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This article describes the long‐term care system in the United States—what long‐term care is, who needs it, in what settings it is provided, and who pays for it. It shows that a substantial portion of those who need long‐term care rely on unpaid care from family and friends, mainly from women, and that almost half of those that need long‐term care receive it in institutional settings, despite a preference for home‐ and community‐based care. It then argues that, for a number of reasons, states and the federal government will have to respond to the preferences of consumers for home‐ and community‐based care. The problems of ensuring an adequate supply of caregivers, focusing particularly on home‐ and community‐based settings are discussed, and the article argues that problems of recruitment and retention will be solved only when wages and benefits meet workers minimal needs for income and health insurance security. The article concludes by suggesting a set of policies that could be implemented at the federa...

This study records the impact on workforce retention of the nearly doubling of wages for homecare workers in San Francisco County over a 52-month period. Using descriptive statistics and logistic regression analysis the author finds that the annual retention rate of new providers rose from 39 percent to 74 percent following significant wage and benefit increases and that a $1 increase in the wage rate from $8 an hour—the national average wage for homecare—would increase retention by 17 percentage points. The author also shows that adding health insurance increases the retention rate by 21 percentage points.

This paper considers the implications of long-term trends in the international economy for the relative employment and income of men and women in developed and developing countries. We find that, given a persistent gender division of labor, mass unemployment in the North is due to different forces operating on men and women. The rate of growth of men's jobs has fallen because of deindustrialization, but men have not withdrawn from the labor force at a comparable rate. Women have been entering the labor force in feminized jobs at a faster rate than they have been created. In the South, women have largely taken traditionally feminized jobs in the labor-intensive, export-oriented growing manufacturing sectors; in Latin America, entry has been largely in the service sector. Men have been losing jobs in agriculture and domestic manufacturing. The paper proposes that the optimal solution to the mass unemployment problem in the North, as well as in the South, and the apparent competition for jobs between the North and the South and between men and women lies in achieving a trend increase in the growth rate of OECD and world aggregate demand and output. But such a trend rise in the long-term rate of growth of demand would only be possible if there were new cooperative institutional arrangements within and between countries. In such arrangements women need to have an important, independent role.

Purpose: The purpose of this study was to investigate the impact of wages and benefits (relative to other jobs available to workers), controlling for personal characteristics, on the recruitment and retention of providers working in a consumer-directed home care program. Design and Methods: I used the results of focus groups to design a survey that was administered to 2,260 workers stratified by ethnicity and working in eight California counties that represented the range of wage and benefit packages available. I used logistic regression to measure the effect of wage and benefit levels, controlling for covariates, on home care workers’ stated reason for entering and remaining in the job. Results: Two thirds of respondents reported that commitment to their consumer was the most important reason why they took the job and flexibility was the second most important reason, regardless of wages and benefits and personal characteristics. However, in the county in which very part-time workers were eligible, health insurance was the most important reason for retention. Wage levels above $9 an hour mattered somewhat, especially where the increase was recent. Family providers responded to wage and benefit incentives similarly to non-family providers. Implications: To improve recruitment and retention of consumerdirected home care workers, jobs should be flexible and provide affordable health insurance for part-time workers. The effect of wages suggests that recruitment might be improved with higher wages, but only when they reach the $9 to $10 range (in 2004 dollars). Finally, policy must recognize that family caregivers have financial needs similar to non-family caregivers.

Author(s): Howes, Candace | Abstract: Candace Howes examines the recent history of one of California’s rapidly growing occupations: home care. As the author’s analysis demonstrates, home care has been extensively transformed in recent years through large-scale unionization and coalition-based political action, which have led to major improvements in wages and benefits. Apart from providing many home care workers with better pay, the upgrading of this occupation has also improved the quality of care that clients receive, since higher wages make for lower turnover. The improved working and living conditions that result benefit caregivers and those they serve alike. The author’s empirical analysis has obvious ramifications for low-wage employment generally, particularly in the burgeoning health care and personal services sector.

This book argues, against the current view, that competitiveness--that is, the competitiveness of the manufacturing sector--matters to the long-term health of the U.S. economy and particularly to its long-term capacity to raise the standard of living of its citizens. The book challenges the arguments popularized most recently by Paul Krugman thatcompetitiveness is a dangerous obsession that distracts us from the question most central to solving the problem of stagnant real income growth, namely, what causes productivity growth, especially in the service sector.The central argument is that, if the U.S. economy is to achieve full employment with rising real wages, it is necessary to enhance the competitiveness of its tradable goods sector. The book shows that current account deficits cannot be explained by macroeconomic mismanagement but are rather the consequence of an uncompetitive manufacturing sector. It finds that the long-term health of the manufacturing sector requires not only across-the-board policies to remedy problems of low or inefficient investment, but also sectoral policies to address problems that are strategic to resolving the balance of payments problems. Lessons are drawn from the experience of some European and Asian countries.This book will be of interest to economists, political scientists, and business researchers concerned with the place of the manufacturing sector in overall health of the U.S. economy, with issues of industrial policy and industrial restructuring, and with the conditions for rising standards of living.Candace Howes is Associate Professor, Barbara Hogate Ferrin Chair, Connecticut College. Ajit Singh is Professor of Economics, Queens College, Cambridge.