Biden’s executive order on care work is an important step for an industry in crisis

Rear view of elderly man in wheelchair and care helper Photo: Shutterstock

For three years, I have been waiting for good news from Washington to share with Yvette Beatty.

Beatty, 63, is a home health aide in Philadelphia who has provided care for elderly adults and people with disabilities for nearly 40 years. Like most direct care workers, she earns very low wages despite the increasing demand for her essential work.

I first met Beatty in April 2020, just as the COVID-19 pandemic began. In our interviews, she shared with me the hardships she endured: the fear she faced as she risked her life going to work, and her daily struggle to afford basics like food and medicine for her family. “It is very hard.” she told me. “Thank God for noodles.” (You can listen to Beatty in her own words in this profile.)

Beatty questioned why leaders in Washington were not doing more to support underpaid yet essential care workers—the vast majority of whom, like her, are women and workers of color.

“With home health aides, we are struggling out here,” Beatty told me in April 2020. “This is a field everyone needs. They need our service. Why can’t we get wages that help us?”

Yvette Beatty

Yvette Beatty: Listen to her own words in this profile.

Two weeks ago, President Joe Biden took important steps toward heeding Beatty’s call. In a Rose Garden ceremony, he signed a historic executive order with more than 50 directives for improving care jobs and expanding access to affordable child care and long-term care. In his remarks, President Biden thanked care workers like Beatty and said they “deserve jobs with good pay and good benefits.”

The new executive order is important for two key reasons. First, it demonstrates the Biden administration’s commitment to addressing three interrelated and critical challenges in the care sector: 1) the struggle that millions of American families face trying to access high-quality, affordable child care and long-term care for their loved ones; 2) the dire shortage of care workers who provide these services; and 3) the inadequate pay, benefits, and job quality that plague the sector. Because pay for care workers is so low, turnover is high, waitlists are long, and families are unable to find the care they need. In his Rose Garden remarks, President Biden framed the stakes in moral and economic terms, calling the issue “fundamental to who we are as a nation” and important to the entire economy.

To this end, the executive order directs the Department of Health and Human Services (HHS) and the Department of Education to use their regulatory power to enhance the job quality and wages for long-term care workers, early educators, and child care workers. For instance, HHS could increase the pay and benefits for Head Start personnel, and the Education Department could encourage its grantees to increase wages for child care staff.

The second key reason for the executive order’s importance is that it harnesses the power of the executive branch at a time when progress in Congress has stalled. Early in his administration, President Biden proposed historic investments in the care sector as part of the Build Back Better agenda, including $400 billion for long-term care, $225 billion for child care, and $200 billion for early childhood education. However, the final version of this legislation signed into law (the Inflation Reduction Act) was ultimately a slimmed down version of Build Back Better that was stripped of any investments in care.

Now, with Republicans in control of the House of Representatives, any major legislation investing in care work seems unlikely for the foreseeable future. But by issuing an executive order on care work, President Biden was able to bypass Congress to make some progress through the executive branch and demonstrate continued support—albeit without bringing any new money to the issue.

Unfortunately, that lack of new money means that America’s care crisis will continue, despite the positive steps outlined in the executive order. Sizable federal and state investment is required to simultaneously improve care jobs and expand access to affordable, quality child care and long-term care. Unlike other low-wage sectors such as retail or fast food (where wages are responsive to labor market demand, as evidenced by fast-growing wages for in-demand leisure and hospitality workers), the hourly pay for workers providing direct long-term care is mainly financed through Medicaid (funded by both the federal and state governments) and restricted by (often inadequate) Medicaid reimbursement rates set by states. Even when demand for workers is high, as it is today, employers in the care sector have little room to raise pay or improve benefits to attract and retain staff, unless states increase Medicaid reimbursement rates and Congress and state governments invest additional money to finance pay bumps.

Recently, several states have made financial commitments to raise pay for care workers permanently. Colorado, Michigan, North Carolina, and New York have funded pay increases for direct care workers providing long-term services, including home health aides. And New Mexico, Washington, D.C., Maine, and Louisiana boosted pay for child care workers. While promising, these examples of state leadership remain the exception. A comprehensive and national solution to the care crisis requires federal action.

To Yvette Beatty, this issue isn’t partisan. “It isn’t a Democrat or a Republican thing,” she told me back in 2020. “It’s a ‘we’ thing.” She noted the appeal to voters in helping both families and workers. “Help the home health aides so we can continue to help our patients. If we can’t keep ourselves together, how are we going to keep our patients together?”

President Biden’s executive order and instances of state action show hopeful signs of progress on solving America’s care crisis. But major federal investment is needed, and I’m still waiting to call Beatty with good news that it’s coming. Three years ago, when I asked her how she would feel if leaders in Washington invested in care workers, she responded: “It would give us hope if they supported us. It would let us know we are appreciated. If the government could help us right now, it would feel beautiful.”