the conversation gap — the quiet crisis in america's care economy

Every September, Labor Day arrives with familiar cultural rituals: parades, end-of-summer sales, long weekend trips and polished corporate statements celebrating the dignity of the American worker. Emerging directly from the late nineteenth-century labor movement, the holiday was established to recognize the social and economic achievements of American workers broadly. Yet our cultural imagination of labor often gravitates toward the most visible forms of it: the physical work that built factories, laid railroad tracks and powered the country’s industrial expansion.

Across the modern economy, however, one of the most consequential labor challenges is unfolding somewhere quieter, inside living rooms, childcare centers and eldercare facilities. America’s care economy, encompassing childcare workers, home health and personal care aides, early childhood educators and others who support children, older adults and people with disabilities, is under enormous strain. The contradiction is difficult to ignore: the economy relies on care to make other forms of work possible, yet the people providing it remain among the country’s lowest-paid workers.

the revolving door of care

This is not a uniform exodus, and different parts of the care economy are moving in different directions. Employment of home health and personal care aides is projected to grow 18 percent between 2025 and 2035, adding roughly 847,000 jobs as an aging population increases demand for care. Childcare employment, by contrast, is projected to decline slightly over the same period.

Yet both sectors face extraordinary replacement needs. The Bureau of Labor Statistics projects roughly 760,500 openings for home health and personal care aides each year, many because workers will transfer to other occupations or leave the labor force. Childcare, despite its projected decline in total employment, is expected to produce roughly 150,000 openings annually for essentially the same reason. The crisis is therefore not simply that care workers are disappearing, but that America needs enormous amounts of care while struggling to make many of the jobs providing it economically sustainable.

the infrastructure behind the infrastructure

Infrastructure usually evokes roads, bridges, power grids and broadband, but those systems depend on something more human. A surgeon entering an operating room, a teacher arriving at school or an executive leading a meeting can do so because someone, somewhere, is caring for the people who cannot accompany them to work. Care may be less visible than a highway or a power line, but its economic function is similarly foundational.

Despite that role, the economics of care contain a persistent paradox: it can be extraordinarily expensive for families to purchase while remaining poorly compensated work to provide. Under federal childcare subsidy rules, states generally may not require eligible families participating in the Child Care and Development Fund to contribute more than 7 percent of family income in copayments. Families paying market rates face a very different equation, with Labor Department data showing that full-day care for one child can consume roughly 9 to 16 percent of median family income, depending on the age of the child and type of care.

Yet the workers providing that care earn substantially less than the typical American worker. Childcare workers earned a median $16.82 an hour in 2025, while home health and personal care aides earned $17.21. The median hourly wage across all occupations was $24.51, illustrating how far compensation in these essential jobs continues to lag behind the broader labor market.

That disconnect is not merely the result of one side charging too much or another being paid too little. Care is inherently labor intensive, which means a childcare center cannot dramatically increase the number of infants assigned to each adult without compromising safety or violating staffing requirements. A home health aide cannot assist several people with bathing, eating or mobility at the same moment. There are limits to how much productivity can be extracted from care without diminishing the care itself.

The result is a difficult economic equation in which families often cannot afford to pay substantially more while workers often cannot afford to earn substantially less. Providers are left trying to reconcile the two, balancing labor costs, rent and regulatory requirements against what families can realistically afford to pay.

when temporary support ended

The pandemic placed enormous new pressure on an already fragile care system. Childcare centers closed or reduced capacity, workers left the sector, families lost access to care and public health restrictions made an already labor-intensive business even harder to operate. At the same time, the crisis exposed how quickly disruptions in care could ripple into the broader labor market when parents and caregivers could no longer rely on their usual arrangements.

Federal relief temporarily changed that equation. Congress provided $52.5 billion in supplemental childcare funding through several pandemic relief measures, and states used the money in different ways, including increasing payments to providers, reducing costs for families and supporting higher compensation for childcare workers.

But the support was temporary. The $24 billion in American Rescue Plan stabilization grants reached its spending deadline in September 2023, while another $15 billion in supplemental Child Care and Development Fund money could be spent through September 2024. As those programs wound down, many of the pressures that existed before the pandemic remained alongside some of the disruptions the pandemic had deepened.

Providers still faced payroll, rent and staffing costs, while parents continued to confront high tuition and workers still had to decide whether the wages justified remaining in the field. The relief did not solve the underlying economics of childcare, but for a period it gave families, providers and workers more room to absorb them.

when care falls back on families

When formal care becomes unaffordable or unavailable, the work does not disappear. It moves somewhere else, usually back into the household, where families absorb the time, financial cost and logistical strain themselves.

The effects are not as simple as millions of women abandoning paid work. Maternal employment recovered beyond its pre-pandemic level after the extraordinary disruption of 2020, but the availability and price of childcare still shape whether and how much mothers can work. Labor Department research has found that a 10 percent reduction in local childcare prices is associated with roughly a 1 percent increase in maternal employment.

For many families, then, the pressure appears not only as an exit from the workforce but in smaller compromises that accumulate over time. Parents may reduce their hours, give up flexibility, decline opportunities or make career decisions around the availability of care rather than their professional ambitions. Women remain disproportionately exposed to those tradeoffs because they continue to perform a larger share of caregiving both professionally and inside the home.

redefining what counts as economic infrastructure

For generations, American policy has often treated caregiving primarily as a private family responsibility, even as the broader economy has become increasingly dependent on paid care. We routinely recognize roads, ports, electricity and broadband as infrastructure because economic activity depends upon them. Care performs a similarly foundational function by allowing parents to work, helping older adults remain safely at home and enabling millions of people with disabilities to live with greater independence.

Recognizing that role does not require treating every form of caregiving as a government service. It does require acknowledging that care produces economic value far beyond the individual household purchasing it, and that the costs of an unstable care system are eventually felt by employers, workers and the broader economy.

Labor Day was always intended to honor the contributions of American workers, and the question today is whether our economic institutions fully recognize some of the workers whose labor makes everyone else’s possible. America is not running out of need for care: the country is aging, families still need childcare and millions of people rely on assistance to live independently.

The harder question is whether we have built an economy in which the people providing that care can afford to keep doing it. That is the conversation gap: between how essential we say care is and how difficult we have made it to sustain the people who provide it.