波士顿咨询：解决2900亿美元的医疗危机 Solving the $290 Billion Care Crisis

Solvingthe$290BillionCareCrisis

November2022

ByEmilyKos,SuchiSastri,NanDasGupta,RohanSajdeh,GabrielleNovacek,AliciaPittman,NeeruRavi,andAnisaVashi

BostonConsultingGrouppartnerswithleadersinbusinessandsocietytotackletheirmost

importantchallengesandcapturetheirgreatestopportunities.BCGwasthepioneerinbusinessstrategywhenitwasfoundedin1963.Today,

weworkcloselywithclientstoembracea

transformationalapproachaimedatbenefitingallstakeholders—empoweringorganizationstogrow,buildsustainablecompetitiveadvantage,and

drivepositivesocietalimpact.

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thatquestionthestatusquoandsparkchange.

BCGdeliverssolutionsthroughleading-edge

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fueledbythegoalofhelpingourclientsthriveandenablingthemtomaketheworldabetterplace.

Solvingthe$290BillionCareCrisis

TheUScareeconomyisbroken.Gettingitrightisvitaltoeconomicprosperityandsocietalwell-being.

I

ttookCOVID-19,adeadlyglobalpandemic,fortheUSto

wakeuptothegapingfaultlinesinthe“careeconomy.”

Whatisthecareeconomy?Itisavastecosystemwhere

families,employers,andinstitutions—fromdaycaresand

nursinghomestoschoolsandhospitals—cometogethertosupporttheyoung,theold,andthesick.Thissupportis

necessaryforthefunctioningofahealthysociety,andthisworkunderpinseverypartoftheeconomy.Wecanignoreitnolonger.

TheDisorganizedCareEconomy

Thestoriesareeverywhere.TakeJoanne,anenvironmentalconsultantwithamaster’sdegreeandfull-timejobinthe

Denveroil-and-gasindustry,whoparedbackherworktotenhoursaweekbecauseshecouldn’tfindchildcareforher

babyson,Miles.Herfirstnannysleptonthejob,shesays,andasecondchosetoworkinaschoolformorepayandbenefits.Milescouldn’tlandaspotindaycare.Joanneismarriedandherhusbandhasastablejob,butwhenshereducedherworkhourstocareforMiles,thefamily’sin-comewashalved.

OrconsiderNaila,aregisterednursesince2013inSan

Francisco,whoworked12-hourshiftsthreetimesaweek.

Shequitfivemonthsafterherfirstbabywasborn,nudged

bythelocaldaycare’shoursofjust8a.m.to3p.m.Althoughherfamilycanliveonherhusband’sincome,sheregrets

leavingnursing,aprofessionshelovesandonethatdesper-atelyneedsexperiencedstaff.Still,Nailadoesn’tplanto

returntonursinguntilherchildisatleastfive.Thenshe’llprobablylookforamedicalclinicwithshortershifts.

Sandraengagedhermothertohelpwithhertwokidswhileshecontinuedhercareerasatalentrecruiter.Thenher

77-year-oldmomgotsick,andSandrahadtoquitherjobtolookafterallthree,movingintotheincreasinglycom-monunpaidroleofcaringforbothchildrenandparents.

Thesestresses—atthenexusoffamilyandwork—playoutmillionsoftimesadayintheUS,affectingusall.They

exposeafundamentalmismatchinsupplyanddemand

forcareservicesintheworld’sbiggesteconomy.Andthe

consequencesaresignificantandgrowing.Already,theUSbirthratehasdippedbelowreplacementrateaspotentialfamilybuildersholdoffhavingchildren,oftencitingthe

costandavailabilityofchildcareandthequalityofpublicschools.Atthesametime,thedemographicbulgeofagingbabyboomersandtherealitythatmorepeoplearelivingintotheir80sand90sputsenormouspressureonse-

nior-caresystems.Ineverycase,technology,efficiency,or

newfacilitiescanonlygosofar;thecareeconomyrequirespresent,skilled,compassionatehumanlabor.

InaMay2022report,weestimatedthesizeofthecareecon-omy,includingbothunpaidandpaidcaregiving,atupto$6trillion,approachingaquarteroftotalUSGDP.(SeeExhibit1.)

Thissegmentoftheeconomyisexpandingveryfastbut

remainsprecarious,withlittlecoordinatedactionsofartoaddressgapsandorganizecomprehensivesolutions.Now,we’vequantifiedwhatthesegapsinthecareeconomycosttheUSinGDPeveryyear.

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BOSTONCONSULTINGGROUP1

Exhibit1-TheUSCareEconomyIsWorthUpto$6Trillion

Valueofunpaid-carelabor1

Formaleconomy2

Grayeconomy3

u$400B

$2.5T–$3.5T

$2.2T

pto

UnpaidcaregivingPaidcaregiving

Sources:USBureauofLaborStatistics;InstituteofEconomicAffairs;BCG/DynataCaregiverSurvey2022(N=3,673);BCGanalysis.

1Calculatedasthevalueofunpaid-carelaborifitwerepaid:numberofindividualsprovidingunpaidcaremultipliedbytheaveragetimespentpro-vidingunpaidcareinanequivalentfull-timepositionmultipliedbytheaveragepaid-caregiverwage.

2CalculatedinrealGDPterms,basedonthenumberofpaidcaregiversmultipliedbytheaveragepaid-caregiverwageforeducationalservices,ambu-latoryhealthcareservices,hospitals,nursingandresidentialcarefacilities,individualandfamilyservices,andchild-daycareservices.

3CalculatedusingInstituteofEconomicAffairsestimatesonUSshadoweconomy.

WeforecastthattheUSwillloseabout$290billiona

yearinGDPin2030andbeyondifwefailtofixtwocriti-calcare-economydynamics:(1)thelackofavailableworkerstofilladramaticallyincreasingnumberofthesehands-on

jobs,and(2)thedepartureofproductiveemployeesfrom

thepaidlaborforcetotakeonunpaid-careduties,whethertheywanttoornot.Thateconomiclossisequivalentto

losinghalfoftheannualGDPgrowthprojectedfrom2022–2023.1Or,putanotherway,itismorethantheannualreve-nueofAlphabet,thesecond-biggestUStechnologycompa-ny.

Thecarecrisisistiedtothemarketforhourlylabor—sig-nificantly,low-wagelabor—and,therefore,intersectswiththepostpandemic“greatre-enrollment”andaUSunem-ploymentratehoveringbelow4%.About1.8millioncriti-cal-carejobs,includingnursingassistants,homehealth

aidesandchildcareworkers,areopen,accordingtothe

USBureauofLaborStatistics.Andthedemandforthese

jobsispoisedtogrowinthenexttenyears,wellbeyond

thesevacancies.However,theserolesgenerallypayless

than$18anhourandofferpoorbenefits.Workersare

requiredtobeonsite,withinflexiblehoursandunexpectedovertime.Trainingisinadequate;turnoverishigh.It’sno

wonderthesepositionsarestarvedforapplicants.

1.SomeGrowthProjectedfortheU.S.Economy,2020-30,CareerOutlook,September2021,USBureauofLaborStatistics,

/

careeroutlook/2021/data-on-display/economic-growth.htm.

2SOLVINGTHE$290BILLIONCARECRISIS

Ampleopeningsinindustriesthatcompeteforthesame

workers,suchasretailandhospitality,exacerbatethe

problem,andarealreadydrawingawaycurrentcare-econo-myemployeeswithbetterpay,perks,andeasierduties.

That’sevidentinthenumbers:asofJuly,pandemic-relatedjoblossesacrossthebroadereconomyhadlargelyrecov-

ered,butjobtotalsinchild-careserviceswerestill8%shortofprepandemiclevels,accordingtotheCenterforAmeri-canProgress.2AboutathirdofUSdaycarecentersclosedorreducedcapacitybymorethan50%inthelasttwoyearsbecauseofalackofworkers.3

ForCEOsandotherleaders,understandingthemagnitudeofthecareeconomyanditscurrentdysfunctioniscriticaltograpplingwithlaborshortagesandbroadertalentcon-cerns.Careworkersrequirecompetitive,livablewages.

Peoplewhohirecareservicesinordertodotheirjobsinotherindustriesrequiresupport.FailingtorecognizethechildcareandeldercareresponsibilitiesofmillionsofUSworkerssapsproductivityandjobsatisfaction.

FixingthecareproblemintheUSnowisn’tjustgoodbusiness,it’snecessarybusiness.

QuantifyingtheCareCrisis

CareactivitiesarecriticaltoGDPgrowthbecausethey

supportworkersineveryotherindustry.Still,economists,

investors,andcorporateexecutiveshavelongoverlooked

thislabor,bothbecauseitstraddlestheinformaleconomyandbecauseithasbeenderidedas“women’swork.”But

careistooimportanttoahealthyUSeconomyandstablesocietytoneglect.Mostothercountrieshaveaddressed

workers’careneedsmoredeliberately.Onedramaticexam-pleistheissueofpaidleave:theUSistheonlydevelopedcountrythatdoesn’tmandatepaidtimeofftosupport

employedwomeninthedaysaftertheygivebirth.Bonding

withanewbornandrecoveringfrompregnancyarefunda-mentaltothematernalexperience,yetwestilldon’t

guaranteeincomeinthisperiodofaworkingwoman’slife.

About56%ofUSworkers—roughly90million

people—havecareresponsibilitiesoutsideoftheirfull-timejobs,accordingtoaproprietarysurveyofmorethan3,600employedcaregiversconductedbyBCGandDynata,our

codingandsamplingpartner.(Seethemethodology.)

Approximately40millionofthesecaregiversrelyon

paidcare—suchasnannies,daycares,ornursinghomes—togotowork,meaningthatwhenpaidcarefallsthrough,theyareatriskofmissingworkorleavingtheirpaidjobs

altogether.Theremainderrelyonunpaidcare,includingfamily,friends,neighbors,andothers,ordoitallthem-selves.(Seethesidebar.)

2.TheChildCareSectorWillContinueToStruggleHiringStaffUnlessItCreatesGoodJobs,CenterforAmericanProgress,September2,2022,

https://www.

/article/the-child-care-sector-will-continue-to-struggle-hiring-staff-unless-it-creates-good-jobs/

.

3.EmmaKLeeandZacharyParolin,“TheCareBurdenDuringCOVID-19:ANationalDatabaseofChildCareClosuresintheUnitedStates,”Socius,7,July21,2021,

/doi/full/10.1177/23780231211032028

.

BOSTONCONSULTINGGROUP3

OverviewoftheCareEconomy

Thecareeconomyiscomposedofbothunpaidandpaidcaregivinginoursociety.Therearethreemaintypesofcaregiversinthiseconomy:

•UnpaidCaregivers.Anyonewithunpaid-carerespon-sibilitiesforchildren,adultfamilymembers,orboth,

whethertheythemselvesareemployed.

•EmployedCaregivers.Asubsetofthefirstgroup—work-ersinthebroadereconomywhoalsohaveunpaid-carere-sponsibilities,forchildren,adultfamilymembers,orboth.

•Paid-CareWorkers.Individualswhoprovidecareastheiroccupation.Manycareworkersarealsoemployedcaregiv-erswithunpaid-careresponsibilities.Manyofthemalso

relyonpaid-careworkersfortheirownfamilymembers.

Tosizethetotalcareeconomy,werefertotheUSBureauofLaborStatistics,whichincludeseducation,healthcare,andsocialassistanceinits“educationandhealthcare

servicessupersector.”Weprimarilyfocusonthesegmentsthatinvolvesupportforchildrenandelderlyadults.Thesesegmentsincludechildcareworkers,teachers,nursing

assistants,homehealthaides,orderlies,andsoon.

SOLVINGTHE$290BILLIONCARECRISIS

In2030andbeyond,theUSisexpectedtolosearound

$290billioninGDPayearasaresultofthecarecrisis.Ourestimatecomprisestwoparts:First,itincludesthelost

wagesbecausesomanycarejobsareunfilled.Second,itincludestheeffectofreducedlaborforceparticipation

becauseofcareshortages—thatis,peoplelikeJoanneinouropeningexample,whocutbackonherpaidworkintheColoradooil-and-gasindustrytotakeonunpaid-carework.

Thisfigureisamid-caseestimatebasedonaveragesofthelasttenyears.InthreedifferentscenariosinExhibit2,weseearangeofGDP-lossoutcomesbasedontherelative

“attractiveness”ofcaresectorjobs.Ononeend,improvingthequality-of-carejobswouldfilterthroughthesystembyattractingandretainingmoreworkers,andthereforemakebettercareservicesavailabletoall.Ontheotherend,morepeopleleavingcarejobsandfeweroptionsforpeople

lookingtohirecareworkershasdireconsequences.

Themid-casescenario—the$290billionloss—restson

thefollowingassumptions:Carejobsfillattheaverageratesince2012,resultinginacare-workershortfallofabout

14%by2030.About20%ofworkerswhocan’tfindade-

quatecareleavetheworkforcetofillthecaregapathome.

Inamoreoptimisticscenario—withaprojectedlossofabout$190billionayearin2030andbeyond—carejobsfillatthehighestratetheyhaveinthelasttenyears,andthe

care-workershortfallisabout13%.Roughly10%ofemployedcaregiversleavetheworkforceiftheirpaidcarefallsthrough.

Ontheotherend—withaprojectedlossofabout$500

billionayear—wemodeledtherelativeattractivenessof

paid-carejobsatthelowestlevelseenoverthelastdecade.Inthiscase,a15%vacancyinpaidcareensues.And40%

ofemployedcaregiversleavetheworkforceiftheirpaidcarefallsthrough,eventhoseworriedaboutthelossoftheirownincome.

ThesescenariosareusefulforexaminingthemagnitudeoftheUScareprobleminthecomingdecade.Buteventheselargedollaramountsdon’ttellthewholestory.Societal

hardships—includingstressandstrainonthosejugglingdemandingjobsandmanagingbothchildcareandelder-care—arecommon.Nearly60%ofemployedcaregiversinoursurveysaidtheystrugglewiththeirmentalandphysi-calhealthandwithproductivityandburnout.

Exhibit2-EconomicLossesfromtheUSCareCrisis:ThreeProjectionsfor

2030andBeyond1

LowCase

Paid-carejobsmore

attractive,feweremployed

caregiversleavethe

workforce

$190B

$110B$80B

MidCase

Paid-carejobsless

attractive,someemployed

caregiversleavethe

workforce

$290B

$110B

$180B

HighCase

Paid-carejobsunattractive,

moreemployedcaregivers

leavetheworkforce

$500B

$120B

$380B

Lostwagesfromunfilledpaid-carejobsLaborforceparticipationGDPloss

Sources:USBureauofLaborStatistics;BCG/DynataCaregiverSurvey(N=3,673);BCGanalysis.

Notes:Economiclossconsideredintermsofreducedincomeorwagesrelativetoforecast.Figureshavebeenrounded.1MeasuredinGDP.

BOSTONCONSULTINGGROUP5

“Careworkersandcarejobsaretrulyessential.Theyenableouremployeestoproductivelyshowupatwork,knowingthattheir

children,parents,lovedonesarewelltakencareof.Withoutthem,wewilllosevaluable,trained,andpassionateworkersandwon’t

beabletofillandkeepfilledthejobsweneedtothrivebothasindividualcompaniesandasacountry.Fillingpaid-carejobs

isn’tjustanissueforgovernments,itneedstobetopofmindforCEOsandexecutivestoo—wecanhelpsolvethis.”

–RichLesser,GlobalChairandformerCEO,BostonConsultingGroup

InterlockingSolutions

Thecareeconomytranscendstraditionalbusinessbound-aries,andsmoothingthepathforworkers,companies,andtheeconomyoverallrequiresinterlockingprivate,public,

cultural,andindividualaction.OurstudyshowsthatasmallchangeintherelativeattractivenessofcarejobsmakesabigdifferenceintheeffectonlostGDP.So,

thoughtful,targetedchangesmayhaveanoutsizedeffectontheproblem.Thatis:thereishope.

Oursuggestedsolutionsstartby(1)addressingthesupplyofpaid-careworkersand(2)

helpingrelievethecareburdensthatpreventablepersonsfromfullyengaginginpaid

workor,inmanycases,forcesthemto

quittheirjobs.(SeeExhibit3.)

Exhibit3-FiveKeyLeversforAddressingtheEconomicBurdenofCareActivities

Interventions

Solutionarea

Improvepaid-caresupply

Reduceunpaid-careburdensonemployedcaregivers

Levers

WagesTrainingandrecruitment

UniversalchildcarePaid-careleave

Workplaceflexibility

Public

sectoractions

•Wagesubsidies

•Increased

reimbursementrates

•Improvedtrainingprograms

•Recruitmentcampaigns

•Caresubsidies

•Subsidized

universalchildcare

•National

paid-caregiverleavepolicies

Privatesectoractions:

corporations

•Advocacyformoreattractiveworkingconditions

•Advocacyfor

care-workerpipelinegeneration

•Caresubsidies

•Onsitechildcare

•Advocacyfor

universalchildcare

programs

•Paid-leave

provisionforchildandadultcare

•Advocacyfor

nationalpaidleave

•Flexibleworkprograms

Privatesector

•Technologyandtoolsthatincreaseefficiency

•Carecoordinationtoolsandtechnology

actions:

innovation

andreducedifficultyofpaid-carework

thatreduceunpaid-careburdens

Enablers

Individualculturechange

toshiftcaregivingbalancesathome,removing“traditional”expectationsofwomenandmothers

Corporateculturechange

tosupportcaregiversandensureworkandfamilylifecancoexist

Societalculturechange

toplacehighereconomicvalueoncaregiversandcarework

Source:BCGanalysis.

BOSTONCONSULTINGGROUP7

BoostCareSupply

Wehaveenoughworking-ageindividualsintheUSto

fillthe1.8million(andgrowing)vacanciesincarejobs.AccordingtotheUSBureauofLaborStatistics,about

9millionindividualscouldbeactivatedtofillroles,

includinghomehealthaides,nursingpractitioners,andpersonalcareworkers,whichareprojectedtobeamongthefastest-growingoccupationsofthenexttenyears.

(SeeExhibit4.)

Thesearepeoplecurrentlyonthesidelines,including

thosewhoreportthattheyaren’tworkingbecausethey

havefamilyresponsibilities,arediscouragedbytheirjob

prospects,orarerecentlyoutofajobandinthemarketforanewone.Ofcourse,carejobshavetobecomeattractiveenoughtoenticepeopletocomeintotheworkforce.And,inmanycases,thesepeoplealsoneedtofindthesupporttomeettheirowncareresponsibilities.

Wemustalsoadjustexpectationsofwhoparticipatesin

thisworkbydestigmatizingcarejobsas“women’swork.”About80%ofpaidcaregiverstodayarewomen,butmen

areequallycapableintheseroles.Additionally,somecom-munity-carejobs—suchasafterschoolprograms—may

suitretireeswhodon’twantfull-timepositions.Adjustingwhatweconsider“workingage”isworthwhile,especiallyasthepopulationagesandhealthyolderAmericansthrivewithsuchsocialengagement.

Cross-generationalcareforoneanother—teensinteractingwithseptuagenarians,forinstance—isavirtuouscircle.

It’shappeningelsewhere.IntheNetherlands,forexample,universitystudentscanlivefreeinnursinghomesin

exchangefor30hoursamonthofprovidingcompanytoelderlyresidentsorteachingskillssuchashowtouse

socialmedia.4

Exhibit4-ActivatingDifferentLaborPoolstoSolveUSPaid-CareShortages

M=Million

Availabletowork

0.8M

(marginallyattached)

butnotlookingdueto

illnessordisability

pool

Activation

0.5M

Availabletowork

(marginallyattached)

butnotlookingbecause

discouragedordueto

familyresponsibilities

Wantajob

nowbutdidnot

seekemploymentinlastmonth

Donotwantajobnow

94M

+

Didnotsearchinlastyear

DTiopuorayejbolorsers

familyresponsibilities

DidnJotbsleavrrshin

Discoternotsr

familyresponsibilities

Didtwseenrtsin

6M

3.6M

Notinlaborforce

99M

+

Currently

unavailable

towork

0.6M

1.4M

Permanentjoblosers

+

Laborforce

165M

1.4M

0.9M

Employed

159M

+

6M

1.8M

16+

Non-institutionalizedcivilianpopulation

264M

Unemployedand

seekingemploymentinlastmonth

+

0.4M

Individualsavailabletofillcurrentjobvacancies

~9M

Sources:USBureauofLaborStatistics,August2022;2020Census.

4.“SeniorCareAroundtheWorld:InnovationandBrightIdeasfromCountriesAcrosstheGlobe,”Arosa,

/senior-care-around-

the-world/

.

8SOLVINGTHE$290BILLIONCARECRISIS

SelectiveimmigrationprogramsforqualifiedhealthcareworkerscanalsobridgegapsinpaidcarebeyondthecurrentUSlaborsupply.Suchprogramsareunderwayinother

countriesbuthaven’tbeentriedintheUS.Forexample,

Canadalaunchedthefive-yearHomeChildCareProvider

PilotandtheHomeSupportWorkerPilotimmigration

programsin2019,lettingindividualsworkinginchildcareorhome-supportprofessionsapplyforpermanentresidence.5

Fillingallthosecarejobs,ofcourse,wouldalsoprovidethecompoundingadvantageofunlockingtalenttofillthe

laborshortageinothersectorsacrosstheeconomy.

IncreaseWages

Toboostsupply,carejobsneedtobemoreappealingandvalued,startingwithhigherwages.TheaveragehourlypayofaUScaregiverislessthan$14.Thatcompareswith$19anhour,onaverage,forentry-levelworkatAmazon.

Onebarriertoboostingcaregiverwagesiswhoisfooting

thebill.Inthemajorityofchildcarecases,familiespay

individualsorcenters,andtheafter-taxexpensecanbe

overwhelming.Parentsofinfantsandtoddlersspendabout10%oftheirincomeonchildcaretoday,despitetheUS

DepartmentofHealthandHumanServicesrecommendedspendingcapof7%.6Withoutfamilies’abilitytopaymore,privateorpublicsubsidiesareaprimarysolution.More

companiescouldincludechild-caresubsidiesinemploy-

mentpackages,althoughpublicdirect-wagesubsidieshaveamoreimmediateeffectonraisingpayforchildcarework-ers—aquickerboostintheappealofthesejobs.TheEarlyChildhoodEducatorPayEquityFund,forinstance,provides$7,000to$14,000peryearinpaymentstoqualifiedfull-

andpart-timeworkersinWashington,DC.7

Ineldercare,raisingpayisrelatedtoreimbursementrates

fromgovernmententities,especiallyMedicaid,theprimarysourceoffundsoflong-termservicesandsupportforolderadults.Thesereimbursementratesanchorthesalariesfor

home-careandnursing-homeworkers—lowreimbursementratesresultinlowwages.Somegovernmentshavealreadyconsideredthis.In2021,Oregonintroducedanenhanced

wageadd-onprogram,increasingMedicaidreimbursementratestohome-andcommunity-servicesprovidersandnurs-ingfacilitiesby10%and4%respectively.Withthisprogram,thestatewasabletomandateminimumwagesforhome-careandnursing-homeworkersbetween$15and$17perhour,withincreasesoverfollowingyears.

Theeconomicargumentforincreasingadult-carewagesisstrong.ACityUniversityofNewYorkstudyestimatesthatpayinghome-careworkersbetween$30,000and$40,000

annuallydependingonthecity(versusthecurrent$22,000median)couldgenerate$3.6billionineconomicsavings

acrossthestate.8Costswouldpayforthemselvesthroughpositiveeconomicspillover,taxrevenue,publicassistancesavings,andproductivitygains,thestudyfound.

ImproveTrainingandRecruitmentOfPaid-CareWorkers

Somestatesalreadyareshiftingthenarrativearound

caregivingcareers,brandingthembothessentialand

rewarding.They’verevampedtrainingprograms,employ-

mentportals,andrecruitingcampaigns.Arizona,forin-

stance,isofferingpersonalizedcareermapsandconnec-tionstotrainingandtestingcentersandissponsoring

sharedworkerstories.Mainebudgeted$20millionto

promotehealthcarejobsin2022,with$1.5milliondedi-

catedtorecruitingcampaigns.Generally,statesshouldopttobothactivelyrecruitcaregiverstotheirworkforceaswellasmaketrainingprogramsmoreeasilyaccessible.They

candosobyprovidingonlineoptionsinmultiplelanguag-esandofferingcareer-pathwaysitestohelpprospective

caregiversunderstandjobprogressionovertime.

“Inourresearch,afewsessionsonchild

developmentincreasedcaregivers’jobsatisfactionbecausetheytaughtthemhowtobetterdotheir

job;inparticular,howtohandledifficultsituationswithgroupsofchildren.”

–MyraStrober,ProfessorofEconomics,GraduateSchoolofBusiness,StanfordUniversity,onprofessionalizingcaremanagementroles

RelievingtheUnpaid-CareBurden

About43%ofemployedcaregivers,orabout40million

people,relyonpaid-caresupporttogotowork.Theseem-

ployedcaregiversspendanother20to40hoursaweekon

theircareresponsibilities,basedonoursurvey.Tackon

another30hoursonreportedchoresanderrands,and

caregivingismorethanasecondfull-timejob.(SeeExhibit5.)

Workershortagesandrisingcostsstrainthecaresystem,

forcingmanyfamiliestomaketradeoffsbetweenpaidworkandcaringforlovedones.Theyneedcost-andtime-savingsupport.

5.“HomeCareProviderPilots,”C,

/canada-immigration/pilot-programs/home-care-provider-pilots.

6.WorkingFamiliesAreSpendingBigMoneyonChildCare,CenterforAmericanProgress,June20,2019,

/article/

working-families-spending-big-money-child-care/

.

7.“Washington,D.C.,OffersFinancialRelieftoLocalChildCareWorkers,”The19th,September20,2022,

https://19/2022/09/child-care-

workers-washington-dc-payments/

.

8.IsaacJabola-Carolus,StephanieLuce,andRuthMilkman,TheCaseforPublicInvestmentinHigherPayforNewYorkStateHomeCareWorkers:

EstimatedCostsandSavings,CityUniversityofNewYork,March2021,

/wp-content/uploads/2021/03/The-Case-for-Public-

Investment-in-Higher-Pay-for-New-York-State-H.pdf.

BOSTONCONSULTINGGROUP