New report underscores need to improve wages and conditions for child care, home care, long-term care workers

September 1, 2022

Boston – Massachusetts faces a looming crisis in its “care economy” if it fails to address the wage, benefits and safety needs of child care, home care and long-term care workers. That’s the central theme of a new report from Boston Indicators, the research center at the Boston Foundation, entitled Care Work in Massachusetts: A Call for Racial and Economic Justice for a Neglected Sector. The report explores the demographics and working conditions of the state’s care workers, finding a stark contrast between the current status of the sector and the growing need for care workers.

“None of the issues cited in this report – the poor job quality, low wages, and high rates of illness and injury – will come as a surprise to anyone who has looked at the child care, home care and long-term care sectors,” said Lee Pelton, President and CEO of the Boston Foundation. “But the magnitude of these equity gaps at a time when we know there is a critical need for care workers can and must be a wake-up call for us to address these longstanding structural and systemic failures.”

Download the report


The new report highlights a particular need for home care and long-term care workers, with the number of jobs in some occupations expected to grow by 20% between 2018-2028 as the population of Massachusetts ages. Despite this high demand, wages for care workers have lagged well behind the median hourly wage in the state. Recent increases in wage rate – and a hike in the state’s minimum wage – have helped, but today care work jobs continue to pay just above half of the state’s median wage, with pay rates that lag well behind other occupations that require a similar level of education and training.

The report also notes that historical and current factors play into this wage gap. Historically, care work has relied on a predominantly female workforce, including a large percentage of women of color, and has been systematically excluded from protections and other labor reforms. Those demographic trends remain today, as women comprise 85 percent of the Massachusetts home care and long-term care workforce and 92 percent of childcare workers. Black and Latino workers make up more than half of the state’s home care and long-term care workforce, and more than a third of home health care workers and nearly half of long-term care workers are foreign-born.

Wages are not the only gap. Report authors note that care workers are less likely to have retirement benefits or employer-provided health insurance than in other occupations, despite the high level of social, emotional and physical strain associated with care work. One example: In 2019, nursing assistants had among the highest overall incidence rate of nonfatal injury and illness requiring time away from work (283.5 per 10,000 full-time workers), above even heavy and tractor-trailer truck drivers and freight, stock and material movers. The strain of care work is reflected in its annual turnover rates – measured at over 30 percent in child care and as high as 128 percent in one study of nursing home workers.

Addressing these issues to meet the state's future needs will require several policy changes to improve job quality for care workers. The report recommends a series of changes that could directly or indirectly improve the lives of care workers. They range from continuing efforts to raise the state minimum wage, to the development of a licensing process for home care agencies, to policies that would strengthen career ladders, expand the Earned Income Tax Credit to those who care for relatives and others without pay, to expanded protection for care workers to organize and exercise their collective power.

“If we paid jobs according to their value to society, child care workers, home care workers and long-term care workers would be at the top of the scale,” noted Andre Green, Director of SkillWorks, which co-sponsored the report. “But too often, we determine our pay scales not by what the job is, but rather by who does it. COVID underscored the essential nature of care work – the question now is whether we are willing to acknowledge and value that essential nature with higher pay and better working conditions.”

The release of this report will be followed by a virtual forum hosted by Boston Indicators, the Boston Foundation and SkillWorks on Wednesday, September 7 at 10 a.m. Speakers and panelists will include Sarah Jane Glynn, Senior Advisor at the Women’s Bureau of the US Department of Labor, Josephine Kalipeni, the Executive Director of Family Values at Work, and Monica Zeno-Martin, Executive Director of Parenting Journey. A full agenda and registration information are available at