“Who Will Care for Us? is a comprehensive and probing work on the challenges and opportunities of building a labor force to do some of the most consequential and sensitive work in our society: providing long-term care for others. Paul Osterman analyzes this complicated landscape with clarity and offers new, creative, and tractable approaches to policy.”

—David Weil, dean, Heller School for Social Policy and Management, Brandeis University, and former Wage and Hour Administrator, U.S. Department of Labor

“In Who Will Care for Us?, Paul Osterman provides important insights into the chall- enges and opportunities for the most important members of the long-term care workforce—the certified nursing assistants and home care aides who provide the lion’s share of services to very vulnerable populations. He combines the best of storytelling and robust scholarship to highlight the systemic factors that explain why this profession is so undervalued. As important, he offers a thoughtful range of policy and practice solutions to elevate this workforce and ultimately deliver better services to a diverse and growing long-term care population.”

—Robyn I. Stone, executive director and senior vice president for research, LeadingAge Center for Applied Research

“With the aging baby boom generation, long-term care will be one of the great policy challenges in the coming decades. In Who Will Care for Us?, Paul Osterman identifies one of the key barriers to achieving high-value long-term care: our underinvestment in how we pay and train the direct care workforce. He makes the compelling case that continuing with the status quo is not the answer. He argues for transforming the direct caregiver job to encompass a much wider set of roles. In order for this to occur, we need to not only retrain our workforce, but also reform many of the policies that have led us to neglect our caregivers.”

—David Grabowski, professor of health care policy, Harvard Medical School

The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us? economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care.

Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the wellbeing of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops.

Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers.

As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.

PAUL OSTERMAN is Nanyang Technological University (NTU) Professor of Human Resources and Management at the M.I.T. Sloan School of Management.

From the Playground Extension Committee of the Russell Sage Foundation, this paper on landscape gardening for children’s recreation spaces was first presented at the second annual Playground Congress for the Playground Association of America in 1909.

CHARLES MULFORD ROBINSON was professor of civic design at University of Illinois at Urbana-Champaign.

A 1908 pamphlet from the Department of Child Hygiene of the Russell Sage Foundation, campaigning for an end to the unsafe and noisy Independence Day celebrations that had been popular around the country at the time.

JULIA HYNEMAN BARNETT RICE, Department of Child Hygiene, Russell Sage Foundation

A review of the development of the community center as a distinct institution and government agency, ten years after such a proposal was made to reformers the 1911 First National Conference on Civic and Social Center Development. The article first appeared in 1921 in the New York Evening Post and reprinted in the September-October 1921 number of the Community Center.

CLARENCE ARTHUR PERRY, Department of Child Hygiene, Russell Sage Foundation

An introduction to the study of the work of child-helping societies, presented at the National Conference of Charities and Correction in 1906.

WILLIAM H. PEAR was manager of the Provident Society, Boston, Massachusetts.

This 1909 paper argues that the great increase of child labor at the time led to a sharp increase in children giving up the opportunity for an education as well as for proper physical development through recreation spaces and playgrounds.

E. W. LORD, Playground Extension Committee, Russell Sage Foundation

A 1910 report of the Fairview Garden School Association of Yonkers, N.Y., detailing the origin and growth of the school garden, including costs and plans for maintenance.

A. L. LIVERMORE was chairman of the Executive Committee of the Fairview Garden School Association.

From the Playground Extension Committee of the Russell Sage Foundation, this paper explores a variety of games for children in the winter months.

ARTHUR LELAND, Playground Extension Committee, Russell Sage Foundation

This 1908 pamphlet, from the Playground Extension Committee of the Russell Sage Foundation, examines the benefits specific to young girls of recreational spaces for their proper mental and physical development.

BEULAH KENNARD was president of the Playground Association of Pittsburg, Pa.

In this 1909 pamphlet, from the proceedings of the third annual Playground Congress, George E. Johnson argues that children in the modern era need facilitation and supervision of play.

GEORGE E. JOHNSON was director of the Pittsburgh Playground Association.