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| Wages for Home Care Aides Lag as Demand Grows | |
| (about 2 hours later) | |
| The analysts at P.H.I., a nonprofit research and consulting group, sift through federal data each year to see how the nation’s swelling corps of home care workers is faring. | The analysts at P.H.I., a nonprofit research and consulting group, sift through federal data each year to see how the nation’s swelling corps of home care workers is faring. |
| That’s how we know that the aides who care for disabled people and older adults in their homes — helping them bathe and dress, preparing their meals, doing laundry and housekeeping — earned a national median of $10.21 an hour in 2005, adjusted for inflation. | That’s how we know that the aides who care for disabled people and older adults in their homes — helping them bathe and dress, preparing their meals, doing laundry and housekeeping — earned a national median of $10.21 an hour in 2005, adjusted for inflation. |
| P.H.I. published its most recent findings this month, so we also know that a decade later, home care aides earn even less: $10.11 an hour. | P.H.I. published its most recent findings this month, so we also know that a decade later, home care aides earn even less: $10.11 an hour. |
| This helps explain why Patricia Walker, 55, a certified nursing assistant who works for a home care agency in Tampa, Fla., and provides care for two older men — and hasn’t received a raise in five years — must rely on $194 in food stamps each month. | This helps explain why Patricia Walker, 55, a certified nursing assistant who works for a home care agency in Tampa, Fla., and provides care for two older men — and hasn’t received a raise in five years — must rely on $194 in food stamps each month. |
| “It helps me a lot, because I don’t have to wait for my paycheck to buy food,” she told me. | “It helps me a lot, because I don’t have to wait for my paycheck to buy food,” she told me. |
| Still, working only 16 hours a week while hoping for more, at $10 an hour means she can’t afford a place to live. “I would love to be able to put a key in my own door and know this is mine,” she said. | Still, working only 16 hours a week while hoping for more, at $10 an hour means she can’t afford a place to live. “I would love to be able to put a key in my own door and know this is mine,” she said. |
| Instead, she pays friends $50 every other week to rent a room in their apartment. | Instead, she pays friends $50 every other week to rent a room in their apartment. |
| Home care aides, mostly women and mostly minorities, represent one of the nation’s fastest-growing occupations, increasing from 700,000 to more than 1.4 million over the past decade. Add the independent caregivers that clients employ directly through public programs, and the total rises to more than two million. | |
| We’ve known for years that it’s hard to keep workers in these crucial but difficult, often thankless jobs. The annual turnover rate is an estimated 40 percent to 60 percent. | We’ve known for years that it’s hard to keep workers in these crucial but difficult, often thankless jobs. The annual turnover rate is an estimated 40 percent to 60 percent. |
| Because wages have stagnated, because most work part time (though many would prefer full-time hours), and because until last year, most weren’t entitled to overtime pay, these caregivers frequently sink into poverty. About a third receive food stamps; 28 percent rely on Medicaid for health insurance. | Because wages have stagnated, because most work part time (though many would prefer full-time hours), and because until last year, most weren’t entitled to overtime pay, these caregivers frequently sink into poverty. About a third receive food stamps; 28 percent rely on Medicaid for health insurance. |
| (The one bright spot, P.H.I. analysts found, was that more have acquired health insurance through the Affordable Care Act.) | (The one bright spot, P.H.I. analysts found, was that more have acquired health insurance through the Affordable Care Act.) |
| Small wonder they leave in droves. Even nursing home aides — another underpaid female work force plagued by turnover and shortages — generally receive higher wages, more hours and more benefits. | Small wonder they leave in droves. Even nursing home aides — another underpaid female work force plagued by turnover and shortages — generally receive higher wages, more hours and more benefits. |
| In 2013, when the Labor Department gave them minimum wage and overtime rights under the federal Fair Labor Standards Act, from which they had been excluded since 1975, workers and supporters cheered. | In 2013, when the Labor Department gave them minimum wage and overtime rights under the federal Fair Labor Standards Act, from which they had been excluded since 1975, workers and supporters cheered. |
| “It was a critical fix,” said Caitlin Connolly, an author of a report by the National Employment Law Project on home care and labor standards. “There’s greater oversight now.” | “It was a critical fix,” said Caitlin Connolly, an author of a report by the National Employment Law Project on home care and labor standards. “There’s greater oversight now.” |
| That change took effect last year despite opposition and court challenges from the home health industry; it’s not yet reflected in the P.H.I. analysis. With the federal minimum wage at $7.25, the action may not substantially raise home care aides’ hourly pay. But being paid for overtime, and for the time spent shuttling between clients’ homes, could help. | That change took effect last year despite opposition and court challenges from the home health industry; it’s not yet reflected in the P.H.I. analysis. With the federal minimum wage at $7.25, the action may not substantially raise home care aides’ hourly pay. But being paid for overtime, and for the time spent shuttling between clients’ homes, could help. |
| Still, the demographics don’t look promising. In surveys, people say overwhelmingly that they want to remain at home as they age. To enable that, the country will need another 633,000 home care workers by 2024, P.H.I. projects. | Still, the demographics don’t look promising. In surveys, people say overwhelmingly that they want to remain at home as they age. To enable that, the country will need another 633,000 home care workers by 2024, P.H.I. projects. |
| The generation behind the aging boomers is smaller, however. Given the low pay, scant benefits and high injury rates, will enough workers materialize? “We’re reaching a breaking point,” said Abby Marquand, P.H.I.’s director of policy research. | The generation behind the aging boomers is smaller, however. Given the low pay, scant benefits and high injury rates, will enough workers materialize? “We’re reaching a breaking point,” said Abby Marquand, P.H.I.’s director of policy research. |
| Already, older adults and their hired caregivers are suffering. | Already, older adults and their hired caregivers are suffering. |
| Ms. Walker left her job at a nearby nursing home because “sometimes you had 12 to 15 people to take care of,” she said. “You’re trying to feed everybody, give them baths, but a lot of people got neglected.” | Ms. Walker left her job at a nearby nursing home because “sometimes you had 12 to 15 people to take care of,” she said. “You’re trying to feed everybody, give them baths, but a lot of people got neglected.” |
| She prefers the personal connections she has forged with her two current clients. She visits one man for four hours every Monday, Wednesday and Friday morning, and cares for the other Wednesday afternoons. “When I leave their house, I know they’re O.K.,” she said. | She prefers the personal connections she has forged with her two current clients. She visits one man for four hours every Monday, Wednesday and Friday morning, and cares for the other Wednesday afternoons. “When I leave their house, I know they’re O.K.,” she said. |
| But although she has requested work for Tuesdays and Thursdays, her agency hasn’t supplied any. She struggles to survive on $160 a week; her monthly bus pass alone costs $60. She just obtained health insurance through a county plan. Previously, she couldn’t afford doctors’ appointments or blood pressure medications. | But although she has requested work for Tuesdays and Thursdays, her agency hasn’t supplied any. She struggles to survive on $160 a week; her monthly bus pass alone costs $60. She just obtained health insurance through a county plan. Previously, she couldn’t afford doctors’ appointments or blood pressure medications. |
| Clients also feel the effects. When Roy Potter was weakened from postpolio syndrome and his wife, Joan, could no longer help him out of bed, a nursing home was “unthinkable,” said Ms. Potter, 83. | Clients also feel the effects. When Roy Potter was weakened from postpolio syndrome and his wife, Joan, could no longer help him out of bed, a nursing home was “unthinkable,” said Ms. Potter, 83. |
| For a year, they paid private aides $14 an hour to come to their home in Mount Kisco, N.Y. When they could no longer afford that, Mr. Potter qualified for Medicaid, which pays the preponderance of home care costs in this country. | For a year, they paid private aides $14 an hour to come to their home in Mount Kisco, N.Y. When they could no longer afford that, Mr. Potter qualified for Medicaid, which pays the preponderance of home care costs in this country. |
| Over the next two and a half years, more than a dozen agency aides — some caring and competent; some not; some disappearing without explanation — cycled through their home, as did a number of short-term substitutes. | Over the next two and a half years, more than a dozen agency aides — some caring and competent; some not; some disappearing without explanation — cycled through their home, as did a number of short-term substitutes. |
| “A new person would come, and I’d have to walk them through everything all over again,” Ms. Potter said. | “A new person would come, and I’d have to walk them through everything all over again,” Ms. Potter said. |
| She grew increasingly anxious about whether an aide would show up. “Every morning I’d hold my breath until the doorbell rang,” she said. “Several times, I had to get in the car and drive to the agency and say, ‘Who is coming today?’” | She grew increasingly anxious about whether an aide would show up. “Every morning I’d hold my breath until the doorbell rang,” she said. “Several times, I had to get in the car and drive to the agency and say, ‘Who is coming today?’” |
| Last year, when federal overtime provisions took effect, the agency cut back helpers’ hours. | Last year, when federal overtime provisions took effect, the agency cut back helpers’ hours. |
| She and her children succeeded in keeping Mr. Potter at home until he died in April, at 86, but finding and keeping help proved a continual battle. | She and her children succeeded in keeping Mr. Potter at home until he died in April, at 86, but finding and keeping help proved a continual battle. |
| Many groups have proposed or tried solutions: | Many groups have proposed or tried solutions: |
| ■ States have established registries where consumers can locate caregivers, eliminating pricey middlemen. | ■ States have established registries where consumers can locate caregivers, eliminating pricey middlemen. |
| ■ Home care aides in the Bronx and Philadelphia have formed worker-owned cooperatives. | ■ Home care aides in the Bronx and Philadelphia have formed worker-owned cooperatives. |
| ■ Despite the challenges of organizing a dispersed work force, more than 600,000 home care workers have negotiated raises after joining the Service Employees International Union. Now that many home care aides, including Ms. Walker, have put their numbers behind the union-backed Fight for $15 campaign, they benefit, even without unions, when cities and states adopt higher minimum wages and corporations raise pay rates. | ■ Despite the challenges of organizing a dispersed work force, more than 600,000 home care workers have negotiated raises after joining the Service Employees International Union. Now that many home care aides, including Ms. Walker, have put their numbers behind the union-backed Fight for $15 campaign, they benefit, even without unions, when cities and states adopt higher minimum wages and corporations raise pay rates. |
| ■ The technology start-up Honor, having raised $62 million in venture capital, intends to retain home care workers as employees, not as independent contractors, and pay them more by using a proprietary “care management platform” to reduce inefficiencies. | ■ The technology start-up Honor, having raised $62 million in venture capital, intends to retain home care workers as employees, not as independent contractors, and pay them more by using a proprietary “care management platform” to reduce inefficiencies. |
| ■ The National Employment Law Project points out that federal laws govern labor standards for other workers paid with federal dollars — construction workers building a federal courthouse, for instance. Legislation could give home care workers paid through Medicaid, as most are, similar protections. | ■ The National Employment Law Project points out that federal laws govern labor standards for other workers paid with federal dollars — construction workers building a federal courthouse, for instance. Legislation could give home care workers paid through Medicaid, as most are, similar protections. |
| Ultimately, though, even if such efforts help, our home care quandaries stem from this country’s lack of a long-term care strategy. Medicaid became our safety net by default, but we’ve never fully grappled with how best to provide daily assistance to people with disabilities, older adults or not, or how to pay for it. | Ultimately, though, even if such efforts help, our home care quandaries stem from this country’s lack of a long-term care strategy. Medicaid became our safety net by default, but we’ve never fully grappled with how best to provide daily assistance to people with disabilities, older adults or not, or how to pay for it. |
| So workers and clients and their families have muddled through, decade after decade, as best they can. What they frequently conclude: There has to be a better way. | So workers and clients and their families have muddled through, decade after decade, as best they can. What they frequently conclude: There has to be a better way. |