If You Can Read This You Don't Deserve 15 Dollars

Contents:

• Introduction
• Underpaid, undervalued, and essential
• A policy agenda for essential, low-wage health workers:
• Keep all health workers safe
• Introduce hazard pay
• Raise pay to a permanent living wage
• Aggrandize paid leave
• Give workers the respect they deserve

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Introduction

The COVID-19 pandemic has inspired an outpouring of public appreciation for the country'due south frontline heroes, from television ads to firefighter salutes to essential worker toys. But while doctors and nurses deserve our praise, they are not the only ones risking their lives during the pandemic—in fact, they represent less than 20% of all essential health workers.

Too often, we overlook the heroism and nobility of millions of depression-paid, undervalued, and essential health workers like Sabrina Hopps, a 46-year-onetime housekeeping aide in an acute nursing facility in Washington, D.C.

"If nosotros don't make clean the rooms correctly, the pandemic volition get worse," said Hopps. She cares securely about the patients she works with, and knows that the value of her job goes well beyond cleaning. "It's me and the other housekeepers who sit and talk with [patients] to burnish upwardly their day, because they tin't have family members visiting."

Despite her contributions, she doesn't experience recognized. "Housekeeping has never been respected," she told me recently. "When yous think about health care piece of work, the first people you think near are the doctors and the nurses. They don't recollect well-nigh housekeeping, maintenance, dietary, nursing assistants, patient care techs, and assistants."

Hopps is one of millions of low-wage essential health workers on the COVID-xix front end lines. Like the college-paid doctors and nurses they piece of work aslope, these essential workers are risking their lives during the pandemic—only with far less prestige and recognition, very depression pay, and less access to the protective equipment that could relieve their lives. They are nursing assistants, phlebotomists, home wellness aides, housekeepers, medical administration, cooks, and more. The vast majority of these workers are women, and they are disproportionately people of color. Median pay is just $thirteen.48 an hr.

Over the last several weeks, I interviewed most a dozen low-wage health workers on the forepart lines of COVID-19. (You tin can read their stories hither.) Despite being alleged "essential," the workers I interviewed described feeling disregarded and deprioritized, even expendable. They spoke with pride about their work, only few felt respected, fifty-fifty as they put their lives on the line. Many expressed frustration—and sometimes anger—over their lack of life-saving protective equipment.

It is long past time that these workers are treated every bit truly essential. This starts with simply recognizing the value of workers like Hopps—but nosotros can and must do more. The policy recommendations in this report aim to keep these workers safe on the job, compensate them with a living wage, back up them if they autumn ill, and give them the respect and appreciation they deserve.

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Underpaid, undervalued, and essential

The underpaid but essential wellness care workforce in America comprises well-nigh vii million people in low-paid wellness jobs in these iii categories:

• Health care back up workers assist health care providers such as doctors and nurses in providing patient care. Roles include orderlies, medical assistants, phlebotomists, and pharmacy aides.
• Direct care workers such as habitation wellness workers, nursing assistants, and personal care aides provide care to individuals with concrete, cognitive, or other needs.
• Health care service workers include housekeepers, janitors, and nutrient preparation and serving workers employed in health care settings such every bit hospitals and nursing homes.

More people are employed in wellness care back up, service, and direct care jobs than in all wellness intendance practitioner and technician jobs (doctors, nurses, EMTs, lab technicians, etc.). In fact, more people piece of work in hospitals equally housekeepers and janitors—like Sabrina Hopps—than as physicians and surgeons. The size of this low-wage health workforce exceeds the size of nearly other occupational groups of essential workers. Information technology employs more people than the entire transportation and warehousing industry and more than than twice as many people every bit the grocery industry.

Median wages in health care support, service, and direct care jobs were only $xiii.48 an hr in 2019—well curt of a living wage and far lower than the median pay of doctors (over $100 per 60 minutes) and nurses ($35.17 per hour). Home health and personal care workers earn even less, with a median hourly wage of just $11.57. The wages are so low that nearly 20% of intendance workers live in poverty and more than than forty% rely on some class of public assistance. These fields are some of the fastest-growing of all occupations, with more than a million new jobs projected past 2028.

Table 1. Demographic profile of workers in the wellness intendance and social assistance manufacture, 2019

Occupation	Number of workers	Median hourly wage	% Women	% African American	% Latino or Hispanic
All health intendance back up, direct care, and service workers	half-dozen,964,410	$13.48	81%	25%	21%
Registered nurses	2,604,000	$35.17	89%	12%	7%
Physicians and surgeons	562,440	>$100	41%	8%	8%

Source: Brookings analysis of U.S. Agency of Labor Statistics' Occupational Employment Statistics and the U.S. Census Agency's Electric current Population Survey.

Over 80% of health intendance support, service, and directly intendance workers are women. They are also disproportionately people of colour. Like other low-wage jobs where women and people of color are concentrated, many of these positions are plagued past underinvestment and a lack of benefits. Now, these jobs pose an even greater risk to workers' lives.

Despite being undervalued, low-wage health workers brand essential contributions during the pandemic and across. "Nobody is insignificant," said Tony Powell, a 62-year-onetime administrative coordinator of a infirmary surgical unit of measurement in Washington, D.C. "Without environmental service, without dietary, without secretaries, without medical and surgical techs and certified nursing administration (CNAs), information technology wouldn't be a infirmary." Habitation health workers, for example, provide the showtime line of defence force against COVID-19 for millions of elderly and vulnerable people living at home. Without that, the limited capacity of hospitals today would be stretched even further.

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A policy agenda for essential, low-wage health workers

Policymakers, employers, and the general public should each do their part for low-wage essential health workers during COVID-xix and beyond. The following policy recommendations are aimed at keeping these workers safe on the job, compensating them with a living wage, supporting them if they fall ill, and giving them the respect and appreciation they deserve.

Go along all wellness workers prophylactic

A first-guild priority for policymakers and employers should be keeping frontline wellness workers safety on the task. Dire shortages of life-saving personal protective equipment (PPE) such every bit surgical masks, N95 respirators, isolation gowns, gloves, and face shields are jeopardizing workers' lives. One poll showed that 2-thirds of health care workers reported insufficient face up masks as recently equally early May. Frustrated nurses and doctors have made urgent appeals to the federal government to activate the Defense Product Deed to mobilize production of needed supplies.

While near news coverage highlights only the risks to nurses and doctors, PPE shortages are too a matter of life and death for millions of health care back up, service, and direct care workers on the COVID-19 front end line. These workers are at a lower priority for the already-insufficient supplies, meaning that hospitals and health intendance facilities sometimes overlook their safe as they ration PPE and prioritize vulnerable clinical staff who treat infectious patients.

The workers I interviewed expressed a range of emotions—from fear to frustration to anger—over their lack of admission to PPE. David Saucedo, a 52-year-erstwhile cook at a Baltimore nursing home, said his supervisors initially denied his requests for PPE.

"Merely considering I am not a nurse or nursing banana doesn't mean I don't come in contact with patients," Saucedo told me. "Every footstep a nurse, nursing assistant, or doctor takes in that facility, I actually walk correct behind them." His Alzheimer's patients, he noted, do non empathise social distancing: "They but come up to you lot, take hold of you, and sit and talk to you lot."

Saucedo had to argue his case to two supervisors before he was finally given the PPE that nurses in his facilities automatically access. "It'south like they prioritized them and forgot about everyone else," he told me. "It makes me experience similar I am secondary, not equal. You are expendable, in a mode."

Andrea (who preferred nosotros simply utilize her get-go name), a 29-year-erstwhile housekeeping aide in a infirmary operating room and mother of two young children, had a similar experience. Later on a patient in a room she was responsible for cleaning was suspected of having the coronavirus, Andrea asked her charge nurse to be fit-tested for an N95 mask. Andrea said the nurse'due south response was, "No, these are for special people."

"1 minute you are of import enough," she told me. "The side by side minute it is similar, no you lot aren't that important to become the proper equipment, but you are important enough to clean it for the adjacent patient."

Domicile care workers face additional hurdles to accessing PPE. Their employers are much lower in priority for state and federal PPE supplies than hospitals, nursing homes, and emergency services, leaving many agencies struggling to procure equipment on their own and pay for its skyrocketing costs on the private market. A recent survey establish more than 75% of dwelling care agencies face up shortages of masks and sanitizer.

Like others in her field, Elizabeth Great, a 49-yr-onetime home wellness aide in Virginia, received no PPE, COVID-19 training, or supplies from her employer. She described driving to towns across Virginia and West Virginia in search of her own equipment. Yvette Beatty, a sixty-year-quondam habitation health aide in Philadelphia, said her employer was unable to access PPE despite concerted efforts.

"I would love to meet us have run a risk masks, instead of putting cloths over our confront, or going to the Dollar Store and buying dollar masks," Beatty told me. "We need equipment. They need to requite equipment to agencies. We are running around with cloths, no protective gear. We need the exact same thing as everyone else."

» Policy recommendations to keep workers safe:

• The federal government should fully utilize the Defense Production Human action to mobilize manufacturers across the country to increment the supply of PPE. Until every wellness care worker has sufficient access to PPE, their lives are at risk.
• Land governments should encourage companies to increment PPE supplies and assistance home health agencies access supplies and finance costs. They can follow the lead of Washington state, which recently added abode health workers and other long-term care providers to the top tier of priority for PPE.
• Home care agencies should increment training, information, and resources to frontline workers, so domicile intendance workers do not feel like they are navigating a pandemic on their own.

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Introduce hazard pay

The extremely low pay that health intendance support, service, and direct care workers earn has long been woefully inadequate. During a pandemic, information technology is morally reprehensible. Congress should enact hazard pay to ensure that no worker risking his or her life during this crisis is paid less than a family-sustaining wage.

For workers in health jobs, federal funding for hazard pay is especially important. Infirmary finances have been hit difficult by the pandemic. Home care agencies are limited in their ability to raise pay due to Medicaid reimbursement rates, a major systemic impediment to improving task quality for millions of care workers. Hazard pay for health workers has lagged behind temporary pay increases for workers in sectors such every bit retail and grocery.

Lawmakers on both sides of the aisle take offered proposals for federally funded take a chance pay. In April, President Donald Trump signaled his support for extra compensation to doctors, nurses, and health workers. On May 15, the House of Representatives passed the HEROES Act, which included $200 billion for run a risk pay for essential workers. Despite this momentum, U.Southward. lawmakers have not passed hazard pay into law. In Canada, even so, Prime Government minister Justin Trudeau appear a $four billion commitment to increase pay for essential workers. He singled out low-paid essential workers as a priority, saying that minimum-wage workers risking their wellness during the pandemic deserve a raise.

The workers I interviewed expressed a potent desire for take a chance pay. David Saucedo likened the hazards of his chore as a nursing home cook to the risks he faced during his military service: "When I was in the Navy, when we went to war, I was getting paid hazardous duty pay. To me, information technology is a chancy task correct at present. We should be getting paid hazardous pay." Saucedo noted that boosted compensation could exist life-saving, affording his colleagues the chance to accept a taxi instead of risking exposure to COVID-nineteen on public transit. "Everybody is contagious on buses," he said. "The all-time thing y'all can do is limit their amount of exposure for a melt or anyone else."

Housekeeping aide Sabrina Hopps agreed that additional compensation could exist life-saving. "If pay was meliorate, I would be able to alive on my own and so could my children," she told me. "What I make, it is non enough. So, I am forced to share an apartment with my son and daughter and my granddaughter. Going dorsum and forth to work, I am jeopardizing their lives." Hopps is especially concerned for her son, who has asthma and is a cancer survivor. Her employer recently introduced a new bonus for employees providing directly patient care, merely excluded housekeepers and other low-paid service workers from the additional bounty.

» Policy recommendations for introducing run a risk pay:

• Congress should pass federally mandated gamble pay for at-risk essential workers in the side by side pandemic relief bill, with a priority for lower-paid workers. Hazard pay should double the wages of low-wage workers. In the HEROES Human action legislation, House Democrats included $200 billion for gamble pay through a "Heroes Fund" that would administer grants to employers of essential workers. Their proposed charge per unit of an additional $13 per hour is roughly equivalent to the median wage of wellness care support, service, and direct intendance workers.

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Raise pay to a permanent living wage

COVID-19 has laid bare the broad gap between the value that health care support, service, and directly intendance workers bring to society and the extremely low wages they earn in return. Short-term fixes such every bit hazard pay are urgently needed. But policymakers and employers should also brand lasting changes then that these essential workers finally earn a permanent living wage.

Infirmary administrative coordinator Tony Powell explained why wage increases are then critical for depression-paid health workers: "They have to realize that these people, just similar any other people—doctors, nurses, whoever—they have families. They accept to enhance their families, too. If you are working just at the poverty level, that is giving you lot plenty to get to work, get luncheon, and try to transport your kids to school. Merely without a living wage, information technology'south not going to mean anything."

Pauline Moffitt, a 50-yr-onetime direct care worker in Philadelphia, is barely surviving on the poverty wages she earns caring for immunocompromised and elderly residents. At $9 an hour, her pay is so low that Moffitt and her recently laid-off husband cannot make ends encounter, even as she commutes nearly three hours each way on five charabanc and railroad train transfers. "It is a struggle," she told me. "I accept to pay a lot of bills. What am I supposed to practise? I pray ever: Lord, please stretch my pay. Delight."

Pennsylvania, where Moffitt works, is one of the 21 states that has not mandated a minimum wage above the federal rate of $7.25 per hour. She wants to see permanent pay increases. "I but wish they would raise it and give us a picayune more than," she said. "Not just for me, but all the other home health aides that are in the same state of affairs."

» Policy recommendations for permanently boosting pay:

• The federal government and state and local governments should raise the minimum wage to at least $15 per 60 minutes.
• Land governments and the federal authorities should increase Medicaid funding to allow employers of dwelling care workers to provide a living wage and offer benefits.

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Expand paid get out

While workers of all incomes are vulnerable to COVID-xix, low-wage workers have the to the lowest degree admission to paid exit if they autumn ill. In 2019, less than a 3rd of workers in the lesser 10% of income earnings had access to paid ill leave, compared to nine out of 10 college-paid workers in the top quarter of income earnings. The gaps for essential workers similar home wellness aides are especially large—a 2017 survey of 3,000 home care workers institute that less than one in five care workers had access to paid exit.

"We don't become whatever benefits," said Elizabeth Dandy, a 49-year-erstwhile home health adjutant who earns $9 an 60 minutes. The funding for her work caring for geriatric patients comes through the state of Virginia, just she is not employed directly by the land. "They have the states work as independent contractors," she told me. "And that way, we get no sick exit, no overtime, no benefits at all. This is pretty standard."

Peachy thinks policymakers should brand changes: "In reality, information technology is a lot cheaper to pay united states a piddling more money, give us some benefits, and allow u.s. to take intendance of those patients, keep those patients from being in an ER or a nursing dwelling, and help them have a good quality of life in their own dwelling."

Low-wage wellness workers without paid leave are in an incommunicable position. They face some of the highest risks of exposure to COVID-xix, but accept little or no ability to stay home to care for themselves or their loved ones. The public health stakes during a pandemic are high—rushing dorsum to their jobs before they are fully recovered jeopardizes workers' well-being and risks spreading the coronavirus to patients and colleagues. "The problem is you lot are going to have some workers who are notwithstanding going to become to piece of work," said Peachy. "And they shouldn't, because they may be sick and they may get the person ill. Information technology would exist better to have paid sick days because we need these workers to go into homes and take care of the thousands of high-risk people."

The Families Start Coronavirus Response Human action took steps to temporarily address this disparity and expand paid sick leave and family and medical go out to workers during the pandemic. However, 2 gaps in the legislation undermine these benefits for low-wage wellness workers. Beginning, the legislation but applies to employers with less than 500 employees, which could exclude upwards of half of all workers. It also stipulates that employers may exempt "health intendance providers," broadly defined by the Department of Labor to include workers across health care institutions and home care settings.

» Policy recommendations for expanding paid sick exit:

• In the next pandemic relief bill, Congress should revoke exemptions for large employers and expand admission to temporary paid sick leave and family and medical go out to all workers. The HEROES Human action, passed on May 15, removes the employer size exemption besides as the health care provider exemptions.
• State governments and the federal government should increase Medicaid funding to allow employers of home care workers to offering benefits such as paid leave, aslope a living wage.

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Give workers the respect they deserve

Long before COVID-19, 53-year-onetime Yolanda Ross felt her work as a home wellness worker outside Richmond, Va. was not respected. She told me that low-wage health workers similar her are "underpaid, overlooked and forgotten near, but still depended upon," while others on the front line who are accounted "important" are valued differently.

Ross's experience is reflected in the data. Brookings's Richard 5. Reeves (who is writing about the importance of respect more mostly) and Hannah Van Drie recently analyzed information on the perceived social continuing of essential jobs. They found a staggering gap between the high prestige of doctors and nurses and the low prestige of lesser-paid but essential hospital workers, including housekeepers.

In interviews, these workers shared stories that bring to life the lack of respect they experience. Several wondered why depression-wage essential workers are never included in TV commercials that applaud doctors and nurses. ICU worker Andrea told me her charge nurse calls her "housekeeping" and still hasn't bothered to larn Andrea's proper name despite working together for 7 years. Ditanya Rosebud, a 46-year-old cook and hostess at a Baltimore nursing dwelling house said her employer responds to her sacrifices by but telling her, "This is what you signed upwards for."

Rosebud and her colleagues are working extra shifts and risking their family's lives during the pandemic. "We are just another body," she explained. "That's it. No more than, no less."

Workers also shared stories of life-saving PPE beingness reserved for "of import people," wages that practice not fifty-fifty cover even basic expenses, hazard pay that is given only to clinical colleagues, and a lack of appreciation for workers' sacrifices. "People are not looking at people similar us on the lower finish of the spectrum," said hospital administrative coordinator Tony Powell. "We're not even getting respect. That is the biggest matter: Nosotros are not even getting respect."

The COVID-nineteen pandemic has already upended so many aspects of lodge, the economy, and our lives. Yolanda Ross hopes that it volition as well upend our long-standing notions of who deserves to be valued. "I pray there is a redirection," she said. "That we stop doing things the same former way and listen to those who don't have a real vocalism."

» Recommendations for giving workers respect:

• Government and other civic leaders can do more to recognize the contributions of low-wage workers and give their work public visibility. A collaboration between city leaders in New York and workforce partners effectually the social media effort #ValueDirectCareWorkers is an instance.
• The full general public can practice more to include lower-wage workers in their recognition of essential workers, including deportment such as meal donations to hospitals, public demonstrations of thanks and support, and social media messages.
• The media should accost the imbalance in coverage of workers, and publish stories, perspectives, and images of lower-wage health workers on the COVID-19 front line.
• Employers should provide low-wage health workers with respect, appreciation, more than equitable pay and support, and opportunities for grooming, advancement, and better job quality.

It is long past fourth dimension that low-wage workers who are essential to our society are treated with dignity. Employers, colleagues, policymakers, and the general public accept their parts to play in finally giving these workers the respect they have always deserved. "It can change," Yolanda Ross reminded me. "At that place is hope."

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Policy recommendations overview

Click here to download a shareable version of this table.

Prioritize all workers' prophylactic:

The federal regime should fully employ the Defense Product Act to increment supply of personal protective equipment (PPE).

Land governments should encourage companies to increase PPE supplies and help home wellness agencies access supplies and finance their costs.

Employers should provide more than COVID-19 training on condom and infection control, equally well as ongoing support to workers.

Pay workers a living wage:

Congress should laissez passer federally mandated hazard pay for at-risk essential workers, including wellness care support, direct care, and service workers.

Country and local governments as well as the federal government should increase the minimum wage so workers earn a living wage.

State governments and the federal government should increase Medicaid funding to allow for higher wages and benefits for home care workers.

Aggrandize paid sick leave:

Congress should plug the holes in the before legislation that denied health care workers admission to paid exit.

Requite workers the respect and appreciation they deserve:

Policymakers, employers, and the public should give workers greater recognition, respect, and appreciation.

The media should feature the stories of depression-wage essential workers and the challenges they confront.

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These interviews were conducted between April 1, 2020 and April 28, 2020. Participants have provided permission to Brookings to use their names, likenesses, task titles, location and transcribed words.

Nosotros are enormously grateful to Tony Powell, Andrea, Yvette Beatty, David Saucedo, Sabrina Hopps, Elizabeth Great, Pauline Moffitt, Ditanya Rosebud, and Yolanda Ross for sharing their stories. We thank and each and every worker on the front lines for the sacrifices they are making.

Cheers to PHI, SEIU, SEIU Local 1199, Angelina Drake, Tatia Cooper, Yvonne Slosarski, Leslie Frane, and LaNoral Thomas for their collaboration with the worker interviews. Thanks to Richard V. Reeves, Angelina Drake, Tiffany Ford, Ai-jen Poo, Greg Larson, Alan Berube, Morgan Welch, Claudia Balog, and Vicki Shabo for substantive comments and thoughtful input.

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Source: https://www.brookings.edu/research/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/

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