STUDY: Home Care Workers Face Pressure to Provide Free Care

Workers in consumer-directed home care programs often feel pressure to provide unpaid “gift” care to their consumers, according to a study published in the December 2015 issue of Milbank Quarterly.

The qualitative study was informed by interviews of 33 workers and 49 consumers in California’s consumer-directed In-Home Supportive Services (IHSS) program. All of the consumers were aged 65 and older and were dual eligible for both Medicare and Medicaid. The workers represented a mix of related and non-related caregivers.

Following more than 300 interviews conducted over a four-year period, the researchers report that IHSS workers who care for a relative are “expected to provide care aside from what they were paid for,” and that these expectations “reflected socialized norms in families or communities as well as personal beliefs about giving back to family members.”

Even IHSS workers who are unrelated to their consumers are expected to provide “gift” care due to IHSS’s “institutional expectation of simply filling in the gaps between paid hours and [consumers’] needs,” the study’s authors write.

Unmet Needs

The authors conclude that IHSS — a consumer-directed home care program for low-income Californians — fails to meet the needs of both its workers and consumers.

“In the case of both related and nonrelated caregivers, the world of the market often does not provide sufficient pay and benefits for their labor, particularly when they are committed to meeting consumers’ needs,” they write.

Meanwhile, consumers have those unmet needs “either because of an inadequate number of care hours or limitations on the specific kinds of services that are compensated.” Given budgetary limitations threatening Medicaid home care programs in other states, similar arrangements and problems likely exist across the country.

Policymakers should work to fill these gaps in care coverage while maintaining fair labor practices for all care workers, whether related or non-related, the authors argue.

— by Matthew Ozga