Yes, Care Is Infrastructure
Curious why President Biden’s infrastructure proposal, the “American Jobs Plan,” includes provisions on childcare and home-based care? Like bridges and roads, robust care networks are critical to both connect people to economic opportunities and to support people, including care workers, to enable them thrive. Because care workers are usually women, often women of color and immigrants, this support is also crucial to address structural inequality in the United States.
Even before Covid-19, there was a care crisis in this country. People cannot afford high quality childcare and often cannot find it even if they have means. Home care is also often extremely expensive. Many lack insurance that will cover it and do not have the ability to pay the out-of- pocket expenses. Recent concerns have also been raised about the formation of home care deserts. Home care workers were and still are amongst the lowest paid workers in the economy making on average less than $13.50 an hour for extremely challenging work. Child care workers on average earn less than $12.50. Covid-19 has only made things worse.
Parents need access to reliable, high-quality childcare in order to work. The American Jobs Plan includes investments to improve existing childcare facilities. It includes tax credits for businesses who build on-site childcare facilities. Lastly, it includes a fund that will enable states to build the supply of child care in areas with unmet needs.
In addition to benefiting parents, high-quality childcare benefits children and ultimately, taxpayers by supporting the economy. Several longitudinal studies, including the Perry Preschool Study and the Abecedarian project, clearly document the benefits for children. Compared to peers from their neighborhoods who did not attend high-quality childcare programs, low-income children who attend high-quality care are: less likely to be on public assistance, less likely to be incarcerated, more likely to be employed, more likely to graduate from high school, and more likely to attend college. Good childcare, in other words, helps people and the economy. Furthermore, money spent on childcare is ultimately returned to the economy and not sent abroad.
Like childcare, home- and community-based services (HBCS) are important parts of America's care infrastructure. The American Jobs Plan recognizes their value and calls for expanding access to long-term care through Medicaid. The change would be implemented in a way that will raise all HBCS wages above poverty-level and will better acknowledge the skill and experience of HBCS workers. The poignant stories care workers shared at the recent Care Can’t Wait Summit underscore how important it is to improve the working conditions of care workers.
Studies show that the well-being of caregivers and care receivers are intertwined. For example, a 2020 report by LeadingAge shows that raising the pay for workers "reduces turnover and staffing shortages, which boosts productivity and quality of care." Increasing HBSC worker wages and service access, in other words, helps care workers and care receivers. Clearly, this has ripple effects for families.
In addition to helping care workers, the American Jobs Plan’s expansion of home-based care would facilitate a care structure that better connects more people to their preferred care situation. Over 75% of adults 40 or older express a preference for long-term care in their own homes over the alternatives. Critically, strengthening home-based care networks and access also promotes equity, dignity, and independence for people with disabilities.
The values of justice, equity and civic responsibility should also push us to support the American Jobs Plan. If we notice that some communities are more likely to have roads full of potholes and crumbling bridges, we should recognize the inconveniences, costs, and dangers of living and driving in those areas. It’s the same with our care infrastructure. If access to high-quality care (childcare or long-term, home-based care) isn’t accessible to everyone, then we are letting race, class, and ability status determine who receives care. Because both unpaid and paid carework disproportionately falls on women and women of color, not supporting care work increases existing structural inequalities and harms the most vulnerable among us.
Supporting better care helps the economy and advances justice. It helps people in tangible, meaningful ways. Let's encourage Congress to help fill the cracks in our care infrastructure by supporting the American Jobs Plan.
Traci Levy is an associate professor of political science and Director of Gender Studies at Adelphi University. Elizabeth Palley is a professor of social work and social policy and Director of the Doctoral Program at the Adelphi University School of Social Work.