Home health aide holding the hand of an elderly patient in a sunlit living room
Home health aides earn a median of $17.36 per hour for some of the most demanding work in healthcare.

The people who keep your parents safe, your children nurtured, and your sick relatives alive earn less per hour than the teenager stocking shelves at your local big-box store. That's not an exaggeration. It's the economic reality facing 5.4 million direct care workers in the United States alone, and it raises a question that should make every policymaker uncomfortable: why does the work we literally cannot live without consistently rank among the lowest-paid labor in the developed world?

The Hidden Engine of Every Economy

The care economy is enormous and growing fast. Globally, informal care represented by nearly 2 billion people accounts for 9% of global GDP, equivalent to roughly $11 trillion. Women perform 16 billion hours of unpaid care work every single day, and if valued at even minimum wage, that labor would be worth at least $10.8 trillion annually, more than three times the size of the global tech industry.

In the United States, the Bureau of Labor Statistics projects 21% growth for home health and personal care aides between 2022 and 2032, far exceeding the national average of 3%. An additional 740,000 home health aide jobs are expected between 2025 and 2034. The health care industry overall will need approximately 1.9 million new workers each year through 2034.

Yet the median wage for direct care workers was just $17.36 per hour in 2024, with median annual earnings under $26,000. Child care workers fare even worse at $14.60 per hour, compared to $23.11 for all U.S. workers. Meanwhile, the median annual salary for all health care professionals sits at $83,090, and physicians earn upward of $239,200. The people who do the most intimate, physically demanding, emotionally exhausting work in health care earn the least.

Direct care workers earn $17.36 per hour while physicians earn over $239,200 per year. The workers closest to patients are the furthest from a living wage.

How We Got Here: A History Written in Unpaid Hours

The roots of care work devaluation run deep, and understanding them matters because they explain why simply raising wages won't fix everything without addressing the underlying cultural machinery.

The story starts with the industrial revolution, when production moved out of households and into factories. Work done for wages in public spaces gained economic legitimacy. Work done in the home, overwhelmingly by women, became invisible. The Victorian "angel in the house" ideal cemented the notion that caregiving was a natural feminine duty rather than skilled labor. As Friedrich Engels argued, women's subjugation was tied to the rise of private property and patriarchal household structures that made domestic labor an unpaid subsidy to the formal economy.

Woman preparing food in a kitchen looking fatigued from household care responsibilities
Women perform an average of 4.1 hours of unpaid care work daily, compared to 1.7 hours for men.

This framing persisted. When women entered the paid workforce in large numbers during the 20th century, they were concentrated in lower-wage sectors like care work, retail, and hospitality. The economist Gary Becker's influential "comparative advantage" model reinforced this pattern, suggesting that households rationally allocated labor based on who had invested more in market-relevant skills. The model assumed, rather than questioned, the existing gendered division.

Sociologist Arlie Hochschild identified another critical blind spot. Her concept of "emotion work" described the invisible emotional management that caregivers perform, work that was gendered as feminine and therefore treated as a natural trait rather than a compensable skill. Research has since confirmed that occupations with low cognitive demands but high emotional labor demands face a wage penalty, the exact profile of most care jobs.

The result is an accounting anomaly that persists today. GDP systematically excludes unpaid housework, creating a hidden subsidy to the formal economy. Hire a housekeeper, and her labor counts. Do the same work yourself, and it vanishes from national accounts. Globally, women perform an average of 4.1 hours of unpaid care work daily, compared to 1.7 hours for men. In developing economies, women handle 80% of unpaid domestic care. Even in developed countries, they shoulder 65%.

"Care work has been accorded relatively low political priority because of the prevailing belief that caregiving is primarily the responsibility of the family and has little impact on economic development and growth."

- King et al. (2023), cited in Frontiers in Public Health

The Numbers Tell the Story: Who Does This Work?

The demographics of care work make the undervaluation impossible to separate from questions of race and gender. Eighty-seven percent of direct care workers are women, and 65% are classified as low-wage. Twenty-eight percent are Black, according to KFF data, significantly higher than the Black share of the overall workforce. Among the 2.2 million domestic care workers tracked by Brookings, 90.2% are women, 28.6% Hispanic, and 21.6% Black. Immigrants make up 42% of home health aides and 27% of personal care aides.

Diverse group of female care workers in scrubs standing outside a nursing facility
Eighty-seven percent of direct care workers are women, and 28% are Black.

The consequences of this demographic concentration are severe. 36% of the direct care workforce lives in or near poverty, and 49% rely on public assistance programs. In Ohio, where 92% of the child care workforce is women and 18.8% is Black, the median hourly wage for childcare workers is just $13.15. In 2024, women working full-time earned about 81 cents for every dollar earned by men, the widest gap since 2016.

As KFF senior policy manager Priya Chidambaram put it bluntly: "For how much you're getting paid, $16, $17 an hour, it's often easier to go to a local retail store and get paid that much for work that is a little bit less emotionally and physically demanding."

The Shortage Crisis Nobody Can Ignore

Low pay creates a predictable cycle. Workers leave, facilities can't hire replacements, quality declines, and remaining workers burn out faster. Median annual turnover for nursing assistants in nursing homes was nearly 100% in 2017-2018. Home care turnover reached 75% in 2024. MIT Professor Paul Osterman estimates a national shortage of 151,000 direct care workers by 2030 and 355,000 by 2040.

The pandemic accelerated every negative trend. The U.S. childcare sector lost approximately 10% of its workforce during COVID-19, and recovery has been painfully slow. Ohio saw its childcare workforce drop 35.89% between 2017 and 2022, with nearly 5,000 workers disappearing in a single year. Healthcare turnover now averages 19.5% annually, with nursing positions hitting 27.1%. Each nurse departure costs facilities an estimated $82,000.

Empty reception desk at a daycare center suggesting staffing shortages
The U.S. childcare sector lost 10% of its workforce during the pandemic.

Temporary pandemic funding briefly lifted wages, but as those funds phased out, wage growth stalled and even reversed. Inflation-adjusted median hourly wages for home care workers actually dropped from $15.22 in 2021 to $14.50 in 2022, proving that one-time injections cannot substitute for structural reform.

Nursing home turnover hit nearly 100%. The childcare sector lost 10% of its workforce during the pandemic. Each nurse who leaves costs $82,000 to replace. The math on underpaying care workers doesn't add up.

What Other Countries Get Right

The contrast with Scandinavian nations is stark and instructive. Denmark and Sweden spend 3-4% of GDP on early childhood education and care. The United States spends roughly 0.5%. That eight-fold spending gap translates directly into better outcomes for workers and families alike.

The Nordic model works through several reinforcing mechanisms. Public sector employment constitutes roughly 30% of the workforce in areas like healthcare and education. Union density ranges from 50.4% in Norway to 90.7% in Iceland, compared to roughly 11% in the United States. Sweden has no statutory minimum wage because unions negotiate wages sector by sector, ensuring even care workers receive living wages. Swedish employers pay 31.42% of total remuneration in social security contributions, covering health insurance, pensions, parental benefits, and workplace injury insurance.

The International Labour Organization has recognized these dynamics. The ILO projects that investing in care could create up to 299 million jobs by 2035 and generate a global GDP return of $3.76 for every dollar invested. Their macro-simulation studies across 82 countries show that every dollar invested in care infrastructure generates $2 to $3 in overall economic activity, surpassing traditional construction multipliers.

"Higher wages attract more care workers to fill the high demand, and thousands of other jobs are created throughout the state because people can pursue the jobs they want when they feel secure with their childcare situations."

- Aly Richards, CEO of Let's Grow Kids

The Policy Toolkit: What Actually Works

Several evidence-based interventions are showing results. Unionized care workers earn an estimated 10-20% more than their non-union counterparts. In nursing specifically, private unions generate a 20% wage advantage, and unionized nurses report lower turnover and are 53.9% more likely to have employer-provided pensions. Research suggests that moving to sectoral bargaining could raise collective bargaining coverage from 11% to 29% of the workforce.

State-level innovations offer additional models. Kentucky expanded its PFCC to cover staff families with matching employer contributions. Maine introduced an 80% wage stipend for care workers. New Mexico created an early childhood trust fund. The Domestic Worker Bill of Rights, adopted in several states, provides basic protections including minimum wage, overtime pay, rest breaks, and safe working conditions for workers who have historically been excluded from labor law.

Bright modern Scandinavian-style public childcare facility with educational materials
Nordic countries invest 3-4% of GDP in early childhood care, versus 0.5% in the U.S.

At the federal level, the Biden administration proposed $400 billion to build care infrastructure, explicitly framing care as infrastructure alongside transportation and broadband. The ILO's 2024-2030 Plan of Action is developing new global statistical standards to better measure care work's economic contribution, while the 2025 revision of the System of National Accounts encourages nations to develop extended accounts that capture the value of unpaid care.

The Investment We Can't Afford Not to Make

The paradox at the heart of the care economy is this: we collectively agree this work is essential, and we collectively refuse to pay for it. That refusal has a cost, and it's one we're already paying in workforce shortages that leave aging parents without adequate help, in childcare deserts that affect 39% of Ohioans, in the 36% of caregivers who report high emotional stress and the 18% who report financial strain.

The evidence from other countries and from economic modeling is unambiguous. Treating care as infrastructure, investing in it seriously, empowering workers through collective bargaining, and reforming economic measures to make care work visible in national accounts all produce returns that dwarf the initial investment. For $3.76 back on every dollar, it's hard to imagine a better deal.

The question was never whether we can afford to value care work properly. The question is how much longer we can afford not to.

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