Report: Home care workers deserve more pay, benefits

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic leader on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Two SEIU home care workers at a rally with Labor Secretary Marty
Walsh (Photo courtesy of Wikimedia Commons)

A new report from the Economic Policy Institute (EPI) paints a stark picture of the financial plight of home care workers. Most of these workers — who care for sick, frail, vulnerable older adults and those with serious disabilities, are significantly undervalued and underpaid and deserve a higher wage.

The Biden Build Back Better Act, which recently passed the House and awaits passage by the Senate, would make an unprecedented investment of $150 billion in home and community-based services over 10 years. It will also increase the demand for qualified home care workers. However, finding people willing to do these jobs will likely get more challenging.

Many employers already can’t find qualified workers at current rates. If workers quit due to job dissatisfaction or burnout or because they can make more money at a big box store, what happens to those who need their help? Journalists can use the data in this report to delve into pay rates, workforce composition and investigate potential worker shortages and solutions in their communities. 

EPI report key findings 

The EPI report revealed that home care workers earn a mean of $13.81/hour, about half of what the average U.S. worker is paid ($27.31). Home care workers are primarily women (88.6%) and disproportionately Black (23.9%) and Hispanic (21.8%). Roughly three in 10 home care workers were born outside the U.S., according to the report.

The authors call for boosting the hourly wage at minimum, to between $21.11 and $25.95, depending on the benchmark applied, to help recruit and retain high-quality, skilled home care workers. Contrary to what some may believe, traditional Medicare typically does not pay for home care unless skilled nursing is also needed. Some Medicare Advantage (MA) plans now cover some in-home help annually, but it’s often far less than what’s needed to help an older person remain independent at home.

Medicaid, on the other hand, does pay for needed home care for people who qualify, but states must apply for waivers to implement home and community-based programs. Currently, there are over 800,000 people across the U.S. who are on waiting lists for home care programs like PACE, a Medicaid-funded state-run initiative that provides comprehensive medical care and assistance with activities like bathing, eating and dressing. (What is the waiting list like in your state for these highly in-demand home and community-based programs?)

The case for higher pay

In addition to higher wages, workers should receive non-wage benefits such as paid leave, health insurance, and retirement benefits, the authors wrote. They make several compelling arguments for this:

  • Higher wages would drastically improve care workers’ lives and financial security, allowing them to cover their costs (including the costs of care) more easily.
  • Better pay translates into higher retention, lower turnover, and increased possibility for recruitment, which all help employers as well as care workers, who bear the burden of short-staffing and constant change.
  • Those receiving care, including people with disabilities, older adults, and children entrusted to care workers, would benefit from the stability of a more secure care workforce.

Accessible and affordable home care is often the difference between older adults or those with disabilities being able to live independently in their own homes or having to move into a residential care facility.

Paying out of pocket for home care is out of reach for many families. According to the Biden administration, it costs around $5,800/year for just four hours of home care a week; a figure that will exponentially increase as workers strive for the higher pay both experts and workers rightfully deserve. Expanding these Medicaid-funded programs will allow more people in need to qualify for and access assistance within their community, without having to bear the financial burden alone.

We deserve respect

“If we don’t do the work, who will?” said Charlene Dickerson, a home care worker in Springfield, Mass, and advisory board member with The Center for Advancing Racial Equity and Job Quality in Long-Term Care. They’re a nonprofit workforce policy organization focusing on long-term care, working to raise standards across the health care industry.

She pointed out how home care workers have stepped up during the COVID-19 crisis, often working with minimal PPE or none at all. “We put our lives on the line for our clients,” she said. “We rose to the occasion. We should be respected for the job that we do and make enough to afford to live in a decent neighborhood, afford to buy food, pay our bills, or pay for medication. We shouldn’t have to choose.” Dickerson said many of her colleagues work second or third jobs to help make ends meet.

Home care workers throughout the U.S. are now fighting to unionize, something the EPI report encourages: “While a strong public sector plays a crucial role in both funding and labor enforcement, unions are another critical intermediary in negotiating and bargaining for higher pay and benefits.”

The report concludes that raising wage standards for care workers makes good economic sense for the workers, for those they care for, and the economy as a whole. It seems obvious to me that if we intend to make a real commitment to helping more people age at home, expanding state and federal programs is only part of the equation; investing in the very people who help make it happen is the other.

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