Should everyone be guaranteed a basic annual income? The idea is gaining traction among those who fear robots and software will soon displace millions of workers.
But in a recent New York Times review of two new books touting the concept, former Labor Secretary Robert Reich worries less about a future without jobs than the growth of low-wage “human-touch jobs” that are resistant to automation and artificial intelligence. “Even today, with technology having already displaced many workers, there's no jobs crisis,” he writes. “We have a good jobs crisis.”
Many of those low-paid “human touch” jobs are in healthcare, where home health aides and hospital support staff are among the fastest-growing occupations in America. Unfortunately, the wages in these occupations are not only scandalously low, they are falling.
In 2009, home health aides averaged $10.83 an hour in jobs that are often part-time and without benefits. In 2017, those jobs averaged $12.23 an hour, a decline in real purchasing power of nearly 5%. Registered nurses, licensed practical nurses and case managers in the home care, hospice and nursing home industries have also seen their inflation-adjusted wages fall over the past decade.
The average hourly wage of all the 4.1 million support staff in the industry (not just health aides but housekeeping, laundry and food service, which make up more than a third of all jobs in the sector) was just $15.05 in 2017, according to Bureau of Labor Statistics data. In inflation-adjusted dollars, that's essentially no different than what they earned a decade ago.
There are at least two harmful consequences from having one-third of the healthcare workforce living in or near poverty. The first is that it engenders hidden costs.
Employers spend more on healthcare for their low-wage workers. They, like many patients living in poverty, are more likely to experience housing, food and financial insecurity, and thus suffer from chronic conditions such as obesity-related diabetes and behavioral health problems.
Rapid turnover in support jobs, another consequence of low wages, triggers higher spending on hiring and training. That in turn reduces overall productivity and diminishes the quality of the essential services they provide.
The second drawback takes the form of a lost opportunity for hospital systems and home health agencies. Forward-thinking healthcare leaders recognize their “high-touch” frontline workers are well-positioned to improve the lives and healthcare outcomes of their patient-customers.
Aides who go into patients' homes have the capacity to not only help with personal care, but to provide help with medication adherence. They can also help organize the social services needed to keep clients out of the hospital.
Workers who are better-trained and better-paid are also more likely to be engaged in their work. They will be more willing to become active participants in team-based care, which is a key element of ongoing efforts to lower overall costs.
What's stopping providers from upgrading those jobs? Industry officials I've spoken with say raising wages and benefits for a third of the workforce is difficult when revenue is stagnant and margins are declining.
But that hasn't stopped health systems from paying hefty salary increases to more highly educated employees. The same BLS data cited earlier show salaries for medical and health service managers, whose ranks swelled by 43% to nearly 350,000 in the past decade, grew by 31% in inflation-adjusted dollars. By comparison, anesthesiologists now earn 18% more than 2007; family practitioners 16%; and occupational therapists 9%.
Growing pay inequality, where those with higher education and advanced training reap all the income gains from economic growth, is a huge problem in healthcare, just as it is in the rest of society. It's going to take a conscious commitment by healthcare's top leaders, sustained over many years, to turn the industry's critical support jobs into good jobs.