How the Rise in Care Work Intensifies New York’s Gender Income Inequality
“Closing the Gender Pay Gap,” a recent report by the Center for New York City Affairs and Women Creating Change found that progress towards gender pay equity in New York City has stalled in the past 25 years. Occupational segregation – the uneven distribution of men and women across job types – is a key reason why. In particular, growth in the care workforce over the past 20 years has outpaced overall workforce growth. It is both low-paid and disproportionately female: in 2022, 83 percent of care workers in New York City were women who had median wages of $18/hour. This is far below the overall median for full-time women workers in the city of $26.00/hour, which itself is below that for full-time male workers, at a median of $28.80/hour.
Care work can be defined as any work that contributes to well-being and supports people's day-to-day needs; this can take the form of paid work in the formal sector, or as unpaid work in the household. Here we focus on paid care workers in the formal economy, who are disproportionately female, disproportionately people of color, and disproportionately foreign-born.
Data from the Quarterly Census of Employment and Wages (QCEW) illuminates the rapid growth of New York City’s care work force, and how it has outpaced national trends. (QCEW is administrative data, reported by employers. Within the QCEW, we have defined paid care work as consisting of the following sub-sectors: home health care; individual and family services, such as counselors and workforce professionals; vocational rehabilitation; emergency and other relief services; and child day care services.)
In 2001, care workers represented six percent of the total workforce in New York City; by 2022 this had doubled to 12 percent. (At the national level today, care workers only represent four percent of all workers.) Growth in the care workforce also has consistently outpaced that in the overall workforce. Between 2001-2022, New York City’s total workforce grew by 26 percent; during that time the number of workers employed in the care sector increased a staggering 166 percent. This equates to a 293,000-worker increase, and accounts for 40 percent of New York City’s total private job growth over that period. In the US, these figures were 18 percent and 130 percent respectively.
In Figure 1 (below), we see that New York City and the US followed a similar growth trajectory until around the end of the last decade. Then the rate of growth here accelerated noticeably. (In 2020 there is a dip in both series, reflecting the impact on employment of the Covid-19 pandemic.)
Figure 1
Rapid growth in home health care (see Figure 2, below) is driving the overall increase in the city’s care workforce. (There has also been substantial growth in individual and family services both in the city and nationally.) Home health care has grown six-fold over the past two decades, an increase of over 200,000 workers. One in five care workers were home health aides in 2001; today that ratio is one in two.
Much of this growth is due to the State’s move to contract out publicly financed home care to private “managed long-term care” (MLTC) providers, broadening the range of healthcare services that Medicaid can be used for. This transition has essentially culminated in “a massive privatization of Medicaid home care,” and the establishment of increasing numbers of profit-driven centers. The number of care workers has increased to support this system, yet there remains a severe shortage of home care workers for elderly and disabled New Yorkers, with demand evidently outstripping supply.
Figure 2
Paid care work is also concentrated geographically and demographically. Care workers make up 30 percent of those employed privately in Brooklyn, 18 percent in the Bronx, and 17 percent in Queens. Similarly, home health aides make up 17 percent of Brooklyn’s workforce, but are only six percent of the city’s overall private workforce. (It is important to note that the QCEW records place of work rather than place of residence, so these figures do not capture where care workers live).
Figure 3
Drawing on the last five years of the most recent Census data also shows that the city’s care workers are disproportionately people of color. Though Black and Hispanic workers make up 21 percent and 25 percent of the total economically active population respectively, they each represent a third of the total care workforce. White workers, on the other hand, are underrepresented: they make up 40 percent of the economically active population, but only 20 percent work as paid carers. (Asian workers are slightly underrepresented in the care workforce, but only marginally so, compared to white workers.) Additionally, care workers are disproportionately foreign-born: 43 percent of the city’s economically active population was born outside of the US, compared to 60 percent of active care workers.
Focusing on the care workforce must be at the heart of planning for a more just and equitable economy. The city could make great strides toward race and gender equity by focusing policy on the carework sector overall. Raising the pay of childcare workers, who are among the city’s lowest-paid workers and are overwhelmingly women and predominantly women of color, could be achieved by several reforms. They include: changing the State’s childcare voucher reimbursement to an alternative cost-based method; and securing City and State public benefit options, including retirement funds, for home-based childcare workers. Addressing human services pay inequities would boost the income of predominantly women of color in the nonprofit human services workforce at the City and State level. And, restoring the hourly wage premium above the minimum wage for home health aide workers, initially secured in the “Fair Pay for Home Care Act,” is essential both for these workers to make ends meet and to recruit workers to meet soaring demand.
Robert Noble is an MA student in the Department of Economics at the New School for Social Research and a research assistant for The Center for New York City Affairs. His quantitative work was featured in the 'Closing the Gender Pay Gap' report and he will be working on future industry-related projects for the Center.