Who Cares for Home Health Care Workers?

The U.S. health care system is far and away the most expensive in the world. And there is a fast-rising demand for workers in the field. So, it seems reasonable to conclude that all critical health care jobs pay good wages.

Sue Williams-Ward knows better.

Williams-Ward has spent nearly 30 years as a home care worker in Indiana. For every client she helps bathe, use the bathroom, and take their medication, she serves as the last line of defense in their quest to live in their preferred surroundings. Williams-Ward loves talking about helping clients regain independence and re-establish their ties in the community. She takes clients who are interested to a weekly Bible study, and she pulls others together into a choir that sings in area churches.

“Every client I have needs somebody in their life,” she says. “I do it because I care. You know I don’t do it because of the money. Because the pay is ridiculous.”

For the two million home care workers in the U.S. like Williams-Ward, that pay averages just over $11 per hour, well below a poverty wage in most communities. More than half of home care workers are paid so little they have to rely on public assistance.

Helping clients in and out of bed and navigating the tasks of getting dressed and cleaned up is often hard labor. Williams-Ward recently suffered a back injury on the job and had to stop taking clients who need lifting. But few employers in the field offer health insurance, and the low wages often mean workers are unable to afford the premiums and deductibles that sometimes accompany health care available under the Affordable Care Act. Nearly 9 of every 10 home care workers don’t get sick days or paid time off. This means that those who provide hands-on care for others often go without care themselves.

sue_williams-ward_1.jpg

Viewed in purely economic terms, this struggle is puzzling. The baby boomer generation is reaching senior status, and the vast majority of Americans prefer to “age in place” rather than move to a nursing home. Home care is far less expensive than institutional care. So, amid all of the hand-wringing about automation replacing U.S. workers, there is a huge demand for real, live humans to provide home care. The Bureau of Labor Statistics ranks it the third fastest-growing occupation in the country.

The lesson from Economics 101 is clear: rising demand and scarcity of workers should be leading to higher wages. But, when it comes to home care workers, the market’s invisible hand is shackled by some of our nation’s ugliest and most enduring flaws. Home care workers are predominately persons of color, the vast majority are women, and many are immigrants. Overall, women of color earn less than 60 cents for every dollar white men make. When those women go to work caring for our must vulnerable family members, race and gender pay disparities are on full display.

So is the legacy of slavery. Southern congressmen ensured that the National Labor Relations Act of 1935 and the Fair Labor Standards Act of 1938 excluded the African-American farmworkers and domestic workers that white southern property owners relied on. That put union organizing off limits for those workers, along with minimum wage and overtime protections.

Eighty years later, these workers have still not caught up. Changes to the law in the 1970s and during the Obama administration extended wage protections to some home care workers, but others that could be categorized as “companions” are still left out. Many home care workers are not protected by the anti-discrimination provisions of the federal Civil Rights Act, because it does not cover employees unless their workplace includes less than 15 employees.

Yet, some Americans do make a healthy profit from home health care. “The companies are getting plenty of money for doing very little, but those of us who are providing the care aren’t,” Williams-Ward says.

Indeed, most home care workers are employed by agencies, some of which siphon off as much as half of what the client or government is paying. Government under-funding of home care is a factor as well. Medicaid is the top payer of home care services, but the rates set at the state level are almost always too low to provide living wages.

The Service Employees International Union (SEIU), National Domestic Workers Alliance, and other advocates are working to change this. Williams-Ward is a member of SEIU, which pushes for higher Medicaid reimbursement rates and a guarantee that most of those fees goes to workers. Home care workers have become leaders in the SEIU-backed Fight for 15 movement for a $15 minimum wage and union rights. Earlier this year, Rep. Pramila Jayapal (D-Wash.) and Sen. Kamala Harris (D-Calif.) introduced the Domestic Workers Bill of Rights Act, a guarantee of federal workplace protection, overtime pay, and paid sick days. Nine states have passed a similar law.

A paycheck that represents a living wage, along with protection from danger and discrimination on the job, are not too much for home care workers to ask for, says Williams-Ward.

“We are taking care of people’s loved ones,” she says. “They prefer to be at home, and our care is necessary for them to stay there. We give our all for our clients, and we deserve to be treated well, too.”