As America’s aging population rapidly increases, there remains a critical shortage of social workers and personal assistants for the elderly and disabled despite a surplus of unfilled jobs. Low pay, lack of basic benefits, and scarcity of growth opportunities have led to huge turnover in the service and long-term support (SSLT) industry. Massachusetts, for example, experienced a healthcare staffing crisis even before the pandemic, and a staff exodus continues in nursing staff. Earlier this year, at Brigham and Women’s and Massachusetts General hospitals, 20 to 30 percent of beds were occupied by patients who needed to be discharged but were hard to find a frame receive long-term care and recover from their injuries or illnesses; at Tufts Medical Center, it was typical to have 20-30 patients per day who would have been released if a nursing home or home care services had been available.
Historically, women of color, who make up the majority of workers in the care industry, do not receive pay, benefits or respect that adequately reflect the essential and valuable nature of the work they provide. Despite stepping up as frontline workers during the pandemic, the national median wage for certified practical nurses in 2021 was $14.56 an hour, according to the according to the Bureau of Labor Statistics. Earlier this summer, a new contract created a pathway for 58,000 personal care attendants in Massachusetts to receive $18 per hour starting in April 2023. These personal care assistants provide services to more than one million seniors and approximately 500 000 adults living with disabilities in Massachusetts.
While states like Massachusetts have made progress in mitigating the crisis by raising wages, the pandemic has shown that the LTSS system in the United States is broken and in need of systematic change. Currently, it does not sufficiently value workers, family caregivers or people receiving services and support. This, in turn, perpetuates and expands existing inequalities of race, gender and disability in our society. “The institution of city planning has helped create the racial disparities that plague us all everywhere, including in the long-term care sector. So, we’re using the nation’s leading planning program, DUSP at MIT, to address this,” said Holly Harriel, associate professor of planning practice in MIT’s Department of Urban Studies and Planning (DUSP).
In an effort to address these concerns, the Mel King Community Fellows of the MIT Community Innovators Lab (CoLab) within DUSP worked to alleviate the national long-term care crisis by considering new funding models. Among their activities to support this mission are further research into the LTSS industry and most recently a trip to Germany to study the German LTSS system.
The Mel King Fellowship brings community leaders, faculty, and DUSP students together to think and act collectively to solve major national problems. Over the past decades, Fellows have come from a variety of sectors and fields and have been selected for their visionary leadership and ability to transform cities and industries by empowering communities. The 2022-23 Mel King Fellowship Cohort is made up of financial leaders as well as labor leaders and community advocates representing hundreds of thousands of workers and millions of consumers in the care industry respectively. The Fellowship provides research capacity, facilitation, and learning exchange opportunities to help care sector leaders develop and implement new financing models for long-term care.
Current Mel King Scholars focus on a broad and deep new vision for LTSS funding. Fellows considered what is possible on many levels focusing on how to build worker-owned cooperatives that support quality care and quality jobs and explore how to create new LTSS funding programs that create a more fair that supports community-building wealth and responds to the care crisis in the sector.
The scholarship produced three papers and hosted three LTSS-focused virtual events nationally and internationally. The Fellowship’s first in-person meeting was held in June in Berlin, Germany, and brought together Fellows from the community, MIT DUSP faculty and staff, and Master of Urban Planning students. At the meeting, fellows, faculty and students looked at Germany’s LTSS funding system – paid through a social insurance model – and explored how this system better meets the needs of workers, consumers and family caregivers. They also explored how certain aspects of the German model could be implemented in the United States or adapted to fit its unique circumstances. During the process, participants explored what coalitions would be needed to build a new sustainable system in diverse states to meet complex state needs.
Simultaneously, fellows explored what would be possible by using cooperatives to transform the way care is delivered in the United States. Seeing German examples of cooperatives and speaking with trade union counterparts in the country, participants explained how cooperatives can be used in different LTSS sectors (homecare, consumer-oriented care and retirement homes) to better value workers and supporting the elderly. adults and people with disabilities. As a result of this trip, fellows develop cooperatives in the LTSS and secure funding for alternative cooperative models in the LTSS sector.
Deeply committed to creating a more equitable LTSS system, fellows are currently developing prototypes that will offer solutions in various states and deliver their plans for change at the next meeting, which will be held at MIT. Scholars share a long-term vision for a system that compensates workers fairly, does not rely heavily on unpaid family caregivers, and enables older people and people with disabilities to live in dignity and build wealth that grows. accumulates over generations. By creating a more equitable LTSS system, DUSP Mel King Scholars work for a more equitable society that values and honors older people, people with disabilities, and the essential work of their caregivers.