Kristin Smith

Dispelling the Myths Self-care, Class, and Race

We use 1995 data from the Survey of Income and Program Participation to examine how race and class are related to self-care among children 5 to 13 years old. We find that contrary to popular belief, self-care is less common among minority and lower-class children. We also find that factors such as income and neighborhood safety are related to self-care and can attenuate the relationships observed between race, class, and self-care. Our analyses also indicate that variations in self-care by race, class, income level, and neighborhood safety are dependent on the age of the child, with a major transition in self-care occurring between the ages of 8 and 10.

Self-care: Why Do Parents Leave Their Children Unsupervised?

We used a preferences-and-constraints model to develop four hypotheses to explain why parents may choose self-care (an unsupervised arrangement) as the primary child care arrangement for their children over supervised alternatives and tested them in a multivariate framework using 1995 data from the Survey of Income and Program Participation. We found that the choice of self-care over supervised care alternatives is linked to the availability of parents’ time to care for children, the child’s level of responsibility and maturity, and the neighborhood context. However, we found no evidence that parents’ ability to pay for child care is related to the choice of self-care. The results also suggest that parents use different decision-making processes, depending on their children’s ages.

An Examination of Full-Time Employment in the Direct-Care Workforce

The article provides a sociodemographic and socioeconomic portrait of individuals in the direct-care workforce. Multinomial logistic regression is used to compare socioeconomic and sociodemographic predictors of part-time and full-time employment in the direct-care occupation and other occupations using data from the 2003 and 2004 Annual Social and Economic Surveys. The results indicate that race, limited education, and having children younger than age 6 are significant predictors of full-time employment in direct care. Full-time and part-time direct-care employees are significantly less likely to have job-related health insurance than those in other occupations. Despite the recognized needs of older Americans and the decreasing number of women available to provide such care, development of this workforce is not a policy priority. State and federal policies should provide the direct-care workforce with wages and benefits sufficient to support their families and enable them to remain in the workforce providing consistent and competent elderly care.

LABOR MOBILITY OF THE DIRECT CARE WORKFORCE: IMPLICATIONS FOR THE PROVISION OF LONG-TERM CARE

This study provides the first comprehensive analysis of the dynamics of labor supply of direct care workers, the lower-skill nursing workers who provide the bulk of long-term care for the elderly in the USA. Our estimates from the 1996 and 2001 panels of the Survey of Income and Program Participation (SIPP) show that the mean (median) duration of employment spells for the same direct care employer is only 9.7 (5.0) months. We find that fewer than one-third of direct care workers leave a job to take another job in the direct care field. There is also little indication of upward mobility in the health sector; direct care workers are approximately equally likely to transition to working as Registered Nurses as they are to working in household service jobs. Additionally, the rate at which spells end in work-limiting disability (5.4%) is very high compared with rates in similar occupations. We estimate duration models of direct care job spell length and find that, after correcting for the endogenous relationship between wages and tenure, wages appear to have a modest effect in preventing turnover; this effect is concentrated among the shortest spells.

The effect of Medicaid wage pass-through programs on the wages of direct care workers.

Background:Despite growing demand for nursing and home health care as the US population ages, compensation levels in the low-skill nursing labor market that provides the bulk of long-term care remain quite low. The challenge facing providers of long-term care is that Medicaid reimbursement rates for nursing home and home health care severely restrict the wage growth that is necessary to attract workers, resulting in high turnover and labor shortages. Almost half of US states have responded by enacting “pass-through” provisions in their Medicaid programs, channeling additional long-term care funding directly to compensation of lower-skill nursing workers. Objectives:We test the effect of Medicaid wage pass-through programs on hourly wages for direct care workers. Research Design:We estimate several specifications of wage models using employment data from the 1996 and 2001 panels of the Survey of Income and Program Participation for nursing, home health, and personal care aides. The effect of pass-through programs is identified by an indicator variable for states with programs; 20 states adopted pass-throughs during the sample period. Results:Workers in states with pass-through programs earn as much as 12% more per hour than workers in other states after those programs are implemented. Conclusions:Medicaid wage pass-through programs appear to be a viable policy option for raising compensation levels of direct care workers, with an eye toward improving recruitment and retention in long-term care settings.

Exploring the spatial wage penalty for women: Does it matter where you live?

Inequality between men and women has decreased over the past four decades in the US, but wage inequality among groups of women has increased. As metropolitan womens earnings grew by 25% over the past four decades, nonmetropolitan womens earnings only grew by 15%. In the current study we draw on data from the Current Population Survey to analyze the spatial wage gap among women. We explore differences in the spatial wage gap by education, occupation, and industry. Regression models that control for marriage, motherhood, race, education, region, age, and work hours indicate that metropolitan women earn 17% more per hour than nonmetropolitan women. Nonmetropolitan women earn less than metropolitan women who live in central cities and outside central cities. The gap in metropolitan-nonmetropolitan wages is higher for more educated women than for less educated women. The wage gap is only 5% for women without a high school degree, but it is 15% for women with a college degree and 26% for women with an advanced degree. Nonmetropolitan college graduates are overrepresented in lower-paying occupations and industries. Metropolitan college graduates, however, are overrepresented in higher-paying occupations and industries, such as professional services and finance.

Rural Families in Transition

This chapter documents the transformation of rural families through an examination of two of the most important changes in American family life—changes in family structure and changes in women’s employment and family breadwinning—from 1970 to 2009, using Current Population Survey (CPS) data. Particular attention is paid to variations between families living in rural areas, central cities, and suburban places. We identify trends in marriage and divorce, the rise in single motherhood, and decreased fertility. Additionally, we examine the rising diversity of families resulting from increased educational attainment and greater female labor force participation. Finally, we discuss the implications of these changes in family structure and family employment patterns for income inequality and poverty. Over time, we find that rural families increasingly resemble urban families, but important differences remain.