Caregiving on and off the clock

Equity issues faced by care workers with dependents
Published: 04.13.2020 Updated: 12.20.2022

Care work is essential to meet the basic needs and wellbeing of any society. However, the U.S. faces a burgeoning care crisis. In the coming years, aging Baby Boomers will require an unprecedented amount of paid elder care services. Meanwhile, the current unmet paid child care needs remain high.Parker, K., & Patton, E. (2013). The sandwich generation: Rising financial burdens for middle-aged Americans. Retrieved from website:;Hartmann, H., Hayes, J., Huber, R., Rolfes-Haase, K., & Suh, J. (2018). The shifting supply and demand of care work: The growing role of people of color and immigrants. Retrieved from website:  On the supply side, our research shows that gender and racial/ethnic inequities are built into the looming care crisis: 9 in 10 low-wage care workers are women and almost half are racial/ethnic minority groups.

While there is clearly a high demand for care workers, little research examines how paid care workers afford and manage their own caregiving needs. Given that paid care workers with children and elderly dependents care around the clock—at work and at home—it is important to understand if they have enough of their own care supports to meet these needs. These questions are especially pressing during the current public health crisis, as care workers are called upon to care for the most vulnerable members of society and the importance of care work is more visible than ever. Paid care workers’ ability to care for their own families even while they continue to care for ours is critical to our ability to weather the COVID-19 storm and be ready to care for our aging population.

In this analysis, our sample of care workers includes a range of well-paid to poorly paid jobs including physicians, physical therapists, Certified Nursing Assistants and personal and home care aides.We define our care worker sample with Howes, Leana and Smith’s (2012) definition, using a combination of industry and occupation codes within the Current Population Survey. Howes, C., Leana, C., & Smith, K. (2012). Paid care work. In N. Folbre (Ed.), For love and money. New York, NY: Russell Sage Foundation. We consider care needs for children under 13 (e.g., child care centers, family child care), adult parents (e.g., at home, in a day program) or both, by race/ethnicity and work and family composition:

  1. Child care only: children under age 13 living in the household
  2. Elder care only: parents age 65 and above living in the household, who are not working and are not providing unpaid family care for another person within the household
  3. Both child and elder care: referred to as sandwich generation care.

Nearly all paid care workers with care needs have children to care for, and 6% need to provide care for elderly parents

Below, we see the potential caregiving needs of care workers with dependents by work and family composition and race/ethnicity. Overall, care workers are more likely to need child care than elder or sandwich generation care. However, single-earner and low-wage single-earner care workers have the highest elder and sandwich generation care needs and therefore experience a unique host of occupational and personal caregiving barriers and burdens. Single-earner care workers are defined as care workers who do not have a spouse or partner in the household, or they have a spouse or partner in the household who does not work and is not providing unpaid care to another person in the household.

 When considered by race/ethnicity, overall, we see that caregiving needs are more similar than different across racial/ethnic groups. However, Asian care workers consistently have the highest need for both elder and sandwich generation care (12%), followed by other/multiracial and black care workers (both 11%). In comparison, only 6% of white care workers have an elder or sandwich generation care need. White care workers are the racial/ethnic group most likely to only have a need for child care.

Compared to the full workforce, low-wage care workers would have to spend 7 to 33 percentage points more of their family income to purchase care

According to the federal government, child care costs should not exceed 7% of a worker’s household income.U.S. Department of Health and Human Services. (2016). 2016 CCDF final rule. Retrieved from website:  But across the board, nearly all care workers would have to spend far more than this proportion to purchase full-time care for dependents in their household.

The graph below shows the median percent of family income a care worker would have to spend in order to purchase private pay full-time full-year care per dependent in their household. Purchasing family child care (which, on average, costs less than center care) would require 9% of a care worker’s family income, whereas adult day care (which, on average, costs less than home care) would require 23% of a care worker’s family income.

Caring for elderly parents at home is prohibitively expensive for all care workers. The median cost to purchase full-time home health elder care ranges from 40% to all of a care worker’s family income. Groups with high elder or sandwich generation care needs (Asian, single-earner and low-wage single-earner care workers) are therefore in an untenable situation where they have to weigh their economic security against their need for quality care for their elderly dependents.

American Indian/Alaska Native care workers have the highest ratio of both child and elder care costs to family income compared to other racial/ethnic groups. Hispanic and black care workers closely follow with child care cost ratios ranging from 11-13% of family income and elder care cost ratios ranging from 27-79% of family income. Among the work and family composition groups we examined, low-wage single-earner care workers have the highest child care costs ratios.

Only 20% of low-wage care workers are eligible for FMLA, and only 8% are both eligible for and could potentially afford to take FMLA

In order to manage caregiving needs, many workers rely on the Family and Medical Leave Act (FMLA). The FMLA allows eligible workers to take unpaid, job-protected leave to address one’s own or an immediate family member’s serious health condition. The FMLA permits three different ways of taking unpaid leave: continuous, reduced schedule or intermittent. Workers may take intermittent or reduced schedule leave to receive or provide care when they or their family members are ill or managing chronic conditions.FMLA leave differs from sick leave in several ways; most notably, sick leave is used for acute short-term illness or injury typically ranging from 1-3 days in length per year, whereas FMLA is used for medium-term chronic health condition management of up to 12 weeks in length per year. For instance, a care worker could take unpaid FMLA to accompany their family member to a planned medical treatment for a serious illness or medical visits to address chronic conditions.

Care workers may rely on taking unpaid FMLA leave to manage the ongoing serious health conditions of their dependents, rather than bearing the prohibitive cost of hiring a paid care worker. However, just over half of all care workers are eligible for FMLA, and only 20% of low-wage care workers are eligible for FMLA. Since the FMLA is an unpaid program, the share of these workers who can both take and afford unpaid FMLA leave is even lower. We define FMLA affordability as having family income above 200% of the federal poverty level after taking unpaid leave. Of all care workers, 43% are both eligible for and can afford FMLA leave, whereas the same is true for only 8% of low-wage care workers. (Read more about equity issues in the FMLA overall and about the costs of taking unpaid leave.)

Supporting the workers who care for us all

Paid care workers are essential to the wellbeing and productivity of the U.S. economy. However, virtually none of these essential workers can afford to care for their own families, and many are not eligible for the FMLA to manage these care needs. If these trends continue, paid care workers will find it increasingly difficult to meet their own paid and unpaid caring duties. As the Baby Boomers age and current unmet child care needs remain high, it is of paramount importance to retain these workers.

Given that the majority of care workers are women and racial/ethnic minority groups are overrepresented in low-wage care work, equitable policy solutions must be developed to address these shortfalls. In recent years, there have been several approaches to improving job quality for care workers. Some examples include employer-level policies, such as career ladders, and federally-funded Health Profession Opportunity Grants, which provide education and training to low-income individuals to enter occupations in the health care field. Another way to improve the job quality of all workers is through state-level programs such as paid family and medical leave, which have wider eligibility criteria than the FMLA and offer targeted wage replacement rates, so workers of all income levels can afford to take time off to address their own or a loved one’s health condition. It’s time to expand these interventions and develop new policies and strategies to ensure that care workers can care for their own families while they care ours.

Learn more about child and elder care
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Rebecca Huber
Research Associate
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Pamela Joshi
Policy Research Director
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Dolores Acevedo-Garcia
Director, Professor of Human Development and Social Policy