Third of three articles. Read the first article, on paid family leave, here, and the second, on state child support, here.
When you hear the word “caregiver,” what image comes to mind?
Most likely it is a woman in her 40s — someone tucking her children in with a phone call to her aging mother before bed. And in fact, this isn’t inaccurate. But did you know that of the 40 million family caregivers in America, nearly half of them are men?
According to Jean Accius of AARP, these once invisible men are starting to “come out” publicly. Dr. Accius has written: “They are husbands taking care of their spouses or partners, sons taking care of Mom or Dad, friends taking care of neighbors. These men are breaking stereotypes and upending misconceptions. They are joining, either by choice or necessity, the army of family caregivers providing care across this country.”
One such man, Louis Colbert, is a social worker who has been working in the field of aging for 40 years. He runs a monthly group for caregivers at his large African-American church in Philadelphia. And yet, it took about a year and a half of providing care for his own mother until he realized he was actually a “caregiver.”
“Once men self-identify as caregivers, it’s easier for them to get the recognition they need and to make sure they’re taking care of themselves, too,” Mr. Colbert said. “I say to my men: ‘Are you getting enough rest? Are you exercising? Are you taking your medication?’”
Burnout is a danger. So is feeling underprepared for the role. So many of the services we used to go to a doctor’s office or hospital for, such as wound care, are now done in the home by untrained family caregivers. As documented in a groundbreaking report first published in 2012 and updated this year, 72 percent of male family caregivers who performed complex medical tasks indicated that no one had prepared them to do so.
In response to these shifts, AARP and others proposed legislation: the CARE (Caregiver Advise, Record and Enable) Act, now passed in 41 states and the District of Columbia, calls for hospitals to provide adequate training in medical tasks to family caregivers before patients are discharged. AARP also offers online a series of instructional videos to help family caregivers learn common care skills.
But still, the strain can be too much for many family caregivers, so they often reach out for paid help. According to PHI, a national research and advocacy organization that promotes quality care for older adults and people with disabilities, the home care work force has already doubled in size over the past 10 years, and the demand is only going to grow. By 2050, the number of people 65 and older will nearly double. PHI predicts that there will be 1,382,200 jobs created in this industry between 2016 and 2026, a 31 percent increase. But there just aren’t enough workers to meet the need.
Making the profession more attractive to men is one way to fill the gap. “We have to challenge the false gender stereotyping that this is something only women can do,” said Robert Espinoza, the vice president of policy at PHI. “It hurts women because their work is not sufficiently valued, but it hurts men, too, because they’re missing out on what can be a really rewarding job experience.”
Historically, the field has been made up mostly of women, particularly women of color. Today, men make up just 14 percent of the direct care work force. But the number of male home care workers is rising — tripling to 182,000 in 2015 from 60,000 in 2005. Home care work is where the biggest unmet demand is expected.
So how are more men recruited into a field historically dominated by women?
Bottom line: If you want to recruit anyone into this field, men included, you have to raise wages. The median hourly wage for home care workers in the United States is a little more than $10. The median annual income for home care workers, most of whom work part-time or only during part of the year, is $13,800. (A majority of those surveyed said they would like full-time work.)
Retention is a huge challenge. “There are no reliable statistics on turnover in this sector, but our estimate is that it’s somewhere around 60 to 80 percent,” Mr. Espinoza said. “That’s devastating for the workers and the families that benefit from their care.”
While wages remain low, strives have been made in job protections. The Fair Labor Standards Act, originally passed in 1938, exempted home care workers from overtime protections, claiming they were mere “companions.” But in 2010, a coalition of organizations finally got the law amended to cover home care workers.
“This work force sits at the intersection of two cultural problems,” Mr. Espinoza said, “the devaluing of working-class women and the devaluing of older people and people with disabilities. That confluence of sexism, racism, ageism and ableism means the sector gets ignored.”
Studies show that when women enter fields in greater numbers, pay declines. Could the reverse also be true? Could more men in direct care work help boost wages for everyone? Paula England, a sociologist and professor at New York University, thinks it’s possible. “It’s a logical extension,” she said. “If the reason pay goes down when women go in is that employers somehow devalue it, you would think that would operate in the reverse. As men go in, we would see that work as substantial and more important. But we don’t really have examples of that.”
The quality of care jobs will have to rise to attract more workers, and the pathways to get hired have to be redesigned. An interesting example is to be found in Albany, Minn., at Mother of Mercy Senior Living. Facing both the general shortage and the particular challenges posed in rural communities with dwindling populations (Albany has fewer than 3,000 people), Mother of Mercy’s leaders struggled to recruit workers for years.
Then, with the help of a marketing group called DAYTA Marketing, they modernized their approach — producing videos and recruiting on social media for the first time. They also took a hard look at their website and redesigned their application, which was almost 50 pages long when used on a cellphone.
“The tables have turned in employment,” Luke Riordan, founder and executive head of DAYTA Marketing, said. “You have to make it easy to apply and respond within an hour of that application.”
Between 2016 and 2017, the number of new applicants seeking work at Mercy increased by 33 percent, the number of hires increased by 46 percent, and the number of vacant positions decreased by 45 percent. The annual employee retention rate has risen to about 75 percent, with turnover at less than 12 percent in 2017 and 2018.
Mr. Riordan urges employers to make sure that male care workers are featured on their websites and in any promotional materials. As Marian Wright Edelman, the children’s rights advocate, said, “You can’t be what you can’t see.”
Mr. Colbert has noticed that in his own community, formerly incarcerated men are starting to go into direct care work more frequently. “They come out and they take care of a grandmother or grandfather who needs help, and then they end up realizing that they can use those skills to be a contributing member of their families,” he said.
In the absence of a formal program, according to Mr. Colbert, a local home health care agency has become known for being open to hiring formerly incarcerated men. “Word of mouth,” he said, “has led many to show up on the director’s doorstep straight from prison.”
There is reason to be optimistic about how attitudes about care work are changing among young people. Nihal Satyadev, a co-founder of the Youth Movement Against Alzheimer’s, a national organization, has reported that nearly half of its chapter leaders and 40 percent of its respite volunteers are men. “Over the course of the four years I’ve been doing this work, I’ve seen more and more millennial and Gen Z men trying to share the realities of their care experience.”
There are now podcasts on caregiving aimed at men, like “Healing Ties” by Chris MacLellan, an advocate from Florida who became outspoken after his own experience of taking care of his partner. Jack’s Caregiver Coalition, based in Minnesota, creates support groups and runs a one-on-one mentoring program for men caring for partners with cancer. And a range of fraternities not only provide respite care but also have gatherings for their alumni focused on caregiving. It remains to be seen whether this momentum for men in the family caregiver space will continue to build, and further, whether the skills those men gain while caring for their family members could lead to employment opportunities for them in the paid care work force.
“What’s exciting is that when we started this work so many years ago, we would go online and find almost no male caregivers,” Dr. Accius said, “and if you did, they were talking about caring for the person and not about their own experience. So many of these men are providing complex medical care, and those skills are transferable to the work force. We see it as a great opportunity.”
Courtney E. Martin is a co-founder of the Solutions Journalism Network, which supports reporting about responses to social problems, and the author of five books, including “Do It Anyway: The New Generation of Activists.”
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