BUILDING THE CARING ECONOMY: Workforce Investm ents to Expand Access to Affordable, High Quality Early and Long-Term Care S E L F D I R E C T I O N C O N F E R E N C E B A L T I M O R E , M A R Y L A N D M A Y 8 , 2 0 17 N I N A K . D A S T U R S E N I O R F E L L O W G E O R G E T O W N C E N T E R O N P O V E R T Y A N D I N E Q U A L I T Y Please do not quote, cite, or distribute inform ation included in this presentation w ithout perm ission.
Why Promote Investments in Care? National Need for Good Jobs National Need for Caregiving
The State of Employment By Educational By Age Attainm ent Education Distribution of Em ployed and Unem ployed, 16+ Unem ploym ent Num ber of Age Rate Unem ployed 100.0% 16-19 15.7% 938,000 90.0% 22.2% 20 -24 8.1% 1,246,000 37.1% 80.0% 25-34 5.2% 1,861,000 Bachelor's Degree or 70.0% More 27.2% 36-44 4.1% 1,331,000 60.0% Some College or 45-54 3.6% 1,232,000 Associate Degree 50.0% 27.7% High School 40.0% 55+ 3.5% 1,268,000 34.9% 30.0% Less than High Total 7,876,000 School 27.1% 20.0% 10.0% 15.7% 8.1% 0.0% Employed Unemployed
Job losses in the recession were Job concentrated among the industries and occupations that provided better Quality earning and advancement opportunities Lower- and mid-wage occupations have experienced proportionately greater declines in their real wages than did higher-wage occupations from 2009 through 2014 Without a concerted national About 42% of workers in the U.S. strategy, a earn less than $15/ hour, including: disproportionate 54.1 %of African American workers share of new jobs Almost 60% of Latino workers may be poorly Women, who represent more than half of paid, low-skill low wage workers (54.7 %) employment
Getting Americans Back to Work Em ploym ent Status by Educational Attainm ent, Age 25+ (August 20 16) Labor Force Participation Rate Employment-Population Ratio 74.1% 72.1% 66.5% 63.7% 57.1% 54.2% 46.5% 43.2% Less than a High School Degree High School Some College Bachelor's Degree or Higher
Caregiving Needs in the U.S. Nearly 60% of American families with children under the age of 6, including both single parent and married couple households, have all parents in the workforce 3 out of 5 of the more than 20.4 million children under the age of 5 are in a regular care arrangement at least once during a typical week Over 12 million Americans currently need long-term assistance with daily living Around half are ages 65+ 47% are adults ages 18-64 3% are children under 18
The Cost of Formal Care Early Care & Education Long Term Care The median annual cost of care for one child across early care settings: Exceeds the HHS affordability threshold as share of the median income; for family households Is more than twice that threshold for families with incomes at 200 % of the federal poverty level, and Rises to approximately 40 % for families with income at 100 % of federal poverty level. Families living in poverty that rely on paid care report spending roughly 30% of their income on child care, four times that of families with income above the poverty line.
Family Caregiving Around 4 in 10 children (42 Around 68 % of adults receiving community-based %) under the age of 5 are LTSS receive support solely cared for by a relative, from an unpaid friend or including more than three- family member fourths of those with An estimated 39.8 million working mothers. These Americans had provided care caregivers are to a family member or friend predominantly over the age of 18 within the grandparents last 12 months More than 1 in 4 adults over Of the 12.5 million children the age of 40 thought it extremely or very likely that a ages 0-5 in a regular care friend or family member arrangement each week, would require long-term fewer than one-fourth are assistance within the next five in center-based care. years
… and Its Impact 6 in 10 caregivers Caregiving Responsibilities: report that their Suppress labor force participation LTC responsibilities Reduce family income and wealth negatively impacted their Impair caregivers’ health employment, including Affect the economy necessitating a The aggregate cost to U.S. employers reduction in their work hours or a attributable to full-time employees with family leave of absence, caregiving responsibilities has been estimated or receiving a performance or at $17.1 to $33.6 billion (2006 dollars) in lost attendance-related productivity notice from their employer.
Demographic Trends Size of Age 65+ Population, Projected Aging of the U.S. Current and Projected Population Share of Population Age 65+, 20 10 -20 50 90,000,000 25.0% 21.0% 20.9% 20.3% 80,000,000 70,000,000 20.0% 16.8% Num ber of Individuals 60,000,000 13.2% 15.0% Age 65+ 50,000,000 Age 65-74 16.4% 17.4% 17.8% 40,000,000 Age 75-84 Age 65-84 10.0% Age 85+ 14.7% 30,000,000 11.1% 20,000,000 5.0% Age 85 and older 4.5% 10,000,000 3.7% 2.5% 2.0% 1.9% 0.0% 0 2010 2020 2030 2040 2050 2013 2020 2030 2050
Current Public The Caregiving Safety Net Investments Are Inadequate Uneven Fragmented Impenetrable
Early Care and Education Subsidies Share of CCDF-Eligible Children Served, 2012 Total Served 1.445 < 12 months 1-2 year-olds 3-4 year olds CCDF-Eligible Children, By Age Total=6.338 million 0.904 2.097 2.220 1.117 5 year olds Total 0.000 2.000 4.000 6.000 Millions
Long Term Care Financing National Expenditures for LTSS, by Source, 20 13 Out of Pocket, 19% Private Insurance, 8% Medicaid, 51% Other Public, 21%
Impact on the Caregiving Workforce F A M I LI E S ’ I N A B I LI TY TO A F F O R D CA R E A N D LI M I TE D P U B LI C F I N A N CI N G CO N S TR A I N CO M P E N S A TI O N A N D M I N I M I ZE I N V E S TM E N TS I N TR A I N I N G A N D CA R E E R P A TH W A YS TH A T TO G E TH E R D R I V E TU R N O V E R A CR O S S TH E CA R E G I V I N G S E CTO R
The Caregiving Workforce Early Care and Education Direct Care Workers Workers Around 3.2 million HCBS Approximately 2 million direct care workers provide paid caregivers work 70- 80% of paid long-term directly with children ages care 0-5 Almost 9 in 10 are women; More than 9 in 10 are Almost half (47%) are women white, 30% are African 53% of all center-based American, and another 16% staff and 30% of home- are Hispanic. based workers report 55% have a high school having at least some college degree or less.
Wages and (Lack of) Benefits HCBS Direct Care Early Care and Education Workers Median hourly wage for Wage variations are tied to personal care aides is $10.09 educational level, but are much lower than earnings of (2015) & $10.54 for home comparably-educated health aides workers; In all states for both categories Median hourly wage for of workers, wages fall below center-based staff = $10.60 200 % of the federal poverty In every state, the median level annual earnings of child care Pre-ACA, almost one-third of workers falls below 150 % of the lowest income aides were the poverty level for a family of three not enrolled in any health insurance plan
Increase wages for existing federally-funded workers to stem Our Goal turnover and eliminate wage disparities Expand federal funding to support the true cost of high Public investment quality care and increase families’ that makes high quality care access to it accessible and Invest in training and affordable for families and professional development to support s the improve care quality and promote creation of high recruitment and retention quality jobs
LTSS Recommendations Support Paid Leave 1. Fund a Wage Pass-Through to Raise Incomes, Promote 2. Equity and Improve Worker Retention without Reducing the Availability of Formal Care Establish a Universal Catastrophic Long-Term Care 3. Insurance Program as a Component of or Companion to Medicare Expand Self-Direction to Promote Recruitment 4. Finance an Enhanced Federal Matching Rate for HCBS 5. under Medicaid to Expand Access to LTC Attach limits on Allowable Costs, including Executive 6. Compensation to Medicaid Funded HCBS Invest in both Preservice Training and Professional 7. Development for Incumbent Workers
State Medicaid HCBS Programs Healthy Alaska, Medicaid Redesign Arizona Health Care Cost Containment System Medi-Cal Health First Colorado Connecticut Home Care Program for Elders Home and Community Based Waivers (DE) Community Care Services Program (GA) Hawaii Quest Illinois Medicaid, Pathways to Community Living Iowa HealthLink
Discussion Questions What are the opportunities and challenges you see in framing advocacy around families' care needs to include both early care and education and long term care? Have you encountered instances or examples that suggest that we need to improve transparency around how long term care is funded? How important do you think it is to standardize the way we "brand" and talk about long term care programs across states and at the federal level?
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