky, CEO of CCA Global, are leaning on unconventional solutions that give workers more power, which sets the bar higher for pay and tends to retain more workers, for longer. Brodsky recommends leveraging worker co-ops as an economic structure to put more income into the pockets of the workers and make these critical jobs more attractive. 

Looking ahead, it’s clear the demand for health care workers will only increase as our population ages. We all – education providers, employers, and policymakers alike – need to encourage and invest in equity efforts, education, and innovation.  History has shown that investments in physical infrastructure yield gains for generations to come. We know that building roads, bridges, and dams can transform a nation and bring jobs and stability to communities. The same will be true for investment in our nation’s most precious resources—our people.

Van Ton-Quinlivan is CEO of Futuro Health, a nonprofit whose mission is to increase the health and wealth of communities by growing the largest network of allied health workers. Her career spans the private, public, and nonprofit sectors. Ton-Quinlivan is former executive vice chancellor of the California Community Colleges and was named a White House Champion of Change.

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