If workers’ salaries were based on the value they provide to society, Andre Green, the executive director of the local nonprofit SkillWorks writes in a new Boston Foundation report, “few people would make more than child-care workers, home care workers, and long-term care facility workers. Almost none of us will get through life without needing at least one of them.”

Unfortunately, care workers typically receive low salaries and limited appreciation.

The report – “Care Work in Massachusetts: A Call for Racial and Economic Justice for a Neglected Sector” — adds:

“Over centuries, policies driven by racism, xenophobia, and misogyny have closed professional doorways and shunted many women of color, particularly immigrant women, into care work, where they contend with low wages, few benefits, and challenging working conditions. As this segment of our economy continues to grow, these issues will confront more and more workers until they are addressed.”

“Nothing made the importance—or precarity—of care work clearer than the COVID-19 pandemic.”

In addition to low salaries (child care salaries are the lowest), care workers are less likely to receive employer benefits. And many care workers rely on public benefits to make ends meet. While slightly fewer than “14 percent of all working adults are enrolled in Medicaid (MassHealth)” more than 25 percent of child care workers rely on Medicaid, as do “more than a third of long-term care facility workers, and almost half of home care workers.”

Similarly, “almost one third of Massachusetts home care workers are enrolled in Supplemental Nutrition Assistance Program (SNAP), the program formerly known as food stamps.”

The ironic misfortune of this situation is that small wage increases can trigger a “cliff effect,” meaning that a slightly higher salary “can lead to the disproportionate loss of benefits.”

Fortunately, Massachusetts has taken steps to address these problems.

“The state passed a Domestic Workers Bill of Rights in 2014, which guarantees things like minimum rest periods, and we are one of 11 states with a public paid family leave program. But there’s much more we can do.”

A Boston Globe article elaborates, noting:

“The problems in the care industry go far beyond the jobs themselves, noted James Fuccione, head of the Massachusetts Healthy Aging Collaborative, which consulted on the report. A licensing process for home care agencies in particular would mean more oversight and policies that could strengthen jobs. Workers also need affordable housing and a reliable transit system. ‘This is a community-wide issue,’ he said.

“Significant investment and policy change is also needed in early education, according to the advocacy group Strategies for Children, which provided input for the report. The Massachusetts Senior Care Association said it was working to retain nursing facility workers and promote career growth, noting that increased government funding was vital to paying employees a living wage.”

To encourage change in Massachusetts, the report makes a number of recommendations, including:

• Continuing to strengthen the state minimum wage

“While recent increases have already raised the wages of many care workers in Massachusetts, the current $14.25 minimum wage remains well below the estimates of what it takes to afford our state’s increasingly high cost of living. According to the MIT Living Wage calculator, for instance, a living wage for a single adult without children in Massachusetts is $21.88 an hour and $44.23 for a single adult with one child,” the report says.

• Increasing Medicaid (MassHealth) reimbursement rates for Home and Community-Based Services (HCBS) and long-term care facilities

“Simply requiring higher pay from employers can be tough for agencies or institutions working with limited budgets, so it is important to pair regulatory changes like minimum wage increases with expanded public funding to help subsidize these increased labor costs.”

• Improving access to training and career ladder programs

“Increased access to training programs, supportive supervision, and mentorship can improve job satisfaction and help improve working conditions. Similarly, providing greater opportunities for advancement both within the occupation through specialized credentialling and career ladders, or into similar fields through clear “career lattices” can help attract new workers and improve worker retention,” and

• Refiling and passing existing legislation to increase access to early education and child care

“State legislation proposed in 2021, and passed by the Senate in July of 2022, would significantly expand family eligibility for child-care subsidies to include, over time, families that earn up to 125 percent state median income. It would also create a new funding stream to directly support the operating costs of early education and child-care providers. New operational funding would offset the high costs associated with early education and child-care provision and, importantly, help raise educator pay.”

As SkillWorks’ executive director Andre Green concludes in his introduction, “The story this report tells is a grim one, but I hope it’s the final chapter of the old story. We have a moral and economic imperative to plot a new path. Nothing about our legacies of racism and sexism are written in stone. As a community we have the tools to treat this work and these workers with the respect they deserve.”