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COMMENTARY: New BLS Analysis Raises Concerns about Paid Sick Leave for Direct-Care Workers

August 6, 2015

By Abby Marquand, PHI Director of Policy Research

It’s easy to take for granted that if I wake up with a migraine headache, I have the option of shooting a quick email to my boss saying I need to take a sick day. When my child comes down with a fever at school, I can leave work to pick her up, without compromising my job security or my take-home pay. But those without paid sick leave don’t have such options or guarantees.

A recent PHI analysis (pdf) found that in the 21 states that did not expand Medicaid eligibility under the Affordable Care Act, hundreds of thousands of direct-care workers have no access to affordable health insurance coverage.

While critical, access to affordable health coverage is just one hurdle for paid caregivers and other low-wage earners. Without paid time off, which few direct-care workers are guaranteed, it’s difficult to see a doctor or have time to recuperate, things those of us with paid-sick-leave benefits take for granted.

Most workers in the U.S. — 65 percent according to a new analysis released by the U.S. Bureau of Labor Statistics (BLS) — have access to paid sick leave through their jobs. But, disparities between people at the top of the income ladder and those at the bottom are staggering — 87 percent of workers in the top quartile of wages have access to paid sick leave, whereas only 34 percent of those in the bottom quartile do.

In 2014, the median hourly wage for direct-care workers was only $10.85, putting them well within the bottom quartile of wage earners according to the BLS analysis. Only a third of workers at this income level can access paid sick leave. These findings echo a 2014 report from the Institute for Women’s Policy Research, which showed that only 31 percent of workers in personal care and service occupations, including many of the lowest-paid direct-care workers, have access to paid sick leave.

The lack of paid sick leave for direct-care workers could have particularly serious consequences. These workers — nursing assistants, home health aides, and personal care aides — provide the bulk of paid hands-on care for our country’s elders and people with disabilities. They assist their clients with bathing and feeding, getting out of bed, traveling to medical appointments, work, and social engagements. They perform paramedical tasks: monitoring vital signs, performing wound care, and helping people manage chronic illnesses. The work they do is essential to the people they care for. In many cases it’s the difference between living at home or in an institution. But these jobs are strenuous. Nursing assistants have higher non-fatal occupational injuries (pdf) than any other occupation — including fire fighters, construction workers, and police officers. All direct-care workers risk exposure to communicable diseases.

Direct-care workers are working sick and injured, potentially putting their clients — who are often medically compromised themselves — at risk. This is an untenable situation and one policymakers need to address.

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