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Better pay, more training and options for career advancement may provide a solution

The people who make a living caring for older adults primarily women, typically women of color, often immigrants are critical to the smooth operation of the health care system. Yet home health aides and other direct-care providers are among the lowest-paid and least respected workers in the U.S.

The problem will only worsen if the jobs don't improve, advocates say. The solution? Better pay, more training and options for career advancement. Since immigrants make up a large portion of the direct-care workforce, immigration policy also needs to be addressed, some say.

"It's been about 20 years since our safety net was put into place."

"We have essentially added another generation onto our lifespan without adapting policies" to account for increasing longevity, said Ai-Jen Poo, president of theNational Domestic Workers Allianceand executive director ofCaring Across Generations, a coalition that advocates for caregivers.

"It's been about 20 years since our safety net was put into place," she told journalists at Columbia University's Age Boom Academy. Caregiving is "among the fastest growing occupations," and one that can't be outsourced or automated, said Poo, a Next Avenue Influencer in Aging.

"We know these are going to be a huge part of the jobs of the future. We simply have to make them good jobs."

"There's no way to meet the demand in this country without a strong immigrant workforce," said Poo. She said that a path to citizenship would help immigrants and the workforce. "Home care workers enable tens of millions of families to go to work; it really is the foundation of all other work."

No Improvement Without Better Pay?

The bottom line is wages, said Nicole Jorwic, chief of campaigns and advocacy for Caring Across America. According to coalition data, home health aides make minimum wage or less in most states. "The reality is these are jobs that are skilled jobs," Jorwic said in an interview.

"Caregivers are really badly prepared. Caregiving is not an easy task."

However, she said that even in states that use their American Rescue Plan funds to raise direct care workers' wages, people can still earn more at big-box stores. "Even states recognizing the importance of this workforce are still struggling with turnover and vacancy rate because of competition and decades of lack of investment," Jorwic said.

"Covid really brought home the inadequacies of the current system," John Beard, a University of New South Wales professor, told journalists at Columbia University's Age Boom Academy. "Caregivers are really badly prepared. Caregiving is not an easy task."

According to Beard, former director of aging and life course at the World Health Organization, "the stress is exacerbated by the fact that they've had inadequate training."

Israel, South Korea, Germany, Japan and the Netherlands have universal long-term care insurance, "structures that create jobs for younger people" in addition to a "care economy," he added.

Providing training to paid and unpaid caregivers alike, perhaps by "linking" family caregivers with professional caregivers, and providing adequate time off are supports that would make caregiving less of a burden, said Beard.

Pay Is Only A Part

The direct-care workforce is more significant than any other single occupation, with 1.2 million new jobs expected between 2020 and 2030, saidKezia Scales, vice president of research and evaluation at policy and advocacy firm PHI.

"There are very limited opportunities for people to progress beyond these entry-level positions."

"A combination of strategies" across the spectrum will be needed to ensure these jobs are filled, Scales said in an interview. For example, better pay is "one part of a broader strategy," she said.

"Another key aspect of the challenge we're facing with recruitment and retention is around training and career development," Scales said. "The training landscape for direct care workers is very fragmented" and often inadequate for the job's complexity.

"There are very limited opportunities for people to progress beyond these entry-level positions," Scales explained, adding that leads people to leave for other, more lucrative industries.

Many long-term care providers are investing in training, but "it's not consistent across the board," said Scales. And some states are targeting training with American Rescue Plan funds for home- and community-based services.

"A number of states are investing some of that enhanced funding in their training infrastructure to think about a system that provides good, solid, recognized entry-level training that includes additional potential credentials and career progression," she noted.

Wisconsin, for example, is launching a program for training and certifying direct care professionals to teach them skills they can take from one employer to another without retraining.

The state says the program, which aims to certify at least 10,000 new workers, will "professionalize the career" as employers officially recognize workers' skills and workers have a "career ladder" to climb.

Researchers say that direct-care jobs are physically and mentally taxing and can hurt workers' health. Scales studied these workers' health care experiences compared with those of other health care workers and found that direct care workers were less likely to have health insurance cost was cited as a primary reason and more likely to have health problems.

"The training landscape for direct care workers is very fragmented" and often inadequate for the job's complexity.

"These are low-wage jobs, and they are filled primarily by women, people of color, and immigrants who face structural barriers" to accessing health care, Scales said. "The work itself is very physically and emotionally demanding," and "it's stressful."

In addition, in-home work can be isolating, and nursing home jobs often come with crushing caseloads, she said. As a result, PHI has published a set of guidelines, "The 5 Pillars of Direct Care Job Quality," laying out elements that would help the direct-care workforce, including wages, training and support.

Immigrants Remain A Force

With immigrants making up one in four direct-care workers, the federal government may have to step up. Changes to immigration policy are still necessary to meet the growing demand for direct care,said Daniel Kosten, assistant vice president of policy and advocacy at the National Immigration Forum.

"I believe things are progressively getting worse," said Kosten, who published a report two years ago highlighting the shortage of direct-care workers and immigrants' vital role in filling the gap.

Limiting immigration has hurt the market in Britain, Beard noted."With Brexit, it became a lot harder to access the sorts of people who often fill caregiving roles," a situation that's been exacerbated by the current economic situation.

"Immigration into the U.S. the last several years, especially during the Trump administration but also going into the Biden administration, hasn't improved a whole lot," Kosten said."There are a lot of backlogs in terms of people waiting for their visas, and also in terms of just processing."

Kosten's group is part of a coalition planning to lobby the Labor Department to expand its list of Schedule A jobs hiring foreign workers would not hurt U.S. workers' wages or working conditions to include positions like home health aides.

Outgoing Labor Secretary Marty Walsh, Kosten noted, has spoken out in favor of immigration reform to address a worker shortage. Though the coalition hasn't yet engaged with the administration, "we think we have an open audience at DOL on this particular issue."

Trade associations are becoming more vocal about the issue, "recognizing the fact that the demand is so large they cannot meet it with native-born Americans," he said.

Editor's Note:This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and The Commonwealth Fund.

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Could Professionalizing the Caregiving Workforce Have Impact? - Next Avenue

The U.S. government's focus on technological competition with China may lead to new rules curbing foreign tech investments.

The Biden administration is allegedly working on an executive order limiting investments in certain technologies, such as artificial intelligence, in overseas countries, according to reporting by the Wall Street Journal earlier this month. Biden has yet to issue such an executive order, but his proposed FY 2024 budget released March 9 requested "discretionary and mandatory resources to out-compete China and advance American prosperity globally."

"China is the United States' only competitor with both the intent to reshape the international order and, increasingly, the economic, diplomatic, military and technological power to do it," according to the budget.

The Biden administration already imposed export controls in October 2022 limiting China's ability to acquire advanced computing chips and is considering further limiting exports to the country. But issuing rules on investments in the Chinese tech sector would be a "radical departure" from former U.S. industrial policy, said Chris Meserole, director of the Brookings Institution's Artificial Intelligence and Emerging Technology Initiative.

"In principle I'm not averse to cutting off nodes of funding from the U.S. to the Chinese tech sector," he said. "The devil will be in the details of how narrowly they are going to circumscribe different investments."

For Robert Atkinson, president of the Information Technology and Innovation Foundation, working closely with allies on export controls and tech transfer limits is "critical."

"Limiting exports of key technology to China can be an important tool to push back against unfair Chinese government technology policy," Atkinson said. "But unless our allies cooperate, we risk simply cutting off U.S. exports and ceding the marketplace to foreign firms."

Tensions between the U.S. and China have escalated as concerns about China's technological advancement are increasing fears among policymakers about how the country might use its position as a global leader in certain technologies. Meserole said that could include the country's use of AI for commercial surveillance or moving against Taiwan, a global leader in semiconductor manufacturing.

The U.S. government should've acted on the competitive threat in advanced technology development posed by China 10 years ago, but Meserole said it's not too late.

One of the Biden administration's first steps in competing with China on a technological front stemmed from legislation Congress passed last year. Before that, former U.S. president Donald Trump also took actions to counter China's growing influence.

Biden signed the Bipartisan Infrastructure Law and the CHIPS and Science Act of 2022 into law last year, which increased investments in domestic manufacturing of technologies like semiconductors as well as research and development into AI and quantum computing.

We created a regime that is very powerful economically. They are learning how to flex that economic might and convert it into political and strategic power. Chris MeseroleDirector, Brookings Institution's Artificial Intelligence and Emerging Technology Initiative

The legislation aims to stem the tide of more than 30 years of U.S. investment and interconnectedness with China, Meserole said. He described increasing U.S. efforts to compete with China as "the ocean liner that takes a while to turn around."

Meserole said U.S. investment in China over the years, particularly in the early 2000s, marked a historical moment where it seemed like investing in the country's industrial and technological development would also influence it, over time, to become more open and less authoritarian economically and politically.

At the time, U.S. leadership in advanced technology development was powerful enough that leaders didn't foresee the possibility of losing that position, he said.

However as Chinese President Xi Jinping came into power in 2013 and the country flourished economically, it didn't come with the kind of political change the U.S. anticipated, Meserole said.

"No administration prior to the Trump administration really thought there is a significant chance that China is going to get so good at this that they could surpass us in certain areas of technological development," Meserole said.

Since China has grown substantially without having liberalized, it means they're going to be a strategic competitor to the U.S., he added.

"We created a regime that is very powerful economically," he said. "They are learning how to flex that economic might and convert it into political and strategic power."

Beyond measures the U.S. has taken already, Meserole said, it's incumbent on both the U.S. and European Union to set standards for use of technology like AI to protect against its misuse by governments and corporations globally.

He said it's also crucial for the U.S. to focus on immigration reform as part of boosting its technological expertise while investments allow new semiconductor plants and other facilities to be built stateside. Immigration reform is a hot button issue that has long been a struggle for Congress to resolve.

"The only way we create a vibrant ecosystem domestically is by bringing in experts around the world to staff these facilities and then, hopefully, stay," he said. "We don't have that expertise in house right now."

Makenzie Holland is a news writer covering big tech and federal regulation. Prior to joining TechTarget, she was a general reporter for the Wilmington StarNews and a crime and education reporter at the Wabash Plain Dealer.

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Tech competition with China remains top of mind for U.S. - TechTarget

For the last three months, Israelis have been taking to the streets in the hundreds of thousands, on a weekly basis, to protest what they see as the far-right governments regime coupa plan (which it has already begun implementing) to subordinate the judicial system and change the system of governance to the point that all checks and balances on those in power are removed.

The plan is being led by a prime minister on trial for corruption in three separate cases, while Israel continues to hold millions of Palestinians under occupation with an agenda to further entrench its control. Each party in the Israeli government has specific and explicit goals that the various laws in this judicial overhaul package would serve.

For the ultra-Orthodox parties, its primarily about ensuring their constituency does not have to serve in the military. (They study Jewish religious law instead.) In 2017, Israels Supreme Court struck down a law exempting ultra-Orthodox seminary students from conscription in the Israel Defense Forces (IDF) on grounds it perpetuates inequality. For the Shas Party specifically, it is also about circumventing existing law to enable its head, Aryeh Deri, to serve as a minister despite several recent convictions of tax fraud.

For the religious, nationalist, racist, far-right partiesJewish Power and Religious Zionism, both headed by settlers who are now senior ministers in governmentits about extending Israeli sovereignty over all occupied territory, what they call the Land of Israel, and making public institutions more religious.

For Prime Minister Benjamin Netanyahus ruling right-wing Likud party, its also about continuing to expand Israels settlement enterprise, consolidate power over media, culture, and public institutionsand for Netanyahu, it is about assuming enough control over the courts, through appointing judges, to evade conviction.

In essence, what the parties that comprise this government all share is the determination to create and shape new laws that serve their narrow interests, even if they violate the rule of law as is commonly understood in democracies both in Israel and abroad, trample certain rights, and shatter liberal democratic norms.

In other words, they seek to legalize those illegal actions that further their interests.

Protests against the contentious judicial overhaul of Israeli Prime Minister Benjamin Netanyahus nationalist coalition government in Tel Aviv, Israel, on March 18, 2023.

Oren Alon/Reuters

The act of creating new laws in order to serve its interests on the ground is precisely what Israel has been doing for 56 years as an occupying power. Since it conquered the West Bank, Golan Heights, East Jerusalem, and Gaza Strip in 1967, the government, through its military and legal experts, created an entirely novel and distinct legal framework to implement long-term military rule over an occupied population that is in line with the rule of law as it always defined it, with the Supreme Courts imprimatur, and thus the norm.

The unprecedented protests taking place across the country are largely ignoring this fact. They include a range of groupstech sector employees, academics, military reservists, former politicians, doctors, LGBTQ rights activists, religious and secular Israelis, and even some settlers who identify as liberalwho are all engaged in various acts of civil disobedience the likes of which Israel has never seen.

There are a plethora of signs at the protests with all kinds of messaging, but as a whole, the protesterswho are almost exclusively Jewishhave galvanized around one main slogan: democracy.

People are screaming it in the streets, blue wrist bands are being handed out with the word, protesters insist they are trying to save it. They say they have risked their lives for a state that is Jewish and democratic and that they will not cooperate with the state if it ceases to be a democracy.

But Israels 56 year-long military occupation has systematically disregarded the principles of democracy and equality they say they are fighting for. While protestersmany of them among the most privileged in Israeli societywalk in the streets demanding the rule of law and democracy, Israeli forces are demolishing Palestinian homes; standing alongside settlers who are terrorizing Palestinians; denying freedom of movement and assembly; holding people in prolonged detention without trial; killing unarmed protesters; carrying out torture; and deporting Palestinian activists. And within Israel, Palestinian citizens face structural discrimination and inequality under an explicit policy that prioritizes Jewish rights.

The occupation is inseparable from Israel. The same government that operates Israels liberal democratic mechanisms presides over millions of stateless Palestinians, who are effectively barred from protesting their condition. The same Supreme Court that struck down a law legalizing Jewish settlement on private Palestinian land has given the green light to Israels continued transfer of citizens to occupied territory and to the siege on Gaza. That is why the Israeli human rights group BTselem defines Israel as an apartheid regime, and why Human Rights Watch and Amnesty International have accused Israel of committing the crime of apartheid.

One of the changes this government has already made that exemplifies just how synonymous the occupation and Israel arebut which hasnt gotten nearly as much attention as the judicial overhaulis the authority it has granted to Finance Minister Bezalel Smotrich.

Smotrich, who advocates for formal annexation of the West Bank and, in late February, called for the Palestinian town of Hawara in the West Bank to be wiped out, has successfully transferred authorities that have been held by the military for 56 years into his own handseffectively becoming the governor of the West Bank. Even if protesters manage to stop the anti-democratic legislation, this step in the direction of de jure annexation will remain.

Most of those warning that Israel is at risk of becoming a dictatorshipincluding many of Israels top former security brass, among them the recent head of Israels internal security service, the Shin Bet, under Netanyahuare compartmentalizing these issues, convinced that Israel can continue to be a liberal democracy as long as it can stop this legislation. Even many of those who oppose occupation believe it will have to be dealt with separately, and at another time. Yet they are trying to save a system that was never fully democratic to begin with, while the new right-wing government they are fighting sees that undemocratic system as still overly restrictive of its own more radical ambitions.

There are, however, indications that some are starting to draw the connection between Israels occupation and the states illiberal direction. After hundreds of settlers went on a rampage burning cars and homes and attacking Palestinians in Hawara as soldiers largely stood idly by, protesters in Tel Aviv began chanting at police, Where were you in Hawara?

There is also a small but dedicated anti-occupation bloc that carries signs at the protests with messages like: There is no democracy with occupation and Democracy for all from the river to the sea. At one of the recent protests, a gray-haired woman held up a sign that may sum it up best: We were silent about occupation, we got a dictatorship.

Israelis who have bent the rule of law to suit their ideology for decades are now themselves becoming the target of a far right that is using its newly won power to bend it even further.

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Israelis Are Trying to Save a Democracy That Never Existed - The Daily Beast

WASHINGTON (AP) The Biden administration has extended invitations to 120 global leaders for next weeks Summit for Democracy, including to representatives from eight countries that werent invited to the White Houses inaugural summit in 2021.

Thats according to a senior administration official, who spoke to The Associated Press on the condition of anonymity to discuss the yet to be publicly released invitations. The countries of Bosnia and Herzegovina., Gambia, Honduras, Ivory Coast, Lichtenstein, Mauritania, Mozambique, and Tanzania were extended invitations to this years summit after being left out of the invite list to the 2021 gathering.

Ukraine President Volodymyr Zelenskyy is slated to take part in a pre-summit event on Tuesday focused on Ukraine with Secretary of State Antony Blinken.

This years summit takes place next Wednesday and Thursday. It will be co-hosted by the governments of Costa Rica, the Netherlands, South Korea and Zambia. The first day of the summit will be a virtual format and will be followed by hybrid gatherings in each of the host countries with representatives from government, civil society and the private sector participating.

The world has seen big change since the December 2021 summit with countries emerging from the global pandemic and Russias invasion of Ukraine, the largest-scale war in Europe since World War II that has devastated the eastern European country and rattled the global economy.

The president will look to make the case that the events of the last year have put into stark relief that democratic government grounded in the rule of law and the will of the governed remains despite its frequent messiness the best system to promote prosperity and peace, according to White House officials.

Biden initially proposed the idea of a democracy summit during his 2020 campaign and has repeatedly made the case that the U.S. and like-minded allies need to show the world that democracies are a better vehicle for societies than autocracies.

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120 leaders invited to Biden's 2nd Summit for Democracy - The Associated Press

Review of Crack-Up Capitalism: Market Radicals and the Dream of a World Without Democracyby Quinn Slobodian (Metropolitan, 2023)

After reading historian Quinn Slobodians new book, you are not likely to think about capitalism the same way. As one blurb aptly put it, the story is head-spinning, and, by the way, great fun to read. Slobodian is a professor of the history of ideas at Wellesley College and bearer of one of my favorite Pynchonesque names on the internet, along with Match Esperloque and Con Skordilis. His style and subject matter call to mind the recently departed Mike Davis.

Slobodians book gets off to a great start, because it speaks to one of my pet peeves about the US left: we tend to think of public policy in exclusively national terms, as if we were a unitary state like France. The reality is that the US federal system, with over ninety thousand local governments, is the most decentralized in the world save for Switzerland. US states are sovereign entities with substantial independent authority; local governments are creatures of their respective state governments.

The key governmental unit in Crack-Up Capitalism is the zone, a space set apart from a countrys standard taxes and business regulations. The archetypal zone is Hong Kong, a favorite model of Milton Friedman and his Chicago School colleagues. Contrary to laissez-faire nostrums, Friedman appreciated the militant defense of free markets by the Hong Kong government.

There are thousands of zones throughout the world. The United States put its toe in the water in the 1980s during the Reagan Administration, proposing enterprise zones as a solution to urban blight. These have never amounted to much, though not for state and local governments lack of trying. Enterprise zones have mostly been an opportunity for business firms to practice locational arbitrage, moving in operations they would have carried out elsewhere for the sake of tax breaks and lax regulation. In fact, such arbitrage is part of the plan, the idea being to erode state restrictions by presenting competitive advantages in zones.

It turns out there is a vast intellectual history behind this libertarian gambit, which Slobodian ably documents. As you might expect, the Mont Pelerin Society (founded in 1947 by a group of right-wing intellectuals famously worried that socialism would engulf the world) is a key player, and neoliberalism (the subject of Slobodians previous book, Globalists) is shown to be a deeply libertarian project, in the anarcho-capitalist sense.

Its a bit disconcerting to learn that all the tech billionaires, not just Peter Thiel, betray some weakness for this hard-right worldview. Our new economic elites are not your grandpas. As Slobodian notes, A hundred years ago, the robber barons built libraries. Today, they build spaceships.

The idea of a market for government itself, founded on a multitude of locational choices, underlies the libertarian dream. Freedom, in this would-be utopia, flows from the ability of individuals to choose the laws under which they live. Businesses unshackled from government restrictions grow without limit, and citizens prosper. Economic islands of a global archipelago flourish by trading with each other.

Commitment to this hypercapitalist model has been much more concerted in other parts of the world. Crack-Up Capitalism features stories of Singapore, Somalia, the United Kingdom, the United Arab Emirates, and the Bantustans of South Africa. In each case, national governments put substantial weight behind the formation of zones.

Perhaps the most novel form of the zone is one that exists completely in cyberspace. Think about the transformation of Facebook into Meta, or virtual currency like Bitcoin (originally intended to sidestep the government-regulated banking sector). Blockchain technology used for a wide variety of trading and contracting fits the bill too. Virtual zones freedom from government regulation stems from policymakers difficulty in keeping pace with new technologies, as well as the enormous sums of money the tech mammoths can use to influence public decisions.

Returning to planet earth, the joker in the deck of free libertarian enclaves is the absence of competition in the labor market. Zones are rife with exploitation of migrant workers who are taken in but afforded no citizenship rights, shipped to work by buses with barred windows, and returned to residential camps enclosed in barbed wire. The worst cases are found in places where democratic institutions are weak or absent to begin with. The working classes of the world have their hands tied when capital is concentrated in deregulated zones that prohibit labor groups of any kind, even social organizations. Zones snuff out civil society.

Zones are not, cannot be, economic autarchies, completely isolated from commerce with outside economic entities. In particular, as noted above, they rely on imported, captive labor and are largely the location for trade in goods produced elsewhere. (Cryptocurrency and virtual worlds like Meta are based on server farms that operate in metaspace.)

At the same time, zones hollow out the economic basis for welfare states by segregating and shielding capital from taxation. Wages are ground down and themselves provide limited sources of public revenue.

In an important respect, the libertarian bona fides of really existing zones are ambiguous. To be established and defended, zones require states. The governments role in the economies of zones can be considerable. In Singapore, for instance, all land is owned by the state. Elsewhere, enclaves can require protection from the outside world. In China, state direction of economic activity is ubiquitous. Basic infrastructure in some zones essential to economic life is provided by the state.

More broadly, however, beyond nation-states, big international alliances and national governments seem as strong as ever. The Russian invasion of Ukraine is fortifying the US-led North Atlantic Treaty Organization. The Chinese, Indian, Japanese, and Brazilian states show no sign of dissolution. The same can be said for the European Union. Brexit could be looked at as an attempt to zone the entire UK. It was certainly spoken about in that fashion by Leavers, going back to the leading Euroskeptic, Maggie Thatcher. But the UKs post-Brexit experience has not been a happy one.

We could reconcile this reality with zone fever by pointing out that there is a division of labor in the interests of capital. The top-level alliances maintain fiscal and monetary regimes that block the advance of social democracy. The local zonal authorities prevent democratic agitation at the base. (It doesnt always work, as the uprising against plans for zones in Honduras attests, but similar schemes remain afoot in neighboring crypto-crazy El Salvador.)

We can also apply this framework to the United States. Elite pressure keeps the brakes on social welfare of all types and substitutes culture war battles for elementary needs for health care, education, and the like. A cheap welfare state leaves more income for the wealthy to nourish their own gated communities and central business districts. Meanwhile, the superrich are said to be building luxurious bolt-holes in remote places like New Zealand, when theyre not fantasizing about leaving the planet altogether. It all adds up to economic segregation, which in the United States is also racial segregation. Actually existing libertarianism happens to be pretty racist.

The crack-up of capitalism is really the dissolution of the state and, along with it, the capacity of a democratic polity to engage in collective action against real threats, such as pandemics and climate change. Such a capability is not easily replaced. As Slobodian recounts, that was the ambition of the deeper thinkers behind Donald Trump, such as Steve Bannon, and we could say it is the program of Floridas execrable governor, presidential hopeful Ron DeSantis.

Crack-Up Capitalism is an important guide to the current struggle over how the ruling class rules. And Slobodian ultimately raises the question of whether there are cracks in the system, or whether the cracks are the system.

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Free-Market Idolatry and Hatred of Democracy Go Hand in Hand - Jacobin magazine