The desperate need to improve our treatment of caregivers
If you are a person of relatively sound mind and body, consider the following question tonight as you get ready for bed: If you needed help with that task and had no family members willing or able to fill the role, what would you consider to be a fair wage to pay someone to assist you?
Seriously, think about it. Imagine that someone had to be hired to help you with your most basic personal and physical needs like bathing, using the toilet and dressing. Now, what would you say that a person should be paid to perform such tasks?
Perhaps more to the point, what would you hope to see such a person get paid in order to attract a skilled, intelligent and reliable assistant (i.e., one who is educated, makes enough money to afford reliable transportation and who does not have to work two other jobs when he or she should be sleeping)?
Such questions have rapidly become front burner policy questions in recent years. With the rapid aging of the American population, millions of people who never gave such matters a second thought now see them as intensely personal and important. These people – perhaps most notably, tens of millions of baby boomers and their children – are suddenly aware of a huge problem that confronts the nation: How can we provide the care for elderly and disabled people that they deserve and assure that the people providing it are able to enjoy a decent quality of life themselves?
The situation in North Carolina
The situation in North Carolina is typical of the challenge that confronts the nation. Consider the following facts that were recently compiled by Allan Freyer, Director of the North Carolina Justice Center’s Workers’ Rights Project and a scheduled presenter at next week’s N.C. Policy “Crucial Conversation, Caring for Caregivers” :
North Carolina is rapidly aging – the population over 65 is projected to more than double by 2050. The aging of the state’s baby boomers will correspond with an increase in community members with functional and cognitive limitations, indicating a growing need for direct care that allows community members to continue to live with dignity.
Direct care occupations, including home care jobs, are some of the fastest growing occupations; but, these jobs offer some of the lowest wages in the state. Median wages in the caregiving occupations pay less than $10 an hour, compared to the state’s $15 an hour median wage. That means that half of all home healthcare workers aren’t earning enough to rise above the federal poverty line despite working full-time.
Moreover, despite the high occupational injury rates, almost half of home care workers remain uninsured and the majority of workers have no earned paid sick days to take time to recover from injuries or illness.
Low wages increase worker turnover, increase long-run costs for providers, and interrupt the continuity of care for consumers. Additionally, making too little to pay for the basics such as food, housing, and health care can lead to increased dependence on public assistance programs.
Medicaid, administered by the state and jointly financed by the state and federal government, is the primary funding source for long-term services and supports (LTSS) for people with disabilities and seniors. Reimbursement by Medicaid programs, in large part, creates the framework in which employers set wages for direct care workers.
North Carolina’s reimbursement rates have been frozen or reduced since 2009 and the most recent reduction places North Carolina rates more than $4 per hour lower than the national average rate paid to provider agencies.
A nationwide crisis
A just-released report by the New York-based Paraprofessional Healthcare Institute entitled “Paying the Price: How Poverty Wages Undermine Home Care in America,”  offers equally damning data. As the report notes:
“With 10,000 baby boomers turning 65 every day, our nation will need one million new home care aides between 2012 and 2022….
Nearly 2 million aides earn average wages of just $9.61 per hour. For a full-time worker that is $1652.92 per month, barely enough to rent an apartment in many areas of the country, let alone pay for utilities, food, health care, and child care expenses.
And these figures don’t even take into account the unpredictable and part-time hours that reduce home care wages even further. The result is median annual earnings of just $13,000 a year.
Not surprisingly, as a result of poverty wages, more than half of home care workers rely on public assistance to support their families….
Low wages — along with inadequate training and the sheer difficulty of the work— result in extremely high turnover. Half the home care workforce turns over every year, disrupting the continuity of relationships that is essential to quality care. To put it simply: workers leave because they cannot afford to stay.”
It is, in short, a ridiculous and even tragic situation. Dozens of professions – even in the world of health and human services – earn vastly higher wages. And yet, imagine if you or a loved one needed assistance with bathing and dressing, meal preparation, laundry and other house cleaning, and even other health-related tasks like catheter or ostomy care. Would you really want the person performing such services to make less than the average teenage babysitter? Less than veterinarians’ assistants? Less than some McDonald’s cashiers?
Beginning to move toward a solution
The plain and obvious reality of the caregiver crisis is that it is not going to abate by itself. Neither the genius of the market nor simple good intentions of aging Americans and/or their families is going to solve this problem. Neither will caregiver pay and benefits rise to living wage levels simply because Americans put more away in retirement accounts or buy more insurance.
The only possible solution, therefore, is the enactment of new and tough public policies. Simply put, policymakers at the federal, state and local levels must enact laws, rules and regulations that are designed to significantly raise pay and benefits for workers and, ultimately, their qualifications.
In the near term, however, there are several specific and concrete steps that can and must be taken to make measurable, if incremental, improvements:
Again, here’s Allan Freyer:
“To address these challenges North Carolina must raise the wage floor for paid caregivers in the context of the state’s Medicaid program and look to best practices in states like Montana and Maine that tie wage-improvement strategies to reimbursement rates. These include:
- An automatic update mechanism, such as a link to an annual inflation-adjustment.
- A way to ensure enforcement through mandatory reporting and data collection.
- A built-in mechanism for evaluating reimbursement rates, or the wage floor, over time to ensure that the rate remains competitive
Additionally, the state should pursue common sense policies that make work pay by improving workplace standards for the lowest-paid workers, including raising the minimum wage, supporting collective bargaining rights, ensuring paid sick days, expanding Medicaid, and providing career paths for home care workers.”
The bottom line: There is a tremendous amount to do and unless we want to find ourselves in a dramatically worse mess a decade from now, it’s essential that we raise the profile of this issue and soon. Please join us at next week’s luncheon  to learn more about how you can be a part of the solution.