The category that the Census calls “health care and social assistance” is the largest sector of employment in the country, accounting for about one in seven jobs nationwide. It encompasses hospitals, clinics, labs, long-term care facilities, home care, and social work agencies. This sector makes up an enormous proportion of low-wage employment growth in the United States over the past several decades: in the bottom quintile of the wage structure, according to sociologist Rachel Dwyer, a majority of new jobs since the 1980s have been care jobs of some kind. This labor market draws heavily on the most economically marginal sections of the working class.
In nursing homes, Medicaid—the poor relation of the healthcare system—supplies the majority of all revenue, while labor accounts for the large majority of costs. This prompts nursing home operators to seek to suppress wages and staffing levels, leading to high turnover and producing negligent care and dangerous working conditions.
Workers’ struggles have intensified with demands for hazard pay, adequate personal protection, and sufficient staffing.
“I hope you’ll still laugh at my jokes when I have dementia,” I said to my husband Ryan on an evening walk not long after my thirty-fourth birthday....