Higher wages are needed to sustain a viable home-care workforce, as demand for home-care services continues to grow with the aging population, home-care worker advocates argue. A new report demonstrates the gravity of the home-care wage issue.
“We know we're facing a crisis—we have an elder boom coming down the pike,” said Abby Marquand, director of policy research at the Paraprofessional Healthcare Institute, which produced the report (PDF). “We know the demand for these services is going to grow exponentially and we have to make a decision to face this now if we don't want this to become the crisis it could become.”
Three out of five of the country's 2 million home-care aides rely on some type of public assistance through programs such as Medicaid, food stamps or help paying for housing and utilities, the PHI report found.
The average hourly wage for home-care workers is around $9.61, for an annual median income of $13,000, just above the individual federal poverty level of $11,770.
The report identifies a number of strategies to improve home-care worker conditions, such as providing paid sick time and requiring more training to better prepare aides to care for patients with more complex medical conditions such as dementia.
Low pay, scarce worker benefits and limited opportunities for advancement have contributed to an annual turnover rate of 50% among home-care workers. Advocates are concerned that such workforce instability may make it harder to recruit more workers at a time when rising demand for home care is expected to require an additional 1 million people to enter the workforce by 2022.
Projections have estimated the number of Americans age 65 and older will more than double, from 40 million in 2010 to 88 million by 2050, according to HHS.
A number of post-acute care providers in recent years have shifted from running traditional nursing facilities to providing more home-health services that require less overhead.
But home-care worker wages have not reflected a field with such high demand. Hourly wages declined by 5% between 2003 and 2013 when adjusted for inflation, according to the report.
That disconnect demonstrates that home-care services are undervalued, which Marquand said may reflect public misperceptions about the nature of the work itself and its many demands.
“I don't think people like to face their own aging and their own mortality and I think that's reflective in the way we treat these workers collectively,” Marquand said. “We don't really want to invest in these services because we don't really like that we may need these services some day, and I think that perpetuates a lot of the really poor job conditions we associate with this work.”
Those sentiments were evident in findings of a study published in January in Health Affairs that found 60% of surveyed adults between the ages of 40 and 65 expected not to need long-term care in the future, despite 70% of elderly Americans needing such services at some point.
Many older adults anticipate family or friends will be available to them as future caregivers but as a 2013 AARP report points out, the projected ratio of potential family caregivers for adults ages 80 and older is expected to decline fall from 7 to 1 in 2010 to 3 to 1 by 2050.
Home-care worker advocates have called for a general wage increase to $15 per hour, part of a nationwide campaign among various low-income workers to raise the minimum wage.
Analysts have said such a pay increase for home-care workers could drive many smaller companies out of business. Smaller providers who have been faced with revenue declines over the past several years because of state Medicaid budget cuts would not be able to afford such an increase, they say, reducing the number of home-care operators and driving up costs.
Marquand acknowledged the issues facing providers, saying it was up to states to increase reimbursement for home-care services. Efforts by the U.S. Department of Labor to increase home-care worker wages were dealt a blow in January when a federal judge ruled to reverse a new agency rule that would have provided overtime pay and wage protections many home health workers currently do not receive.
Follow Steven Ross Johnson on Twitter: @MHsjohnson
