In September the President’s Commission on Bioethics published Taking Care: Ethical Caregiving in Our Aging Society. It is a broad review and set of recommendations regarding a number of issues facing society and the special medical care needs of the elderly. Of particular interest to women and justice is the following quote:
“Once the typical caregiver was a woman who did not work outside the home; today the typical caregiver, still a woman, is employed outside the home, and often obliged in addition to care for her own young children. At the same time, there are already shortages of professional caregivers—nurses and geriatricians—and caregiving jobs such as nurse’s aides often lack the levels of compensation and benefits that might attract sufficient numbers of workers.” (Chapter 5, section I, paragraph A, point 4)
This point, and its disproportionate impact on women, has been dramatically illustrated by an article in today’s Chicago Tribune. The point of the article isn’t just that women are more often professional caregivers and that they are underpaid, but that by the very act of taking on a paid caregiver position they are, ironically, left without a way to pay for their own healthcare. The personal stories in the article are gripping and tragic. The article quotes the journal Health Affairs as stating that of the 6 million Americans who joined the ranks of the uninsured between 2000 and 2004, nearly two-thirds were working, mostly in low-wage jobs. Nursing home and home-care aides fall in this category, with median annual incomes of $13,287 and $12,265, respectively. Professional caregivers may or may not have access to employer-sponsored health insurance, but even those who do often pass it up because of the high premiums which can easily be 10% of their gross salary for individual coverage and up to half of their salary for family coverage. And since sick days are not covered by home care agencies, women cannot take the time to stand in line for hours at free clinics. Any serious illness requiring hospitalization and resulting bills will force women and their families into a bankruptcy situation. Thus it’s not surprising that the majority of women who work as professional caregivers do not get routine medical exams and screenings and do not seek care early in an illness. Instead, like other working poor without insurance, many of these women resort to using emergency rooms as their primary mode of health care and suffer health outcomes far inferior to those who have general access to health care.
While the typical reaction to such “news” is to bemoan the sad facts, we have to do more than that as a society. As our population ages, the demand for home care givers is on the rise. If people do not respond to this need by becoming home care workers, we, as a society, have a huge problem of figuring out how to care for this population. On the other hand, if people, predominantly women, do respond to this call and we have not reformed the system, then we are complicit in the unjust treatment of women who literally trade their own health to care for the better-off who can afford it.