ABSTRACT
During and beyond the COVID-19 pandemic, direct care workers have served as the paid frontline of support for millions of older adults and people with disabilities. Yet poor-quality jobs continue to threaten their livelihood and this job sector. This article describes the roles, responsibilities, and key characteristics of the direct care workforce, examines COVID-19's impact on these workers, and discusses how government leaders, employers, and others have responded. It concludes with critical themes from this crisis, and policy and practice recommendations to improve these jobs, navigate this crisis, and strengthen this job sector in the long term.
ABSTRACT
Long-term services and supports for older persons in the United States are provided in a complex, racially segregated system, with striking racial disparities in access, process, and outcomes of care for residents, which have been magnified during the Coronavirus Disease 2019 pandemic. These disparities are in large measure the result of longstanding patterns of structural, interpersonal, and cultural racism in US society, which in aggregate represent an underpinning of systemic racism that permeates the long-term care system's organization, administration, regulations, and human services. Mechanisms underlying the role of systemic racism in producing the observed disparities are numerous. Long-term care is fundamentally tied to geography, thereby reflecting disparities associated with residential segregation. Additional foundational drivers include a fragmented payment system that advantages persons with financial resources, and reimbursement policies that systematically undervalue long-term care workers. Eliminating disparities in health outcomes in these settings will therefore require a comprehensive approach to eliminating the role of systemic racism in promoting racial disparities.