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Poverty of America's Home Care Aides Undermines Care

February 17, 2015

PHI Reports Low Wages Getting Lower for Nation's Fastest-Growing Workforce

The median annual income for home care workers is just $13,000, after factoring in the part-time hours that are typical for this occupation, according to a new report from PHI, Paying the Price: How Poverty Wages Undermine Home Care in America. Moreover, real wages (adjusted for inflation) have been going down over the last decade.

While a typical home care worker earns $9.61 per hour, that hourly wage doesn't tell the whole story, the report shows.

Paying the Price attributes these low wages to the history of undervaluing domestic service. Though home care is physically and emotionally demanding work that takes specialized knowledge in areas of health, nutrition, and physical and mental disability, as well as expert interpersonal skills, it is undervalued because of who does the work: women (90 percent of workers) and people of color (over 50 percent).

As Theresa King, a home care aide featured in the report, says, her work caring for an elder with Alzheimer's disease takes "love, patience, and understanding…. It requires organizational skills and a lot of physical strength and hard work." Yet efforts over several decades to raise wages and improve working conditions have had limited success.

Living in Poverty

"I work at a for-profit home care company," says Roxanne Trigg, a home care worker from Milwaukee, Wisconsin. "After five years, I make just $9.15 an hour, with no sick leave and no vacation." Trigg goes on to report that she is often juggling bills: "A few months ago, I had to risk getting the lights turned off…so I could buy shoes and clothes for the two grandkids I take care of."

Trigg's story, as well as others featured in the report, are typical of home care aides, who provide vital services to millions of elders and people with disabilities. With families stretched to the limit and scattered over long distances, home care aides assist with bathing and dressing, mobility, meal preparation, laundry, housecleaning, and managing medications, as well as some health-related tasks such as catheter or ostomy care.

Among our nation's 2 million home care aides, more than half live in households with incomes below 200 percent of the federal poverty level. Because their incomes are low, they rely on public benefits such as Medicaid, food stamps, and housing supports to make ends meet.

Poor Wages, High Turnover

Home care will create more new jobs than any sector of the economy in the decade 2012-2022, according to the PHI report. We will need 1 million additional home care aides — both home health aides and personal care aides — to meet growing demand from an aging population. Yet the poor quality of these jobs makes it increasingly difficult to recruit and retain qualified workers.

"Individuals and families are already having a hard time finding consistent, quality care," says Jodi M. Sturgeon, president of PHI. "Turnover hovers around 50 percent, meaning one of every two home care workers leaves her job each year. That disrupts the vital relationships that ensure that individuals who receive home care services are less likely to end up in emergency rooms, hospitals and other institutions."

Better Jobs Mean Better Care

Shirley Thompson knows the importance of a reliable home care aide. A former truck driver from Cleveland, Ohio, Thompson spent two years in a nursing home as the result of a chronic illness. She says, "I didn't like it one bit."

With the assistance of her aide Jasmin Almodovar, Thompson was able to return to her home, where she has more control over her day-to-day life. "Without Jasmin," she says, "I'd still be there." But Jasmin, who brings home $500 per week working 60 hours, says, "I love my job, but without a raise, I can't keep doing this."

"Home care workers are calling for a $15 per hour wage," Sturgeon says. "But home care wages are primarily set through public reimbursement systems, given that the vast majority of these services are funded through Medicaid and Medicare programs. It will take increased public investment to raise wages, but better wages are essential to creating a stable, qualified workforce in the years ahead."

In its report, PHI recommends several additional strategies for improving home care jobs. These include providing workers with paid sick time, requiring more comprehensive training, and developing career paths that prepare aides to care for individuals with conditions such as multiple sclerosis, diabetes, or Alzheimer's disease, and to play a more integral role in care teams.

Paying the Price notes that one of the most successful strategies for strengthening the home care workforce has been collective bargaining. For example, both Washington and California have significantly increased wages and reduced turnover as a result of union contracts. In Washington, SEIU775 has also led efforts to improve training and increase the overall competency of home care aides.

Long-time home care worker Patricia Evans says, "When it comes to home care workers, you live in poverty. You work in poverty. You retire poor…then, you die in poverty." But as Evans points out, that doesn't make it right. Home care aides play a vital role in our health and aging systems and as Evans says, their paychecks should reflect that.

To download Paying the Price, go to: www.PHInational.org/payingtheprice.

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PHI's State Data Center (www.PHInational.org/statedata) provides state-based data on home care aides and nursing assistants. Additional wage information is available at www.phinational.org/policy/issues/wages.

PHI (www.PHInational.org) works to transform eldercare and disability services. We foster dignity, respect, and independence — for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality care.  

Deane Beebe, PHI Media Relations Director

646-285-1039; dbeebe@phinational.org

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